Most people ovulate 9-14 days after an abortion. Patients presenting to end a pregnancy may be interested in starting or changing their contraceptive method.

Depending on a patient’s medical eligibility, the following contraceptive methods are safe and effective post-abortion:

• Estrogen/progestin pill, patch, ring
• Progestin-only pill, injection, implant, IUD
• Copper IUD
• Barrier methods
• Sterilization
• Fertility Awareness Methods

Initiating all contraceptive methods at the time of an aspiration abortion is safe. While adherence increases when patients begin contraception right after the abortion, some patients do not want to address contraception at this time, and contraceptive counseling can occur at a future visit.

Following the medication abortion, the timing of initiation depends on the method. An IUD can be inserted as early as 4 days after the patient uses misoprostol. Patients may start any other contraceptive method (pills, patch, ring, shot, and barrier methods) on the day they use mifepristone. However, there is some evidence that Depo Provera decreases the effectiveness of mifepristone. Patients who choose Depo after a medication abortion have three options: they can receive the shot the same day if they accept possible decrease in effectiveness; they can return for the shot after the medication abortion is complete; or they can receive a prescription for sub-q Depo Provera and self-administer at home after the abortion is complete. Combined hormonal contraceptives take one week to be fully effective, as do the Skyla and Kyleena IUDs; the implant takes 4 days; and the progestin-only pill takes two days. People should use a back-up method for these durations if the method is started more than 7 days after the abortion is initiated. The Paragard, Mirena, and Liletta IUDs are effective immediately. No back-up is needed for those who start a method within the first 7 days after taking mifepristone.

Resources 

Medical Eligibility Criteria for Initiating Contraception

Quick Start Algorithm

Your Birth Control Choices Fact Sheet

Sources 

Cansino C, Lichtenberg ES, Perriera LK, et al. Do women want to talk about birth control at the time of a first-trimester abortion? Contraception. 2018 Dec;98(6):535-540. doi: 10.1016/j.contraception.2018.08.005. 

Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(4):1. 

Denny C. How to start birth control after an abortion. Bedsider website. August 2019. Accessed May 2021. https://www.bedsider.org/features/1319-how-to-start-birth-control-after-an-abortion. 

Jain J, Dutton C, Nicosia A, et al. Pharmacokinetics, ovulation suppression and return to ovulation following a lower dose subcutaneous formulation of Depo-Provera. Contraception. 2004;70(1):11. 

Matulich M, Cansino C, Culwell KR, Creinin MD. Contraception. Understanding women’s desires for contraceptive counseling at the time of first-trimester surgical abortion. 2014;89(1):36.

Raymond EG, Weaver MA, Louie KS, et al. Effects of depot medroxyprogesterone acetate injection timing on medication abortion efficacy and repeat pregnancy random controlled trial. Obstet Gynecol. 2016;128(4):739.  

Raymond EG, Weaver MA, Tan YL, et al. Effect of immediate compared with delayed insertion of etonogestrel implants on medical abortion efficacy and repeat pregnancy: A randomized controlled trial. Obstet Gynecol. 2016 Feb;127(2):306-12.