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Contraception for new mums

Did you know that you may become pregnant if you have sex as soon as three weeks after giving birth? Even if you are breastfeeding or your periods haven’t returned.

Getting pregnant again may be the last thing on your ‘to do’ list right now, and you may want to allow your body time to recover before having another baby, so now is a good time to start thinking about contraception.

There are many questions surrounding the right contraception for new mums, particularly those who are breastfeeding. Here, you will find information aimed at supporting you to choose the right contraception to suit your life.

Note that this is an online guide for new mothers. It is not a replacement for the prescribing information leaflet included with your contraceptive medication. Please adhere to the prescribing information and direct any questions to your doctor.
Apart from condoms, all of the contraceptive methods below will not protect you against sexually transmitted infections (STIs), so you may need to use a condom as well to help protect you against most STIs.

Long-acting reversible contraceptives (LARC)

If you don’t want to have to think about contraception every day or every time you have sex, then why don’t you consider one of the four different LARC options.

You can choose between a LARC that is put inside your womb, or an implant or injection. If you use a LARC you might notice changes to your periods (lighter or heavier) or bleeding pattern (no bleeding, less frequent, more frequent, continuous).

  • No need to remember a daily pill
  • They provide extended contraceptive cover beyond that achievable with a daily pill

The contraceptive implant

implant

What is it?

The contraceptive implant is a small flexible rod, which is inserted by a trained doctor or nurse just underneath the skin in the upper arm.

  • Contains a progestogen hormone
  • More than 99% effective in most people
  • Lasts for up to three years

If you ARE breastfeeding…

You can still have the implant if you are breastfeeding, but you should wait until 28 days after giving birth and use a barrier method of contraception (e.g. condoms) for the first seven days. Consult your doctor if you intend to breastfeed while using the implant.

If you ARE NOT breastfeeding…

If you are not breastfeeding, you can have the implant from 21 days after giving birth. If you have the implant between 21 and 28 days after giving birth, your contraception cover will begin straight away. If you have the implant inserted later than 28 days after giving birth, you will need to use a barrier method of contraception (e.g. condoms) for the first seven days. If intercourse has already occurred, pregnancy should be excluded.

If you want to try for another baby, your doctor or nurse can remove the implant and your fertility should quickly return to normal.

Find out more about whether the contraceptive implant might be right for you.

The contraceptive injection

What is it?

The contraceptive hormone injection, which is given in the buttocks, arm, leg or abdomen.

  • Contains the hormone progestogen
  • 94% effective in most people
  • Injections are repeated every 8 to 13 weeks

If you ARE breastfeeding…

If you are breastfeeding, the initial injection should be given no sooner than six weeks after giving birth.

If you ARE NOT breastfeeding…

If you do not intend to breastfeed the injection can be given in the first five days after giving birth, however use of the LARC immediately after birth may cause heavy or prolonged bleeding. Your doctor or healthcare professional may advise that you wait until at least 6 weeks after your baby has been born before you start using a contraceptive injection, so consultation with your doctor is important.

If you experience any side effects from taking the contraceptive injection they cannot be immediately reversed. In all women receiving a contraceptive injection long term, a decrease in bone mineral density may occur. Please discuss with your doctor.

Find out more about whether the injection might be right for you.

Intrauterine device (IUD; the coil)

What is it?

The IUD is a small device made from plastic and copper that is inserted into the womb by a trained doctor or nurse.

  • Contains no hormones
  • More than 99% effective in most people
  • Lasts for up to five to 10 years, depending on which type you use

If you ARE or ARE NOT breastfeeding…

You can have an IUD fitted regardless of whether you are breastfeeding or not. You should wait at least 6 weeks after having your baby before having the coil fitted. The IUD could be implanted just after you have given birth, or two months after you have had your baby, depending on advice from your doctor. Your doctor may advise you to wait longer if there is a risk of triggering bleeding.

If you want to try for another baby, your doctor or nurse can remove the IUD and your fertility should quickly return to normal.

In some women, bleeding and pain after birth may make use of the IUD unsuitable, particularly in the first 36 weeks after birth. Your doctor can advise you.

Find out more about whether the IUD might be right for you.

Intrauterine system (IUS)

What is it?

The IUS is a small hormone-containing device made from plastic, which is inserted into your womb by a doctor or nurse.

  • Contains the hormone progestogen
  • More than 99% effective in most people
  • Lasts for up to three to five years, depending on which type you use.

If you ARE or ARE NOT breastfeeding…

As long as you don’t experience any problems after giving birth, you can have the IUS fitted when your baby is 6 weeks old, whether you are breastfeeding or not, and depending on the advice of your doctor.

