Expert / 2 August, 2017 / Jane Knight

What Do I Do About Contraception Post Pregnancy?

I’m really confused with all the contraception options. What would you suggest post pregnancy?

There are a number of contraceptive choices available to women after childbirth. It depends on whether you are breast-feeding and the degree of effectiveness you want from the method.

Breastfeeding alone is not a reliable contraceptive, but provided you follow a set of guidelines carefully, Lactational Amenorrhoea Method (lactation = breast-feeding and amenorrhoea = no periods) is 99% effective, but this is only suitable provided:

• Your periods haven’t returned; and
• You are fully breastfeeding. Your baby gets no formula milk or other food and is still getting night feeds; and
• Your baby is less than 6 months old.

All three of these LAM rules must be strictly followed. If you are using LAM, you also need to avoid dummies, and avoid feeding your baby anything from a bottle, even expressed milk or water. Expressing milk reduces the effectiveness of LAM to about 95%.

Breastfeeding has to be going well for LAM to work, so if you need any support, contact the national breastfeeding helpline on 0300 100 0212.

LAM is a temporary method, and as soon as there is any change, the method will not be so effective, so you need to switch to another method of contraception.

Fertility awareness methods can work well (this involves observing bodily changes including changes in your cervical secretions and changes in your waking temperature).  Fertility awareness methods can be used alone (with abstinence during the fertile time), known as natural family planning, or combined with a barrier method (such as condoms) during the fertile time. You need to be taught this method by a specially-trained fertility awareness practitioner – see  www.fertilityuk. FertilityUK site for a list of local practitioner to teach LAM and fertility awareness methods.

There are a number of other contraceptive choices available after having a baby:

• male or female condoms can be used at any time
• diaphragm can be used from six weeks after the birth
• progestogen-only pill or contraceptive implant (progestogen-only) can be used from three weeks after the birth.
• If you are not breastfeeding then you can use the combined pill, the contraceptive vaginal ring and the contraceptive patch from three weeks after the birth.
• An intrauterine device (IUD) or intrauterine system (IUS) can also be fitted.

The method choice really depends on your personal preference (and that of your partner)  your medical history, any problems you had in your pregnancy, if you are breastfeeding and whether and when you might be planning another pregnancy.

You can find more information about contraceptive choices after you have had a baby at  The FPA web site or talk to your GP or local family planning clinic.

When do I need to start thinking about contraception? Can you get pregnant whilst breastfeeding?

Your fertility could return within 2-3 weeks of birth if you are not breast-feeding. If you are breast-feeding your baby, then the prolactin (breast-feeding hormone) will suppress the activity in your ovaries and suppress ovulation and fertility for a varied length of time.  For most women this is suppressed while fully breast-feeding.  But, yes – you can still get pregnant, even if you are breast-feeding.  If you are fully breast-feeding and you don’t have any periods, then LAM can be a highly effective method (as above) – but it does require a strong commitment to breast-feeding.

Can the pill and other forms of contraception have an effect of future fertility?

The pill and other hormonal methods have no adverse effect on future fertility.  The only issue with taking hormonal methods in the longer-term is that for the years you are taking the hormones, you are getting older and it is the declining fertility associated with advanced age that is the problem  (not the pill).  The only other caution is that if you are taking hormones, you will have regular ‘periods’ which are really due to the withdrawal of the pill hormones (and not true periods), so if anything changes, for example you are seriously over- or under-weight, or you develop a gynaecological problem such as polycystic ovaries (PCOS) then this may be masked by the regular ‘periods’ of the pill and may go unnoticed for longer.  Irregular cycles is a warning sign that there may be a problem and you will not notice this if you are taking hormonal methods.

For most women, provided you have discussed it with a doctor, your weight is within normal limits and you are a non-smoker, hormonal methods are very safe and will not affect future fertility.

Similarly there is no concern with modern intrauterine devices.  Some of the older devices were linked to an increased risk of pelvic infection but newer devices are safe and have no effect on future fertility.  Sexually transmitted infections (STIs), including the silent infection chlamydia, cause pelvic infections – not intrauterine devices. Always consider your risk of STIs and use barrier protection such as a condom if you are not in a stable relationship.  Make sure to get a regular sexual health check.

Jane Knight, Specialist Fertility Nurse at Zita West Clinic

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