Contraceptive Pearl: Abnormal Pap Smears and Contraceptive Options

In the past, many clinicians refused to start contraceptives for women who had not had a recent pap smear. While a thorough medical history is essential before starting a new contraceptive method, a pap smear is not necessary or even recommended. The delay in starting contraception while awaiting a pap smear creates an unnecessary gap in which many women become pregnant unintentionally.

A history of an abnormal pap smear does not rule out the use of any available method. Cervical intraepithelial neoplasia leads to only a mild caution for certain methods.

According to the CDC guidelines, women with cervical intraepithelial neoplasia can generally use the copper IUD (CDC risk level 1), hormonal IUDs (level 2), injections (level 2), combined hormonal contraceptives (level 2), and progestin-only pills (level 1). Therefore a pap smear is not necessary for the safe initiation of these methods.  

Women with cervical cancer cannot use either type of IUD. The CDC rates both the progestin and copper IUDs as a risk level 4 in women awaiting treatment for cervical cancer. Implants, injections, combined hormonal contraceptives, and progestin-only pills all maintain their same low risk levels for women diagnosed with cervical cancer.


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Helpful Resources

Medical Eligibility for Initiating Contraception
Breaking the Contraceptive Barrier: Techniques for Effective Contraceptive Consultations
Your Birth Control Choices Fact Sheet



Lesnewski R, Prine L. Initiating hormonal contraception. Am Fam Physician. 2006; 74: 105-112.

Bauer U, Barfield W, Curtis KM. U.S. selected practice recommendations for contraceptive use, 2013: Adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. Morbidity and Mortality Weekly Report. 2013; 62: 1-46.



The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.

Contraceptive Pearls

This monthly clinical e-newsletter highlights evidence-based best practice for contraceptive care

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