Intervention Review

Immediate start of hormonal contraceptives for contraception

  1. Laureen M Lopez1,*,
  2. Sara J Newmann2,
  3. David A Grimes1,
  4. Kavita Nanda1,
  5. Kenneth F Schulz3

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 26 SEP 2010

DOI: 10.1002/14651858.CD006260.pub2

Database Title

Additional Information

How to Cite

Lopez LM, Newmann SJ, Grimes DA, Nanda K, Schulz KF. Immediate start of hormonal contraceptives for contraception. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006260. DOI: 10.1002/14651858.CD006260.pub2.

Author Information

  1. 1

    FHI, Clinical Sciences, Research Triangle Park, North Carolina, USA

  2. 2

    University of California, San Francisco General Hospital, Obstetrics and Gynecology and Reproductive Sciences, San Francisco, California, USA

  3. 3

    FHI, Quantitative Sciences, Research Triangle Park, North Carolina, USA

*Laureen M Lopez, Clinical Sciences, FHI, P.O. Box 13950, Research Triangle Park, North Carolina, 27709, USA. llopez@fhi.org.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Health care providers often tell women to wait until the next menses to begin hormonal contraception. The intent is to avoid contraceptive use during an undetected pregnancy. An alternative is to start hormonal contraception immediately with back-up birth control for the first seven days. Immediate initiation was introduced with combined oral contraceptives (COCs), and has expanded to other hormonal contraceptives. How immediate start compares to conventional menses-dependent start is unclear regarding effectiveness, continuation, and acceptability. The immediate-start approach may improve women's access to, and continuation of, hormonal contraception.

Objectives

This review examined randomized controlled trials (RCTs) of immediate-start hormonal contraception for differences in effectiveness, continuation, and acceptability.

Search methods

We searched MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, ClinicalTrials.gov, and ICTRP for trials of immediate-start hormonal contraceptives. We contacted researchers to find other studies.

Selection criteria

We included RCTs that compared immediate start to conventional start of hormonal contraception. Also included were trials that compared immediate start of different hormonal contraceptive methods with each other.

Data collection and analysis

Data were abstracted by two authors and entered into RevMan. The Peto odds ratio (OR) with 95% confidence interval (CI) was calculated.

Main results

Five studies were included. Method discontinuation was similar between groups in all trials. Bleeding patterns and side effects were similar in trials that compared immediate with conventional start. In a study of depot medroxyprogesterone acetate (DMPA), immediate start of DMPA showed fewer pregnancies than a 'bridge' method before DMPA (OR 0.36; 95% CI 0.16 to 0.84). Further, more women in the immediate-DMPA group were very satisfied versus those with a 'bridge' method (OR 1.99; 95% CI 1.05 to 3.77). A trial of two immediate-start methods showed the vaginal ring group had less prolonged bleeding (OR 0.42; 95% CI 0.20 to 0.89) and less frequent bleeding (OR 0.23; 95% CI 0.05 to 1.03) than COC users. The ring group also reported fewer side effects. Also, more immediate ring users were very satisfied than immediate COC users (OR 2.88; 95% CI 1.59 to 5.22).

Authors' conclusions

We found limited evidence that immediate start of hormonal contraception reduces unintended pregnancies or increases method continuation. However, the pregnancy rate was lower with immediate start of DMPA versus another method. Some differences were associated with contraceptive type rather than initiation method, i.e., immediate ring versus immediate COC. More studies are needed of immediate versus conventional start of the same hormonal contraceptive.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Immediate start of hormonal birth control

Health care providers often tell women to wait until their next menstrual cycle to begin birth control pills. The main reason is to avoid using birth control during an undetected pregnancy. Another method involves starting the pills right away ('immediate start' or 'quick start'). Another birth control method should be used as back-up for the first seven days. Unclear issues are whether quick start of hormonal birth control works as well as the usual start and whether women like it. The quick start method might improve women's use of hormonal birth control.

We did computer searches for randomized controlled trials of the quick-start method for pills and other hormonal birth control. We contacted researchers to find other studies. We included trials that compared quick start to the usual start of birth control. Also included were studies that compared quick start of different types of hormonal birth control with each other. Birth control methods could have the hormones estrogen and progestin (combined hormonal birth control) or just the progestin.

Five studies were included. In a study of 'depo,' a progestin-only injection, fewer women with quick start of depo became pregnant than those who used another method for 21 days before depo. In this review, the numbers of women who stopped using their birth control method early were similar between groups in all trials. In the depo trial, more women with quick start of depo were very satisfied.

A trial of two quick-start methods showed women with the vaginal ring had less long-term bleeding and less frequent bleeding than those with pills. For six side effects, including changes in breasts, mood, and nausea, quick start of the ring showed fewer problems than quick start of pills. For satisfaction in that trial, more women in the ring group were very satisfied with their method of birth control.

