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Initiation of Oral Contraceptives Using a Quick Start Compared With a Conventional Start

A Randomized Controlled Trial

From the¹ Department of Obstetrics and Gynecology, Columbia University, New York, New York; ²Department of Obstetrics and Gynecology, University of Texas—Southwestern, Dallas, Texas; ³Adolescent Health Center, Mt. Sinai School of Medicine, New York, New York; ⁴Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia; and ⁵Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York.

OBJECTIVE: To estimate whether young women taking the first pill on the day of prescription had higher continuation rates and lower pregnancy rates than women who waited until menses to start the oral contraceptive pill (OCP).

METHODS: We recruited 1,716 women aged younger than 25 years seeking to initiate the oral contraceptive at three publicly funded family planning clinics, and randomly assigned them to conventional initiation of the pill (conventional start) or immediate, directly observed ingestion of the first pill (quick start) during the clinic visit. Women underwent follow-up interviews at 3 and 6 months.

RESULTS: Sixty percent of participants discontinued the pill, and 8% became pregnant during follow-up. Women who took the first pill in the clinic were more likely to continue to the second OCP pack (odds ratio 1.5, 95% confidence interval 1.0–2.1.); however, the Quick Start approach did not improve OCP continuation rates at 3 and 6 months. Those assigned to Quick Start were slightly less likely to become pregnant within 6 months from the time they started the pill (hazard ratio 0.90, 95% confidence interval 0.64—1.25). Eighty-one percent of women rated the Quick Start approach as acceptable or preferable to waiting. Rates of serious adverse events were low and similar in the two groups.

CONCLUSION: Protocols that require a woman to wait until the next menses to start hormonal contraceptives are an obstacle to contraceptive initiation. Directly observed, immediate initiation of the pill improves short-term continuation.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00068848

LEVEL OF EVIDENCE: I

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