O&G: Contraception

Question 1

A 31-year-old female presents 5 weeks postpartum. She asks about methods of contraception that would be safe for her baby as she is exclusively breastfeeding. Which of these methods of contraception would not be recommended for this patient?

Answer 1

Combined Oral contraceptive pill

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The combined oral contraceptive pill is absolutely contraindicated in women who are breastfeeding and less than 6 weeks postpartum. This is because combined hormonal contraceptives reduce breast milk volume.

Question 2

How long after giving birth do women require contraception?

Answer 2

Day 21 postpartum.

Question 3

What is the Lactational amenorrhoea method (LAM)

Answer 3

Where the mother is breast feeding, amenorrhoeaic, and <6 months postpartum, there is a 98% success of contraceptive effect.

Question 4

A 19 year-old woman attends her GP for a repeat prescription of her combined oral contraceptive pill (COCP). Since starting it, she has been suffering from severe left sided headaches with changes in her vision before the headache begins. Clinical examination is normal. What is the most appropriate step in her management?

Answer 4

Stop the COCP and start on the progesterone only pill.

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The woman is having migraines with aura - a condition that can increase using the COCP. Women who have migraine with aura should stop the pill immediately - this is because the oestrogen component of the COCP can increase the risk of the women having an ischaemic stroke. A progesterone-only contraceptive pill is therefore the only alternative contraceptive medication that can be prescribed, as the others have oestrogen.