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Starting the pill: How about now?

If you thought you needed to wait until Sunday, think again.

by Sara Kennedy, MD, MPH

Sometimes old ideas die hard. One good example is the old idea that you have to start taking the pill on a Sunday, or start it five days after your period begins. Research has shown that this is just plain wrong.

Out with the old…

In the old days, health care providers often advised women starting the pill to wait until the next Sunday, or even until five days after the start of their next period. Couples were supposed to rely on condoms or not have sex in the meantime. Unfortunately, condoms are much less effective than the pill, ring, or patch, so some of these women became pregnant while they were waiting to start their new method. Sure enough, studies showed that a delay in starting to use the pill, ring, or patch is one of the most common reasons women become accidentally pregnant.

…In with the new.

This inspired researchers to test a new way of starting the pill, patch, and ring: right away! They tested this by asking one group of women to start their birth control immediately, while another group of women followed the old rules. Women who started their birth control right away were less likely to become accidentally pregnant, and they reported they were more satisfied with their methods. The researchers showed that starting the pill, ring or patch immediately is safe, effective, and doesn’t increase spotting or other side effects.

To start a combined hormonal method right away:

  • You still have to make an appointment to visit a health care provider, where they’ll ask you questions about your medical history, measure your blood pressure, and confirm that you are not pregnant. (You don’t need a pelvic exam or Pap smear.)

  • Some clinics keep the pill, patch, or ring on hand, so you might not have to go to a drug store to fill the prescription. That makes it really easy to start right away, even before leaving the clinic.

  • To start right away, pill users should take the first pill in the pack immediately, then take one pill per day until the pack is done. Ring users can put the ring in while still in the clinic, or later that same day, and use it for 3 weeks. Patch users can put the first patch on in the clinic or the same day and replace it with a fresh patch one week later. If you’re worried about remembering to take your pill, change your patch or ring, or refill your prescription, Bedsider's reminders app can help.

  • Unless you’re using an "extended cycle" pill (like Seasonale/Seasonique) or using the pill or ring continuously, your next period will be about 3 weeks later with any of these methods. That might be later than usual, but it’s nothing to worry about.

• Unless you’re using an ‘extended cycle’ pill (like Seasonale/Seasonique) or using the pill or ring continuously, your next period will be about 3 weeks later with any of these methods. That might be later than usual, but it’s nothing to worry about.

So what’s the catch?

You may still need to use a condom for a week to give the pill, patch, or ring time to get up to speed, or you might not… Whether or not you need to double-up on birth control depends on what method you switch from and when in your menstrual cycle you make the switch. Here are the details:

The bottom line is that it’s okay to start the pill, patch, or ring pretty much any time that works for you—but you may need to boost your pregnancy protection with condoms for a week. Talk to your health care provider for more information. If they aren’t familiar with this “quick start” method, you can tell them it’s recommended by the CDC.

Sara Kennedy, MD, MPH, is an Obstetrician/Gynecologist in Oakland, California. Originally from Pennsylvania, Sara has studied and lived around the world, including a residency at Northwestern University in Chicago and a master’s degree in Australia, where she met her husband! Sara is passionate about women's health, particularly helping women in vulnerable situations obtain the knowledge and resources they need in order to control their reproductive health.

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