Contraception Flashcards
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What forms of contraception are available in the puerperium?
Lactational amenorrhoea (LAM) POP Combined pills Emergency contraception Depot injections Progesterone implants IUCD Diaphragms and cervical caps Sterilisation
What is LAM?
Lactational amenorrhoea, natural form of contraception
Breastfeeding prevents ovulation by disrupting GnRH activity
How effective is LAM?
In women fully breastfeeding day and night and are <6m postpartum, 98% effective
What reduces the effectiveness of LAM contraception?
>6m postpartum Return of periods Reduction in breastfeeding If night feeding stops Separation from baby e.g. return to work Baby on supplements Mother/baby become ill/stressed
Additional contraception should be considered once decrease in efficacy anticipated
When can POP contraception be started in puerperium?
Anytime postpartum, but if started after 21d additional precautions needed for 2 days
No effect on breast milk production (low doses, <1%, found in milk but no detrimental effect on baby)
When can COCP be started in puerperium?
At 3w if not breastfeeding
Not recommended in early breastfeeding until 6m (but can be used from 6w if other methods unacceptable)
Hormone levels in milk similar to that of ovulatory cycles
When can emergency contraception be used?
Progesterone method suitable for all
Not needed before 21d
When are depot injections recommended for contraception?
Not recommended <6w if breastfeeding (theoretical risk of sex steroid to baby immature nervous system/liver)
Medroxyprogesterone acetate 150mg IM every 12w can start 5d postpartum if bottle feeding
Norethisterone enantate 200mg IM every 8w alternative (only short term use, but can be given immediately postpartum, when medroxyprogesterone use can cause heavy bleeding)
When are progesterone implants recommended?
Insertion not recommended until 6w postpartum if breastfeeding
Implant in 21-28d if bottle feeding
When are IUCDs recommended?
Should be inserted within 48hrs postpartum or delayed until 4w
Minimises risk of uterine perforation at insertion
Levonorgestrel releasing devices also inserted at 4w
When can diaphragms and cervical caps be used?
Should be fitted at 6w (as different sizes may be required at different stages of puerperium)
Alternative contraception needed from 21d until new ones confidently handled
When is sterilisation recommended?
Unless highly advised at CS (e.g. repeat sections, family complete), should wait until suitable period has passed (high rate regret)
