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Wednesday, April 21, 2021
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Post-baby birth control

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Reading Time: 7 minutesYou’ve just survived childbirth. Surely with all the physical trauma you’ve just experienced down below, there’s no way the universe would allow you to get pregnant again straight away, right? Actually, ovulation can occur as soon as 25 days after delivery, which means that you could be fertile before your first post-delivery period. Since studies show that many women resume sexual activity within the first six weeks after giving birth, there’s a risky window of opportunity for an unplanned pregnancy if couples don’t take precautions to prevent it.

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Although breastfeeding can suppress ovulation, relying on this as your sole method of contraception is not recommended, mainly because it is only effective if the following specific conditions are met:

• You are still within the first six months from delivery.

• You are exclusively breastfeeding, and not providing any non-breast milk food or other liquids to the baby.

• You have not had any period at all.

Only a small minority of new mums would fall within these narrow criteria. However, the good news is that there are more contraception choices available now than ever before, including more options for breastfeeding mothers.

Choosing the right contraception can be difficult and will depend on many factors, such as your preference, medical history, whether you are breastfeeding and whether you plan to have more children. The options listed here are all temporary and reversible; however, some require more frequent upkeep and attention than others.

 User maintenance required
Progestogen-only pill (POP)

The POP, or mini pill as it’s sometimes called, is over 99 per cent effective, which means that fewer than one woman in 100 will get pregnant in a year of using the pill correctly. This pill can be taken when you are breastfeeding and can be started any time after the birth. If you start the POP after day 21 of your cycle, you will need to use additional contraception for two days.

The POP works by releasing a hormone that’s similar to the progesterone hormone made naturally by the ovaries. It creates a plug in the cervix which prevents sperm from getting through to the womb to fertilise an egg.

In addition, these hormonal changes make it unlikely that a fertilised egg can implant into the womb lining. It also reduces the frequency of ovulation. One brand of POP, Cerazette, stops ovulation in more than 90 per cent of women.

The advantages to using the POP include:

• It can be taken when breastfeeding.

• It might help with painful periods and premenstrual symptoms.

• It can be taken by smokers and women over 35.

• It’s useful for women who cannot take oestrogens like those found in the combined pill, contraceptive patch or contraceptive vaginal ring.

• It doesn’t interfere with intercourse.

However, there are also disadvantages, which include:

• To ensure effectiveness, this pill needs to be taken at the same time every day.

• Taking this pill can affect your periods. For example, periods might become irregular, light, or more or less frequent. For some women, these effects are only short-term and may settle down over time.

• Users may experience temporary side effects such as spots, breast tenderness, weight change and headaches.

• Some medicines can make the POP less effective, so you’ll need to check with your doctor regarding any other medicines you’re taking.

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The combined pill  

This pill contains synthetic forms of both oestrogen and progesterone, and is 99 per cent effective when used correctly. Like the POP, this pill is less effective if it isn’t taken at the same time every day.

The combined pill releases hormones that inhibit ovulation, thicken cervical secretion, and thin the lining of the womb so it won’t accept a fertilised egg for implantation. This pill should be taken daily for 21 days, followed by a seven-day break where bleeding occurs during each cycle.

The advantages of this pill include:

• Periods can become regular, lighter and less painful.

• Using this pill can reduce the risk of cancers of the uterus, ovary and colon.

• Use of this pill doesn’t interfere with intercourse.

The disadvantages of this pill include:

• It cannot be used during the first six months of breastfeeding because the oestrogen it contains can suppress milk flow.

• This pill can cause a rise in blood pressure, so regular monitoring is required.

• Using this pill may cause side effects such as headaches, weight gain, nausea and mood changes.

• For some women, the combination of oestrogen and progesterone can increase the risk of blood clots, so it’s important for your doctor to assess your risks before starting a course.

Contraceptive patch (Evra) 

This is exactly as the name implies: a small, beige-coloured patch, around 5cm x 5cm in size, that’s stuck onto the skin. The patch releases both oestrogen and progesterone like the combined pill and should be applied once per week for three weeks, followed by one patch-free week, when regular bleeding should occur.

Like the combined pill, the patch cannot be used during the first six months of breastfeeding because it contains oestrogen, which can suppress milk flow. Although proper use of the patch provides 99 per cent effectiveness, some research has shown that the patch is less effective for women who weigh more than 90kg.

Contraceptive ring (Nuvaring) 

This is a transparent, flexible device that releases the same hormonal combination as the patch and combined pill. The woman inserts it into her vagina and it is left in place for three weeks, after which it is removed to allow a one-week ring-free interval, during which bleeding occurs.

