Contraception after pregnancy.

Authors:
Anna Glasier
Anna Glasier
University of Edinburgh
Edinburgh | United Kingdom
Siladitya Bhattacharya
Siladitya Bhattacharya
University of Aberdeen
United Kingdom
Kristina Gemzell-Danielsson
Kristina Gemzell-Danielsson
Karolinska Institutet
Sweden
Sarah Hardman
Sarah Hardman
Sexual and Reproductive Health
Oskari Heikinheimo
Oskari Heikinheimo
University of Helsinki
Finland
Edgardo Somigliana
Edgardo Somigliana
Italy; Università degli Studi di Milano
Italy

Acta Obstet Gynecol Scand 2019 Apr 18. Epub 2019 Apr 18.

University degli Studi di Milano, Milan, Italy.

Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1-2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen-containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin-only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

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Source
https://onlinelibrary.wiley.com/doi/abs/10.1111/aogs.13627
Publisher Site
http://dx.doi.org/10.1111/aogs.13627DOI Listing
April 2019
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