The 2016 US Selected Practice Recommendations for Contraceptive Use for health care providers were updated by the Centers for Disease Control & Prevention (CDC) and include revised recommendations for starting regular contraception after the use of emergency contraceptive pills as well as new recommendations for the use of medications to ease insertion of intrauterine devices.
Updated recommendations regarding when to start regular contraception after ulipristal acetate (UPA) emergency contraceptive pills:
• Advise the woman to start or resume hormonal contraception no sooner than 5 days after use of UPA, and provide or prescribe the regular contraceptive method as needed. For methods requiring a visit to a health care provider, such as depo-medroxyprogesterone acetate (DMPA), implants, and IUDs, starting the method at the time of UPA use may be considered; the risk that the regular contraceptive method might decrease the effectiveness of UPA must be weighed against the risk of not starting a regular hormonal contraceptive method.
• The woman needs to abstain from sexual intercourse or use barrier contraception for the next 7 days after starting or resuming regular contraception or until her next menses, whichever comes first.
• Any nonhormonal contraceptive method can be started immediately after the use of UPA.
• Advise the woman to have a pregnancy test if she does not have a withdrawal bleed within 3 weeks.
New recommendations for medications to ease IUD insertion:
• Misoprostol is not recommended for routine use before IUD insertion. Misoprostol might be helpful in select circumstances (eg, in women with a recent failed insertion).
• Paracervical block with lidocaine might reduce patient pain during IUD insertion.
Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65(No. RR-4):1–66. doi:10.15585/mmwr.rr6504a1.
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