Quick Starting Contraception

Cochrane Review (2012)

• Cochrane review regarding effectiveness, continuation and acceptability (2012)
• Quick start may improve women’s access and continuation
• 5 RCTs from 2003 to 2007 were included

Cochrane Results (2012)

• Method discontinuation was similar between groups in all trials
• Bleeding patterns and side effects similar between quick start vs menses-dependent start
• Quick start Depo-Provera showed
  • fewer pregnancies (OR 0.36; 95% CI 0.16 to 0.84)
  • more were “very satisfied” (OR 1.99; 95% CI 1.05 to 3.77)
• Trial of 2 quick start method comparing vaginal ring and COC showed vaginal ring users have
  • Less prolonged bleeding (OR 0.42; 95% CI 0.20 to 0.89)
  • Less frequent bleeding (OR 0.23; 95% CI 0.05 to 1.03)
  • Less side effects eg changes in breast, weight, mood and nausea
  • More were “very satisfied” (OR 2.88; CI 1.59 to 5.22)

Cochrane Conclusion (2012)

• Limited evidence that quick start reduces unintended pregnancies or increases method continuation.
• Pregnancy rate lower with quick start Depo-Provera versus “bridging” to Depo-Provera with another method
• Some differences were associated with contraceptive type rather than initiation method (i.e. quick start vaginal ring vs quick start COC)
• More studies on quick start versus menses-dependent start of the same hormonal contraceptive needed