If you want to try for another baby, your doctor or nurse can remove the IUS and your fertility should quickly return to normal.

In some women, bleeding and pain after birth may make use of the IUS unsuitable, particularly in the first 36 weeks after birth. Your doctor can advise you.

Find out more about whether the IUS might be right for you.

Monthly

If you don’t like the idea of taking a pill every day and don’t want a long-acting method, then the contraceptive ring may be for you.

Vaginal ring

What is it?

The vaginal ring is a flexible, transparent ring, which is placed inside your vagina. Your doctor or nurse can show you how to use it correctly.

  • Contains two hormones: progestogen and oestrogen
  • More than 99% effective if used correctly
  • The ring is left in your vagina for three weeks, you remove it for one week when you may bleed, and then insert a new ring

If you ARE breastfeeding…

Oestrogen can reduce milk production and change milk composition; therefore, the ring is not suitable if you are breastfeeding. Your doctor can advise you.

If you ARE NOT breastfeeding…

If you’re not breastfeeding then you can use it from after your first normal period, or sooner if your doctor advises that is appropriate. If you start using the ring more than 4 weeks after giving birth, your contraceptive cover will not start straight away and so you will need to use barrier contraception for the first seven days.

Like all combined hormonal contraceptives that contain oestrogens in addition to progestogen, the ring may not be suitable if you have certain conditions like high blood pressure or severe diabetes. Please tell your doctor about your lifestyle and any medical conditions you have.

Find out more about whether the vaginal ring might be right for you.

Weekly

If a weekly option sounds appealing, then the contraceptive patch may be an option for you.

The contraceptive patch

What is it?

You stick the patch to your skin and it releases hormones into your system.

  • Contains two hormones: oestrogen and progestogen
  • More than 99% effective if used correctly
  • You replace the patch each week for three weeks, then have a week free when you will bleed

If you ARE breastfeeding…

Oestrogen can reduce milk production and change milk composition; therefore, the patch is not suitable if you are breastfeeding.

If you ARE NOT breastfeeding…

If you’re not breastfeeding then you can use the patch 4 weeks after giving birth. If you start using the patch later than four weeks, the contraceptive protection will not start straight away so barrier methods will need to be used for the first seven days.

The patch might not work as well as it should if you weigh more than 90kg (14 stone), and it might not be suitable for you if you have high blood pressure, or are over 35 years old and a smoker.

If you stop using the patch and want to try for another baby, it may take a while for your fertility to return to normal.

Find out more about whether the the patch might be right for you.

Daily

The pill has been around for more than 50 years and there are two main types — the combined contraceptive pill and the progestogen-only pill. The clue about the difference between the two is all in the name — the combined contraceptive pill contains both progestogen and oestrogen whilst the progestogen-only pill contains only progestogen. There are various types of pills containing different combinations of different types of oestrogens and progestogen in different amounts – it is important to find the one that suits you best.

Combined contraceptive pill

What is it?

The combined pill contains a combination of two hormones and must be taken every day, at around the same time.

  • Contains two hormones: oestrogen and progestogen
  • More than 99% effective if used correctly
  • You take a combined pill every day, you have a break in taking pills or take placebo pills for seven days, when you may bleed.

The combined pill might not be suitable for you if you have high blood pressure, or if you are over 35 years old and a smoker. Vomiting or diarrhoea may reduce the effectiveness of the combined pill, barriers and spermicides should be used during vomiting and diarrhoea episodes, and for 7 days after recovery. If these 7 days overrun the end of a pack, the next pack should be started without a break.

If you ARE breastfeeding…

Oestrogen can reduce milk production and change milk composition; therefore, the combined pill is usually not suitable if you are breastfeeding. Your doctor can advise.

If you ARE NOT breastfeeding…

If you’re not breastfeeding, you can start the combined pill from when your baby is 21 days old. If you start later than 21 days post-delivery, then you may need to use a barrier method of contraception for the first seven days.

Your fertility should quickly return to normal after you stop taking the combined pill.

Find out more about whether the combined pill might be right for you.

Progestogen only pills (POP)

What is it?

POP contains a single hormone and must be taken every day at around the same time. There are two main types, one has a 3-hour ‘missed pill window’, and the other has a 12-hour 'missed pill window'.

  • Contains progestogen
  • More than 99% effective if used correctly
  • You take a POP every day without a break

If you vomit within 4 hours of taking your pill, take your next pill at the usual time, but consider using an additional method of contraception for the next 7 days. If you vomit less than 12 hours before taking your next pill, take your pill at the usual time and continue as normal.

If you ARE or ARE NOT breastfeeding…

Unlike the combined contraceptive pill, POP do not contain oestrogen so you can take them if you are breastfeeding. You should start them between 21 days and 28 days after you have had your baby, if you start POP more than 28 days after giving birth, you will need to use barrier contraception for the first seven days.

