CDC Updates Contraceptive Recommendations Relating to Emergency Contraception, IUD Insertion

The 2016 recommendations include a revision for initiating regular contraception after the use of emergency pills
The 2016 recommendations include a revision for initiating regular contraception after the use of emergency pills

The Centers for Disease Control and Prevention (CDC) released an update to the 2013 U.S. Selected Practice Recommendations for Contraceptive Use guideline after review of scientific data and expert consultation.  The 2016 U.S. Selected Practice Recommendations for Contraceptive Use addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. 

The 2013 recommendations were adapted from global guidance developed by the World Health Organization (WHO), which offered evidence-based guidance on how to use contraceptive methods safely and effectively when deemed appropriate for the patient. In 2014, the CDC reviewed all existing recommendations for new data identified by the continuous identification of research evidence (CIRE) system that had the potential to result in a modified recommendation. Then in 2015, a panel of 29 met to conduct a systematic review for each topic presented. 

Major updates for 2016 include revised recommendations for initiating regular contraception after the use of emergency contraceptive pills and new recommendations for the use of medications to ease insertion of intrauterine devices. 

When starting regular contraception after ulipristal acetate (UPA) emergency contraceptive pills, the following is recommended: 

  • 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 healthcare 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.

Regarding the use of medications to ease intrauterine device insertion, new recommendations include:

  • 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.

These updated recommendations serve as clinical guidance for healthcare providers and show evidence-based guidance to decrease medical barriers to contraception access and use. The CDC will continue to identify and evaluate any new literature for the recommendations not included in the WHO guidance, and will completely review the U.S. Selected Practice Recommendations every 5 years.

The full guidance can be found on the website.

For more information visit CDC.gov.

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