We found little strong evidence that quick start leads to fewer pregnancies or fewer women stopping early. However, fewer women on quick-start of depo became pregnant than the women who started with another method. Other differences were between types of birth control rather than start times. Women using the vaginal ring had fewer problems than women using birth control pills. More studies are needed comparing quick start versus usual start of the same hormonal birth control method.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

賀爾蒙避孕藥的立即起始投藥法

健康照護者時常要女性等到下次月經再開始使用賀爾蒙避孕藥。這種作法主要是為了避免在不知道有懷孕的狀況下使用了賀爾蒙。另一個方式則是立即起始用藥，並在最初的七天加上其他避孕方式。這種模式，首度是隨著複合式口服避孕藥(combined oral contraceptives, COCs)的使用而採用，並已擴展到其他賀爾蒙避孕藥的使用。立即起始投藥法相較於傳統的依經期起始投藥法，在有效性、延續性、和接受度等方面的比較仍不清楚。採用立即起始投藥法的給藥方式，應可促進女性對賀爾蒙避孕藥的取得及延續使用。

目標

審視關於立即起始投藥法在有效性、延續性、和接受度之差異的隨機對照研究。

搜尋策略

我們在MEDLINE, CENTRAL, POPLINE, EMBASE, 和LILACS等資料庫中，搜尋以立即起始投藥法使用賀爾蒙避孕藥的研究。我們並聯繫研究者以找尋其他研究。

選擇標準

我們含括的隨機對照研究，會將立即起始投藥法與傳統的依經期起始投藥法作比較。若研究的是，以立即起始法給予的不同賀爾蒙避孕法彼此的比較，也會包括在這項回顧中。

資料收集與分析

所有原始資料由兩位作者擷取、輸入RevMan，並計算佩托勝算比(Peto odds ratio, OR)及95%信賴區間(confidence interval, CI).

主要結論

共有五個研究被納入。所有研究中，各組之間【method discontinuation避孕法的中斷】是相似的。在比較「立即起始」與「傳統依經期起始」投藥法的研究中，出血的模式與副作用是相似的。在一項depot medroxyprogesterone acetate(DMPA)的研究中，比起投予DMPA前先用過渡方法，立即起始投予DMPA有較少的懷孕次數(OR 0.36; 95% CI 0.16 to 0.84)。此外，在立即起始投予DMPA這組中，感到非常滿意的女性較先用過渡方法的女性多(OR 1.99; 95% CI 1.05 to 3.77)。 有一項研究兩組皆使用「立即起始投藥法」。使用陰道環那組比起使用複合式口服避孕藥的組別，其延長出血(OR 0.42; 95% CI 0.20 to 0.89)與頻繁出血(OR 0.23; 95% CI 0.05 to 1.03)的情形都較為少。使用陰道環的組別也報告有較少的副作用。滿意度方面，感到非常滿意者，在立即起始使用陰道環那組，比起立即起始使用複合式口服避孕藥組為多(OR 2.88; 95% CI 1.59 to 5.22)。

作者結論

以立即起始的方式投予賀爾蒙避孕藥，是否能降低非預期懷孕或增加避孕法持續性，我們所找到的證據有限。不過，立即起始DMPA比起另一方法，其懷孕率較低。有些差異，是與避孕方式相關，而非起始方式。「立即起始使用陰道環」與「立即起始複合式口服避孕藥」的比較即如是。我們仍需更多在使用同一賀爾蒙避孕藥下，比較「立即起始法」與「傳統起始法」的研究。

翻譯人

本摘要由臺灣大學附設醫院楊育絜翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

賀爾蒙避孕的立即起始投藥法 健康照護者時常要女性等到下次月經再開始使用避孕藥。這種作法主要是為了避免在未測得有懷孕的狀況下使用了避孕藥。另一個方式是立即開始使用避孕藥(「立即起始」或「快速起始」)。最初的七天需要再加上其它方式避孕。 賀爾蒙避孕以快速起始法使用是否一樣有效尚不清楚，也不知道女性是否願意接受這種方法。快速起始法或許能促使女性使用賀爾蒙避孕法。 我們以電腦搜尋用快速起始法投予藥丸或其他賀爾蒙避孕法的隨機對照試驗。 我們並聯繫研究者以找尋其他研究。我們收納了比較快速起始法與一般起始法避孕的研究。若研究的是同樣以快速起始法給予的不同賀爾蒙避孕藥彼此的比較，也會包括在這項回顧中。 避孕法可包含使用兩種賀爾蒙，estrogen和progestin的避孕法(複合式賀爾蒙避孕)，或僅含progestin。 共有五個研究被納入。Depo是僅含progestin的注射劑。在一項“depo”的研究中，比起使用depo之前先使用另一方法21天的女性，以快速起始使用depo的女性當中後來懷孕者較少。 在此文獻回顧中的所有研究，各組之間「早期停止避孕」的女性人數是相近的。 在depo的研究中，以快速起始法使用depo的女性當中，認為「非常滿意」者較多。 有一項研究，兩組皆使用「快速起始法」。使用陰道環那組比起使用口服避孕藥的組別，其延長出血與頻繁出血的情形都較為少。 副作用的評估有六項，其中包括乳房變化，情緒變化和噁心。比起「快速起始使用口服避孕藥」，「快速起始使用陰道環」的組別顯示有副作用較少。滿意度方面，認為「非常滿意」者在使用陰道環那組較多。 藉由快速起始的方式，是否能降低非預期懷孕，或降低避孕的提早中斷，我們所找到的有力證據有限。不過，使用快速起始depo的女性比起另一起始法，其懷孕者較少。其它差異，是與避孕方式相關，而非起始時間。使用「陰道環」比起使用「避孕藥」的女性，有不適問題者較少。我們仍需更多研究，在使用相同賀爾蒙避孕下，來比較「快速起始法」與「傳統起始法」。

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