If you stop taking POP and want to try for another baby, your fertility should return to normal within a few weeks.

Find out more about whether the progestogen-only pill might be right for you.

Barrier methods

Barrier contraception physically prevents sperm reaching your womb where it could fertilise an egg. They can be used on their own whenever you want to have sex, or as an additional method in the short-term, for example when starting to use hormonal contraception.

Condoms

What is it?

Male condoms, worn on the penis, and female condoms, worn inside the vagina, are usually made of latex, although non-latex versions are available.

  • Contain no hormones
  • Male condoms are 98% effective, if used correctly
  • Female condoms are 95% effective, if used correctly
  • Condoms are the only method that fully protects from sexually-transmitted diseases (STIs)

If you ARE or ARE NOT breastfeeding…

You can use condoms as soon as you are ready to start having sex again after having your baby, whether you are breastfeeding or not. Using condoms can interrupt intercourse but they will also provide you with protection against many STIs.

Find out more about whether condoms might be right for you.

Diaphragm/cap

What is it?

A diaphragm or cap is made of latex or silicone and provides a barrier to stop sperm reaching your cervix. You insert the diaphragm or cap inside your vagina before you have sex and it must be left there for at least six hours afterwards.

  • Contains no hormones
  • Should be used with spermicide
  • 94% effective when used correctly and with spermicide

If you ARE or ARE NOT breastfeeding…

The diaphragm can be used whether you are breastfeeding or not, however because you must insert the diaphragm inside your vagina you may wish to wait six weeks after having your baby to allow the area time to heal.

The diaphragm/cap will need to be fitted by a doctor or nurse initially to show you how to use it correctly and make sure you have the right size. If you used a diaphragm before you had your baby, you must go back to have it refitted because your cervix could have changed during delivery. Inserting the diaphragm/cap with spermicide may be messy and interrupts intercourse.

Find out more about whether the diaphragm/cap might be right for you.

Natural contraception methods

If you do not want to take any hormones or use barrier methods of contraception, you may wish to consider natural contraception methods, which involves you identifying when you may or may not be fertile.

Natural family planning

What is it?

Natural family planning or fertility awareness relies on you tracking your menstrual cycle, to work out when you are likely to ovulate by monitoring fertility indicators:

  • Your body temperature
  • Cervical mucous
  • Cycle length

Devices can be bought from a pharmacy that tell you when you are fertile.

Being aware of the fertile and infertile times during your cycle can help you plan when to have sex or when to avoid having sex or use barrier methods.

If you ARE or ARE NOT breastfeeding…

There is no harm in being aware of your fertility indicators as soon as you have given birth, and natural family planning can be used whether you are breastfeeding or not. Natural family planning can be around 76% effective. However, after having a baby it may take a while for your body to readjust and for your periods and menstrual cycle to return to normal, therefore this method may not be as effective or provide much certainty in the months after giving birth. Additional stress and illness can also affect your cycle and you will need to be highly motivated to monitor fertility indicators every day.

Find out more about whether natural family planning might be right for you.

Breastfeeding

What is it?

When you are breastfeeding your body releases higher levels of a hormone called prolactin, which can prevent ovulation (your eggs being released from your ovaries) and therefore prevent you from getting pregnant, IF:

  • your baby is less than six months old
  • you are breastfeeding exclusively and not giving your baby any formula or solid food
  • your baby is feeding on demand, more frequently than every four hours during the day and every six hours at night
  • your periods haven’t returned

If all of the above are true, you should have protection against pregnancy of around 98%. However, if any of the above are not true, you may wish to consider another type of contraceptive.

Permanent contraception

If you are certain that you don’t wish to have any more children, you may want to consider permanent contraception/sterilisation.

Sterilisation

What is it?

These are surgical methods, which require no hormones and are very reliable (more than 99% effective). However, any surgery must be carefully considered and reversal may either be impossible or extremely difficult.

Sterilisation for men involves a vasectomy, where the tubes that carry sperm to the penis are cut, blocked or sealed. Sterilisation for women involves blocking or sealing the fallopian tubes that carry eggs to the womb.

If you ARE or ARE NOT breastfeeding…

Obviously, men can have a vasectomy whether you are breastfeeding or not and a vasectomy can usually be performed as soon as it is convenient for you both. However, you may need to wait a while before having a sterilisation operation to give your body time to recover from giving birth and to be certain that this is what you want.

Find out more about whether sterilisation might be right for you.

© 2015 Merck Sharp & Dohme Ltd. All rights reserved.

Job code: WOMN-1193246-0000

Date of preparation: September 2016

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