Immediate start of hormonal contraceptives for contraception

Laureen M Lopez; Sara J Newmann; David A Grimes; Kavita Nanda; Kenneth F Schulz

doi:10.1002/14651858.CD006260.pub3

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Analysis 1.1

Comparison 1 Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg), Outcome 1 Pregnancy per woman.

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Analysis 1.2

Comparison 1 Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg), Outcome 2 Discontinued OCs during 90‐day period.

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Analysis 1.3

Comparison 1 Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg), Outcome 3 Frequent bleeding (> 4 episodes of bleeding or spotting).

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Analysis 1.4

Comparison 1 Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg), Outcome 4 Irregular bleeding (bleeding‐free interval > 17 days).

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Analysis 1.5

Comparison 1 Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg), Outcome 5 Prolonged bleeding (bleeding or spotting episode lasting >= 10 days).

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Analysis 1.6

Comparison 1 Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg), Outcome 6 Amenorrhea (no bleeding).

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Analysis 1.7

Comparison 1 Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg), Outcome 7 Overall satisfaction with OCs.

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Analysis 1.8

Comparison 1 Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg), Outcome 8 Would make the same decision to start OCs.

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Analysis 2.1

Comparison 2 Immediate versus conventional start of OCs, Outcome 1 Pregnancy per woman.

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Analysis 2.2

Comparison 2 Immediate versus conventional start of OCs, Outcome 2 Pregnancy per young woman (<18 years old).

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Analysis 2.3

Comparison 2 Immediate versus conventional start of OCs, Outcome 3 Serious adverse events.

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Analysis 3.1

Comparison 3 Immediate versus conventional start of contraceptive patch (norelgestromin 150 µg + EE 20 µg), Outcome 1 Discontinuation of patch by cycle 3.

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Analysis 3.2

Comparison 3 Immediate versus conventional start of contraceptive patch (norelgestromin 150 µg + EE 20 µg), Outcome 2 Breakthrough bleeding.

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Analysis 3.3

Comparison 3 Immediate versus conventional start of contraceptive patch (norelgestromin 150 µg + EE 20 µg), Outcome 3 Nausea.

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Analysis 4.1

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 1 Pregnancy per woman.

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Analysis 4.2

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 2 Discontinued method in 84‐day period.

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Analysis 4.3

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 3 Frequent bleeding (> 4 episodes of bleeding or spotting).

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Analysis 4.4

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 4 Irregular bleeding (bleeding‐free interval > 17 days).

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Analysis 4.5

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 5 Prolonged bleeding (bleeding or spotting episode lasting >= 10 days).

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Analysis 4.6

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 6 Amenorrhea.

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Analysis 4.7

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 7 Very satisfied with method.

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Analysis 4.8

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 8 Planned to use method.

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Analysis 4.9

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 9 Reported bad change in weight.

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Analysis 4.10

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 10 Reported bad change in bleeding.

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Analysis 4.11

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 11 Reported bad change in headache.

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Analysis 4.12

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 12 Reported bad change in breasts.

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Analysis 4.13

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 13 Reported bad change in mood.

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Analysis 4.14

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 14 Reported bad change in acne.

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Analysis 4.15

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 15 Reported bad change in appetite.

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Analysis 4.16

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 16 Reported bad change in nausea.

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Analysis 4.17

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 17 Reported bad change in cramps.

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Analysis 4.18

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 18 Reported bad change in hair.

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Analysis 4.19

Comparison 4 Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg), Outcome 19 Serious adverse events (total).

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Analysis 5.1

Comparison 5 Immediate DMPA versus contraceptive bridge to DMPA, Outcome 1 Pregnancy per woman.

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Analysis 5.2

Comparison 5 Immediate DMPA versus contraceptive bridge to DMPA, Outcome 2 Discontinued method before 6 months.

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Analysis 5.3

Comparison 5 Immediate DMPA versus contraceptive bridge to DMPA, Outcome 3 Very satisfied with method at 6 months.

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Analysis 5.4

Comparison 5 Immediate DMPA versus contraceptive bridge to DMPA, Outcome 4 Adverse events.