Both the patch and the ring offer the advantage over the combined pill of not needing to remember to take it every day. Its effectiveness is also not impaired if you are vomiting or have diarrhoea, because it is not absorbed through the stomach. But the ring cannot be used during the first six months of breastfeeding because it contains oestrogen, which can suppress milk flow. And, as with the combined pill, the combination of oestrogen and progesterone can increase the risk of blood clots for some women, so it’s important for your doctor to assess your risks before starting.

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Long-acting reversible contraception (LARCs)

This is the name given to methods of contraception that are effective for an extended period of time and don’t require any maintenance from the user. They are particularly useful for women who don’t want to have to remember to take a daily contraceptive.

Contraceptive implant (Nexplanon)

This form of contraception is relatively new to Hong Kong, but has been available for six years in other countries such as the US, Australia and the UK.

In this method, a small plastic rod – about the length of a matchstick – is inserted under the skin in the upper inner arm and releases a synthetic hormone called etonogestrel – a type of progestogen. The implant works in a similar manner to the POP by preventing ovulation, thickening cervical secretion and thinning the womb lining, which prevents the fertilised egg from implanting. It’s over 99 per cent effective.

The insertion procedure can be performed in your doctor’s clinic with only a local anaesthetic. No stitches are required, but mild bruising and tenderness may occur for a few days after the procedure. The implant is discreetly located below the biceps and not obviously visible to other people. After three years, the old implant can be removed and a new one inserted in the same site.

The advantages of this method include:

• It can be used when breastfeeding, though women are advised to wait until three weeks after delivery to have it implanted.

• It remains effective for three years, so there’s no need to worry about daily maintenance.

• Fertility can return to normal immediately after removal.

• It does not raise blood pressure, unlike the combined contraceptive pill.

There are a few disadvantages, which include:

• Possible adverse effects, including: headaches, acne, weight gain and breast pain.

• The potential for unpredictable periods, which might become heavier or prolonged, or may stop altogether.

• A small procedure with local anaesthetic is required to insert and remove it.

Mirena coil (intrauterine system, or IUS)

The Mirena is a small, T-shaped plastic device that’s inserted into the uterus. It releases the progestogen hormone, which prevents pregnancy by stopping ovulation, thickening cervical secretions so sperm cannot reach the egg, and thinning the uterine wall to prevent implantation. It is over 99 per cent effective.

The advantages of this method include:

• It’s safe to use while breastfeeding.

• It’s effective for five years.

• It can help reduce or stop heavy periods.

• This method is highly reversible, meaning fertility returns to normal quickly, in the next cycle after removal.

• If fitted after age 45, it can stay in place until menopause.

As always, there are a few disadvantages, too:

• The insertion procedure can be uncomfortable.

• Irregular bleeding or spotting can occur within the first six months of use.

• There is a small risk of pelvic infection in the first 20 days after insertion.

• Some users may develop cysts on the ovaries, which usually disappear without treatment.

Copper IUD (intrauterine device)

A small plastic and copper device is inserted into the uterus. No hormones are released; instead, the device itself prevents sperm from reaching an egg and can also stop a fertilised egg from implanting. It is over 99 per cent effective.

Advantages to this method include:

• It’s safe to use while breastfeeding.

• It’s effective for five to ten years depending on the type.

• It does not contain hormones.

• Fertility is restored as soon as the coil is removed.

• If fitted after age 45, it can stay in place until menopause.

Disadvantages include:

• Periods may become heavier, longer or more painful.

• There is a small risk of a pelvic infection within the first 20 days of insertion.

• A risk of ectopic pregnancy may occur if the coil fails.

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Contraceptive injection (Depo-Provera)

In this method, the hormone DMPA (depot medroxyprogesterone acetate) is injected into a muscle, usually in your bottom or arm. It releases the progestogen hormone, which inhibits ovulation, thickens cervical secretion and thins the lining of the uterus to prevent a fertilised egg from implanting. It is more than 99 per cent effective.

The advantages for this method include:

• It’s effective for 12 weeks.

• It’s helpful for women who do not want regular periods, since users will not experience a period during the 12 weeks of effectiveness.

• It may protect against cancer of the uterus, and offers some protection from pelvic inflammatory disease.

Disadvantages of this method include:

• Periods may stop, or become irregular or longer following use.

• Periods and fertility may take time to return after stopping the injection. Fifty per cent of women will fall pregnant within 10 months after stopping, but, in a small percentage of women, conception may take up to 18 months after the last injection.

• Some women gain weight.

• Some women report experiencing headaches, acne, mood changes and breast tenderness.

• Use of this method can cause reduced bone mineral density. However, the bone tends to replace itself when the injection is stopped and there has been no evidence of significant increases in the risk of fractures.

These are only some of the contraception choices on offer. If you are unsure of which method would suit you best, speak to your doctor, who can suggest what might work for you. Remember, none of these options provides protection against sexually transmitted diseases. But, if you’re looking for an effective family planning method, one of these might just be your answer.

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