This Insight is an update to a previous Contraceptive Pearl article published in May 2021.

After an abortion, patients may want to start or change contraception. 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

All contraceptive methods can be safely initiated immediately following an aspiration abortion. Following a medication abortion using mifepristone and misoprostol, the timing of initiation depends on the contraceptive method. An IUD can be inserted as early as 4 days after the patient uses misoprostol. Patients can insert the ring within a few days of using misoprostol, after the heaviest cramping and bleeding. Patients may start most other contraceptive methods (pills, patch, and barrier methods) on the day they use mifepristone.

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 injection the day they take mifepristone if they accept a possible decrease in mifepristone’s effectiveness; they can return for the shot after the medication abortion is complete; or they can receive a prescription for Depo-SubQ Provera and self-administer at home after the abortion is complete. After a misoprostol-only medication abortion, there are no special timing restrictions for Depo Provera.

The need for backup contraception depends on timing and method. Patients whose IUD or implant was inserted right after abortion completion need no backup contraception. Patients whose progestin IUD or implant was inserted later need backup for 7 days. Estrogen-containing contraceptives require no backup if started the day of the abortion – if started later, these methods require 7 days of backup. For progestin-only pills, backup depends on the type. Patients using norethindrone or norgestrel pills require 2 days of backup, and patients using drospirenone pills require 7 days of backup.

RHAP Resources:

Medical Eligibility Criteria for Initiating Contraception

Quick Start Algorithm

Your Birth Control Choices Fact Sheet

Post-Abortion Self-Care Card

Sources:

1. Postabortion contraception: When and what type. Ipas. Published February 6, 2024. Accessed October 16, 2024. https://www.ipas.org/clinical-update/english/postabortion-care/postabortion-contraception-when-and-what-type/

2. Best Practice in Post-Abortion Contraception. Royal College of Obstetricians and Gynaecologists; 2022. Accessed October 16, 2024. https://www.rcog.org.uk/media/53fhrbz2/post-abortion-contraception-best-practice-paper-2022.pdf

3. Curtis KM, Nguyen AT, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep 2024;73(No. RR-3):1–77. DOI: http://dx.doi.org/10.15585/mmwr.rr7303a1 (https://www.cdc.gov/mmwr/volumes/73/rr/rr7303a1.htm?s_cid=rr7303a1_w).

4. Access to Postabortion Contraception. www.acog.org. Published August 2021. Accessed October 16, 2024. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/08/access-to-postabortion-contraception

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.

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