Contraceptive Pearl: Quick Starting the Progestin IUD or Implant
Many clinicians follow a two-visit protocol for IUD and implant insertion: the first visit for counseling and testing, the second visit for insertion. Is this delay necessary? Or can we safely quick start progestin IUDs and implants?
When there’s no concern about early pregnancy, the decision is easy: insert the IUD or implant without delay. If the first day of your patient’s last menstrual period (LMP) was less than 5 days ago – or if she hasn’t had unprotected intercourse since her LMP – you can quick start without any special follow-up. You can test for chlamydia and gonorrhea on the day of insertion (and treat infections, if the results are positive, without removing the IUD/implant).
What if there’s a small chance of early pregnancy? A patient who has had unprotected sex since her LMP should get a urine pregnancy test. If this test is negative, you should explain the possibility of a pregnancy too early to detect at today’s visit. To cover the 2-week interval before a pregnancy test would be positive, offer a bridge method such as the pill/patch/ring. However, if your patient declines a bridge method and wants the IUD/implant right away, you can insert the IUD/implant today. She should have a repeat urine pregnancy test in 2 weeks.
Note: Neither the progestin IUD nor implant is teratogenic. If your patient is pregnant, progestin won’t harm the patient or the pregnancy. However, if she stops having periods and attributes this to the IUD/implant, her pregnancy diagnosis may be delayed.
Bottom line: Don’t delay insertion of the IUD or implant! Quick start prevents pregnancies that may occur while your patient waits for her next appointment.
We appreciate your feedback! Please write us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.
Helpful Resources
Medical Eligibility for Initiating Contraception: Absolute and Relative Contraindications
Sources
Shepard T, Lemire R. Catalog of Teratogenic Agents. 11th ed. Maryland: JHU Press; 2004.
Pharma-free
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.
