When choosing a method of contraception it is always necessary to weigh up the various advantages and disadvantages. Consideration must be given to the effectiveness and the side-effects of the method as well as to your individual circumstances, your health, your age and your personal preferences.

Your doctor is an important partner in helping you choose the suitable form of contraception, but he cannot make the decision for you.

It is therefore important to know all the selection criteria for a contraceptive and to inform yourself about the advantages and disadvantages of all hormonal methods and non-hormonal methods.

After giving birth there are particular considerations to be made.

Contraception after giving birth

Immediately after giving birth the ovaries are largely inactive so that a woman is less likely to become pregnant again during this time. This relative protection against pregnancy exists particularly in women who are breast feeding. The prolactin that stimulates milk production prevents ovulation from taking place. Even if menstruation begins again, often no eggs mature. But breast feeding does not provide 100 percent contraceptive protection! And the protection is lost if there is an interval of more than 6 hours between feeds and if the total feeding time is less than 65 minutes per day.

Women should therefore also use some form of contraception shortly after giving birth if they have intercourse and do not wish to become pregnant again.

However, not all methods are equally suitable.

Condoms can be particularly recommended. If the vagina is still dry after childbirth, water-based lubricants may be used.

Chemical spermicides should not be used as the lining of the vagina is still sensitive after childbirth and they can cause irritation. Also, the chemicals can be passed to the child via the breast milk.

Three months after delivery the pelvic floor is already stable enough to have a diaphragm fitted. The old diaphragm should not be used any more.

Natural family planning methods are not suitable at this time. After giving birth the cycle takes a few months to get back into its normal rhythm and be predictable.

About 6 to 8 weeks after delivery, when the uterus has returned to its normal size, a copper coil can also be fitted.

After the first spontaneous menstruation hormonal methods (such as the combined pill) can also be used again.

Hormonal contraceptives while breast feeding

Hormonal contraceptives are not the method of choice for women who are breast feeding. However, progestin-only preparations can be used.

The minipill (progestin-only pill) must be taken reliably every 24 hours. Although very small amounts of progestin are secreted into the breast milk, these do not harm the child. The combined estrogen-progestin pill (combined oral contraceptive) is not recommended for women who are breast feeding as estrogens can suppress milk production.

The intrauterine system can be fitted 6 to 8 weeks after giving birth, as soon as the uterus has returned to its normal size. This is a very effective form of contraception. The IUS is a T-shaped plastic structure which contains a hormone reservoir. It is placed in the uterine cavity where it releases small amounts of a progestin continuously for up to 5 years.