Postpartum contraception

Choice of contraception in the first 6 weeks postpartum is limited by the risk of venous thromboembolism and by breastfeeding. For the UKMEC restrictions on postpartum use of hormonal contraception, see the Faculty of Sexual and Reproductive Healthcare website.

Although contraception is not required until 21 days after delivery, an immediate start before leaving hospital eliminates the need for a return visit and can reduce the risk of rapid repeat pregnancy.

The etonogestrel implant can be inserted any time postpartum, including immediately before leaving hospital and during breastfeeding.

A levonorgestrel-releasing or copper intrauterine contraceptive device (IUD) can be inserted immediately postpartum (within 48 hours), including after a caesarean delivery and while breastfeeding. IUD insertion between 48 hours and 4 weeks postpartum should only be considered in exceptional circumstances by a specialist or experienced provider (UKMEC 3) because there is a higher risk of expulsion, malposition or perforation.
IUD insertion is considered safe from 4 weeks postpartum (UKMEC 1), but there is a higher risk of perforation in postpartum individuals, particularly those who are breastfeeding. Evidence is insufficient to determine whether a caesarean section is associated with an increased risk of perforation. The risk of perforation is increased up to 36 weeks postpartum. Individuals who are breastfeeding have a higher relative risk of perforation (six-fold increase), but the absolute risk of perforation remains low (approximately 1 in 100 people).
Depot medroxyprogesterone injection is safe to use (UKMEC 2) immediately postpartum and during breastfeeding. It can be a useful option for those awaiting IUD insertion after delivery.

Progestogen-only pills (POPs) are commonly prescribed for individuals who are breastfeeding because they do not increase the risk of VTE (unlike combined hormonal contraception). POPs that contain levonorgestrel or norethisterone have to be taken within a narrow 3-hour window each day (a maximum interval of 27 hours between pills); this timing can be challenging at this busy stage of life. POPs containing drospirenone may be easier to use because the maximum interval between pills is 48 hours (the same duration as for combined oral contraceptive pills). All POPs can be started immediately after delivery.

Combined hormonal contraception (COC or contraceptive vaginal ring) can generally be used from 6 weeks postpartum, even if breastfeeding. It does not adversely affect breastmilk or neonatal growth when used from 6 weeks.

Note: Combined hormonal contraception can be used from 6 weeks postpartum, even if breastfeeding.

Condoms can be started at any time postpartum, but use of a diaphragm is not recommended until 6 weeks postpartum.

Lactational amenorrhoea is 98% effective if all the criteria for use are met (see here for more information). However, an additional method of contraception is generally recommended if possible.