When to Start

IMPORTANT: A woman can start using POPs any time she wants if it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist.  Also, a woman can be given POPs at any time and told when to start taking them.

Woman's situation When to start
Fully or nearly fully breastfeeding

Less than 6 months after giving birth

  • If her monthly bleeding has not returned, she can start POPs any time between giving birth and 6 months. No need for a backup method.
  • If her monthly bleeding has returned, she can start POPs as advised for  women having menstrual cycles.

More than 6 months after giving birth

  • If her monthly bleeding has not returned, she can start POPs any time it is reasonably certain she is not pregnant. She will need a backup method* for the first 2 days of taking pills. (If you cannot be reasonably certain, see How and When to Use the Pregnancy Checklist and Pregnancy Tests.)
  • If her monthly bleeding has returned, she can start POPs as advised for women having menstrual cycles.
Partially breastfeeding

If her monthly bleeding has not returned

If her monthly bleeding has returned

  • She can start POPs as advised for women having menstrual cycles (see below).
Not breastfeeding

Less than 4 weeks after giving birth

  • She can start POPs at any time. No need for a backup method.
More than 4 weeks after giving birth
  • If her monthly bleeding has not returned, she can start POPs any time it is reasonably certain she is not pregnant.† She will need a backup method for the first 2 days of taking pills. (If you cannot be reasonably certain, see How and When to Use the Pregnancy Checklist and Pregnancy Tests.)

  • If her monthly bleeding has returned, she can start POPs as advised for women having menstrual cycles (see below).
Switching from a hormonal method
  • Immediately, if she has been using the hormonal method consistently and correctly or if it is otherwise reasonably certain she is not pregnant. No need to wait for her next monthly bleeding. No need for a backup method.
  • If she is switching from injectables, she can begin taking POPs when the repeat injection would have been given. No need for a backup method.
Having menstrual cycles or switching from a nonhormonal method

Any time of the month

No monthly bleeding (not related to childbirth or breastfeeding)
  • She can start POPs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 2 days of taking pills.
After miscarriage or abortion
  • Immediately. If she is starting within 7 days after first- or second-trimester miscarriage or abortion, no need for a backup method.
  • If it is more than 7 days after first- or second- trimester miscarriage or abortion, she can start POPs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 2 days of taking pills. (If you cannot be reasonably certain, see How and When to Use the Pregnancy Checklist and Pregnancy Tests.)

After taking emergency contraceptive pills (ECPs)

After taking progestin-only or combined ECPs:

  • She can start or restart POPs immediately after she takes the ECPs. No need to wait for her next monthly bleeding.
    • A continuing user who needed ECPs due to pill-taking errors can continue where she left off with her current pack.
  • If she does not start immediately, but returns for POPs, she can start at any time if it is reasonably certain she is not pregnant.

  • All women will need to use a backup method for the first 2 days of taking pills.

After taking ulipristal acetate (UPA) ECPs:

  • She can start or restart POPs on the 6th day after taking UPA-ECPs. No need to wait for her next monthly bleeding. POPs and UPA interact. If POPs are started sooner, and thus both are present in the body, one or both may be less effective.
  • Give her a supply of pills and tell her to start them on the 6th day after taking the UPA-ECPs.

  • She will need to use a backup method* from the time she takes UPA-ECPs until she has been taking POPs for 2 days.

  • If she does not start on the 6th day but returns later for POPs, she may start at any time if it is reasonably certain she is not pregnant.

* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.

Where a visit 6 weeks after childbirth is routinely recommended and other opportunities to obtain contraception are limited, some providers and programs may allow a woman to start POPs at the 6-week visit, without further evidence that the woman is not pregnant, if her monthly bleeding has not yet returned.