| Contraceptive methods |
Follow-up guidance |
| All methods |
Assure every client that she or he is welcome back anytime—for example, if she or he has problems, questions, or wants another method. |
| Combined oral contraceptives (COCs) |
- Annual visit is recommended to check on correct use, side effects, blood pressure, and any new health problems or major life changes1 since her last visit.
- Some clients benefit from contact after 3 months of COC use to answer any questions, help with any problems, and check on correct use.
- Encourage the client to come back for more pills before she finishes her supply.
|
| Progestin-only pills (POPs) |
- A visit after 3 months of POP use is recommended to check on correct use, side effects, and any new health problems or major life changes since her last visit.
- Encourage the client to come back for more pills before she finishes her supply.
|
| Emergency contraceptive pills |
- No routine return visit is required.
- Ask the client to return if she thinks she may be pregnant, especially if she has no monthly bleeding, or her next monthly bleeding is more than one week late.
|
| Progestin-only injectables |
- Client should return for her next injection in 13 weeks for DMPA or in 8 weeks for NET-EN.
- Ask the client to try to come back on time. She may come up to 2 weeks early or 2 weeks late and still get an injection, but she should come back no matter how late she is for her next injection.
- If the client returns late, discuss why the client was late and solutions. If coming back on time is often a problem, discuss using a backup method when she is late for her next injection, using emergency contraceptive pills, or choosing another method.
- If the woman comes to the clinic for any reason, also do the following to provide good quality of care: check on correct use, side effects, blood pressure, and any new health problems or major life changes since her last visit.
|
| Monthly injectables |
- Client should return for her next injection in 4 weeks.
- Ask the client to try to come back on time. She may come up to 7 days early or 7 days late and still get an injection, but she should come back no matter how late she is for her next injection.
- If the client returns late, discuss why the client was late and solutions. If coming back on time is often a problem, discuss using a backup method when she is late for her next injection, using emergency contraceptive pills, or choosing another method.
- If the woman comes to the clinic for any reason, also do the following to provide good quality of care: check on correct use, side effects, blood pressure, and any new health problems or major life changes since her last visit.
|
| Combined patch or combined vaginal ring |
- Annual visit is recommended to check on correct use, side effects, blood pressure, and any new health problems or major life changes since her last visit.
- Some clients benefit from contact after 3 months of use to answer any questions, help with any problems, and check on correct use.
- Encourage the client to come back for more patches or rings before she uses up her supply.
|
| Implants |
- No routine visit is required until the implants reach the end of their lifespan (between 3 and 7 years depending on the type of implant) or the client wants them removed.
- If the woman comes to the clinic for any reason, also do the following to provide good quality of care: check on correct use, side effects, and any new health problems or major life changes since her last visit.
|
| Copper-bearing intrauterine device (IUD) or levonorgestrel-releasing IUD |
- A follow-up visit after her first monthly bleeding or 3 to 6 weeks after insertion is recommended to check on side effects, possible expulsion, and symptoms of pelvic inflammatory disease.
- No client should be denied an IUD, however, if follow-up would be difficult or not possible.
|
| Female sterilization |
- Following up within 7 days or at least within 2 weeks after sterilization is strongly recommended to check the site of incision, look for any signs of infection, and remove any stitches (if necessary).
- No client should be denied sterilization, however, if follow-up would be difficult or not possible.
|
| Vasectomy |
- Ask the client to return 3 months after vasectomy for semen analysis, if available.
- No client should be denied vasectomy, however, if follow-up would be difficult or not possible.
|
| Male condom or female condom |
- No routine return visit is required.
- Encourage the client to come back for more condoms before running out of supply.
- If the client comes to the clinic for any reason, also do the following to provide good quality of care: check satisfaction with the method, if having any trouble using condoms correctly and every time, and any major life changes since the last visit.
|
| Spermicides and diaphragms or cervical cap |
- No routine return visit is required.
- Ask the client to return 6 weeks after she has had a baby or second-trimester miscarriage or abortion. When her uterus and cervix have returned to normal size, she should be re-fitted for a new diaphragm or cervical cap.
- When a diaphragm or cervical cap gets thin, develops holes, or becomes stiff, it should not be used and needs to be replaced. Client should obtain a new diaphragm or cervical cap about every 2 years.
- Encourage the client to come back for more spermicides before she runs out.
|
| Lactational amenorrhea method (LAM) |
- Plan for the next visit while the LAM criteria still apply, so that the client can choose another method and continue to be protected from pregnancy.
|
| Fertility awareness methods |
- No routine return visit is required.
- Invite the woman or couple to return a few times during the first few cycles if they want more help. Ask her to return if she has any problems with the method or develops new health problems.
|
| Withdrawal |
- No routine return visit is required.
|
1 Ask about major life changes that may affect her needs—particularly plans for having children and STI/HIV risk.
Source: WHO 2007 (134) |
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