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Contraceptive pill advice set to change following Cochrane review

By Lilian Anekwe

The findings of a gold-standard systematic review are set to change established GP advice for women wanting to start taking the contraceptive pill.

Current guidance recommends that women begin taking oral contraceptives on day one of their menstrual cycle, and other hormonal contraceptives, such as injections and intra-uterine systems, between five and seven days of the cycle.

But a review has found that starting immediately – and using a back-up method of birth control for seven days – does not increase the risk of unintended pregnancy or interfering with an undetected pregnancy, and may have other beneficial effects.

The review, by researchers at the Cochrane Library, analysed the data in five studies including 2,427 women comparing the immediate with delayed initiation of different hormonal contraceptives to see which offered women better efficacy, access to contraception and compliance.

In a study of the Depo injection, fewer women who started immediately became pregnant than those who used another method for 21 days before the injection was given, and more described themselves as very satisfied with their method of contraception.

A trial of two immediate-start methods showed women using an intra-uterine system had less long-term bleeding and less frequent bleeding than those taking pills.

Lead researcher Dr Laureen Lopez, a research associate at Family Health International in North Carolina, USA, concluded: ‘Immediate start is one of several acceptable options for starting COCs although more data are needed.'

Dr Carrie Sadler, a GPSI in sexual health in Brailsford, Derbyshire, said: ‘Many women are happy to wait for their next menses to initiate their contraceptive of choice. However in some situations it is more sensible and practical to use the quick start method.

‘In each case, however, it is important to exclude pregnancy risk, advise extra precautions for seven days, consider a follow up pregnancy test as amenorrhoea may be induced and explain the unlicensed use of the product.

‘This review will give GPs more confidence in initiating hormonal contraceptives tailored to the individual woman's situation.'

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