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Comparison 1. Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pregnancy per woman Show forest plot	1	111	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.67 [0.04, 11.47]

2 Discontinued OCs during 90‐day period Show forest plot	1	111	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.48 [0.10, 2.28]

3 Frequent bleeding (> 4 episodes of bleeding or spotting) Show forest plot	1	104	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.71 [0.28, 1.79]

4 Irregular bleeding (bleeding‐free interval > 17 days) Show forest plot	1	104	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.82 [0.34, 1.99]

5 Prolonged bleeding (bleeding or spotting episode lasting >= 10 days) Show forest plot	1	104	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.89 [0.35, 2.24]

6 Amenorrhea (no bleeding) Show forest plot	1	104	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Overall satisfaction with OCs Show forest plot	1	104	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.76 [0.14, 4.10]

8 Would make the same decision to start OCs Show forest plot	1	104	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.62 [0.13, 2.94]

Comparison 1. Immediate versus conventional start of COC (norethindrone 1 mg + EE 35 µg)

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Comparison 2. Immediate versus conventional start of OCs

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pregnancy per woman Show forest plot	1	1590	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.89 [0.63, 1.26]

2 Pregnancy per young woman (<18 years old) Show forest plot	1	539	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.58 [0.31, 1.06]

3 Serious adverse events Show forest plot	1	1683	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.38 [0.64, 3.00]

Comparison 2. Immediate versus conventional start of OCs

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Comparison 3. Immediate versus conventional start of contraceptive patch (norelgestromin 150 µg + EE 20 µg)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Discontinuation of patch by cycle 3 Show forest plot	1	60	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.65 [0.11, 4.00]

2 Breakthrough bleeding Show forest plot	1	60	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.65 [0.11, 4.00]

3 Nausea Show forest plot	1	60	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.40 [0.75, 7.64]

Comparison 3. Immediate versus conventional start of contraceptive patch (norelgestromin 150 µg + EE 20 µg)

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Comparison 4. Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pregnancy per woman Show forest plot	1	201	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 Discontinued method in 84‐day period Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.84 [0.33, 2.18]

3 Frequent bleeding (> 4 episodes of bleeding or spotting) Show forest plot	1	156	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.23 [0.05, 1.03]

4 Irregular bleeding (bleeding‐free interval > 17 days) Show forest plot	1	156	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.77 [0.33, 1.75]

5 Prolonged bleeding (bleeding or spotting episode lasting >= 10 days) Show forest plot	1	156	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.42 [0.20, 0.89]

6 Amenorrhea Show forest plot	1	156	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Very satisfied with method Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.88 [1.59, 5.22]

8 Planned to use method Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.51 [1.32, 4.77]

9 Reported bad change in weight Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.42 [0.21, 0.87]

10 Reported bad change in bleeding Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.28 [0.14, 0.55]

11 Reported bad change in headache Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.53 [0.24, 1.18]

12 Reported bad change in breasts Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.36 [0.18, 0.73]

13 Reported bad change in mood Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.36 [0.19, 0.69]

14 Reported bad change in acne Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.39 [0.59, 3.29]

15 Reported bad change in appetite Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.44 [0.21, 0.95]

16 Reported bad change in nausea Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.30 [0.14, 0.62]

17 Reported bad change in cramps Show forest plot	1	145	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.79 [0.37, 1.67]

18 Reported bad change in hair Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.28 [0.05, 1.65]

19 Serious adverse events (total) Show forest plot	1	174	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Immediate ring (etonogestrel 120 µg + EE 15 µg) versus immediate COC (NGM 180/215/250 µg + EE 30 µg)

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Comparison 5. Immediate DMPA versus contraceptive bridge to DMPA

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pregnancy per woman Show forest plot	1	333	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.36 [0.16, 0.84]

2 Discontinued method before 6 months Show forest plot	1	333	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.64 [0.37, 1.11]

3 Very satisfied with method at 6 months Show forest plot	1	227	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.99 [1.05, 3.77]

4 Adverse events Show forest plot	1	333	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Immediate DMPA versus contraceptive bridge to DMPA

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