What is the best way to protect yourself after childbirth? Hormonal implants and injections. Intrauterine device with hormones

There is a very popular statement that it is not necessary to use contraception during the first few months after childbirth, because a woman cannot conceive a child. Where then do children of the same age come from? How to protect yourself from unplanned pregnancy?

What determines the timing of the next pregnancy?

Not only different women, but even for the same woman after the next birth, the duration of the period of restoration of the ability to conceive can vary greatly. This depends on several factors:

on the balance of sex hormones in the body;
on the condition of the ovaries;
from the readiness of the uterine endometrium for embryo implantation.

Pregnancy – natural state woman's body. As soon as the level of hormones responsible for the preservation and development of the fetus begins to decrease, the brain (hypothalamus) immediately “gives the command” to the ovaries and uterus to prepare for a new conception. The ripening of the young egg begins, and a new endometrium develops to replace the endometrium that was rejected after childbirth. This process can be slowed down by biologically active substances released yellow body. This is the name of a small hormonally active area in the ovary. It is formed after the release of an egg, which, after merging with a sperm, gives the beginning of a new life. The corpus luteum initially supports pregnancy and, after childbirth, milk production. Over the course of several months, it dissolves, releasing less and less hormones that inhibit the onset of the next pregnancy.

The first menstrual cycles with the formation of mature eggs can take place with very scanty discharge and even without them at all. The endometrium, which lines the uterine cavity from the inside, is shed in a thick layer after childbirth, and sometimes it takes a long time for a new one to appear. But in the event of fertilization, the embryo is easily implanted into young tender villi.

A rapid onset of pregnancy can be expected if there are one or more signs:

Pregnancy, childbirth and the recovery period after them proceeded without complications.
The discharge of lochia gradually stopped by the end of the first week after the birth of the baby.
The woman is between 22 and 35 years old.
The mother has primary hypogalactia, or she has decided not to breastfeed.
On ultrasound, the corpus luteum in the ovaries is small or completely absent.
6 weeks after birth, menstrual flow appeared, and subsequently they recurred at intervals of 21 to 35 days.

When is fertility slow to recover?

After manual separation of the placenta or instrumental curettage of the uterine cavity due to intrauterine infection or atonic bleeding.
Against the background of active lactation. This is a combination of getting enough milk and frequent breastfeeding.
If before pregnancy a woman was diagnosed with endometriosis or fibroids in the uterus.
Under the age of 20 and after 40 years.

Ways to prevent pregnancy after childbirth

Placement of the intrauterine device

If the pregnancy proceeded without colpitis, the placenta passed away on its own, there are no deep tears, then it is possible to insert an IUD within the first 2 hours after birth. Over the next 2 to 6 months, strong contractions of the uterus may push the IUD out. Therefore, it is advisable to discuss the possibility of using this method before giving birth in order to take her with you to the hospital. Otherwise, you will have to wait until the uterus has completely contracted.

Lactational amenorrhea method

Indeed, thanks to the corpus luteum of the ovary, the maturation of new eggs and the endometrium of the uterus slows down in a woman who is actively breastfeeding. But it only slows down, not stops! This reduces the risk of getting pregnant without protection, but is not a guarantee. Therefore, if you decide to use this particular method, in the third month you need to visit a gynecologist, make sure there is no pregnancy and choose a more reliable way contraception.

Hormonal contraception

From 5-6 weeks after birth you can start taking oral contraceptives. If a woman is breastfeeding, these should be purely progestin preparations that do not contain estrogen, for example, Charozetta or Exluton mini-pills. Remember that with this method, punctuality is very important: you need to drink them every day at the same time with a permissible error of no more than one hour. This is very difficult for a young mother busy caring for her baby.

Oral contraceptives containing estrogens are contraindicated during lactation. If a woman does not breastfeed, from the second month after birth, the gynecologist will select a suitable drug.

Calendar method of contraception

If the start of birth control is delayed until the onset of the first menstruation, you may, without waiting for it, be surprised to feel fetal movements.

Temperature method of contraception

On value basal temperature Even tiny tears and healing sutures in the perineum and cervix, as well as hormonal imbalance, are affected. Inflammatory processes especially distort the temperature reaction: endometritis, colpitis. Therefore, until the woman’s body fully recovers after childbirth, this method is absolutely unreliable.

Ovulation tests

In a nursing mother, the hormone prolactin, which is responsible for the production of breast milk, prolongs the life corpus luteum in the ovary. The main thing is biologically active substance produced by the corpus luteum - luteinizing hormone (LH). This is what is determined by ovulation tests. With a regular menstrual cycle, its level increases only 1.5 days before the release of the egg from the ovary. In a woman who has recently given birth, high LH levels persist until the corpus luteum resolves. Therefore, this method of birth control in the first 2 to 6 months after birth is not informative.

Coitus interruptus

The beginning of sexual relations in the early postpartum period is, perhaps, the only case when a similar method of protection can be recommended. The husband, in order not to cause pain to his beloved, tries to control himself and be very gentle. Therefore, he will not miss the approach of detente. When assessing your strength, it is important to take into account one feature: after the passage of the fetal head, the vaginal tissues are stretched for some time, which reduces the intensity of sensations in the partner. If a woman had sutures placed on her perineum, then the entrance to the vagina will not only be tighter, but also significantly narrower. And remember: for the first 3 weeks, obstetricians and gynecologists recommend complete sexual rest.

Barrier methods of contraception

Condom – best option protection not only from unwanted pregnancy. After giving birth to a young mother due to hormonal imbalance and inflammation of the vaginal mucosa at the site of cracks and sutured ruptures, dryness of the genital tract is often observed. This temporary nuisance can cause a lot painful sensations during sexual intercourse and aggravate dormant infections, including thrush. Therefore, a condom with lubricant is an excellent way out.

Spermicidal tablets or suppositories, inserted into the vagina a few minutes before sexual intercourse, deprive sperm of activity and the ability to fertilize. Doctors allow their use after childbirth, but only after examination by a gynecologist. For erosions, colpitis and unhealed sutured ruptures, this method of protection cannot be used.

A female diaphragm or cervical cap is not recommended for use after childbirth. This is due to the increased sensitivity of the woman’s reproductive tract to infections and the high incidence of unsuccessful contraceptive administration.

Voluntary surgical sterilization

This is the most reliable method of birth control for a woman who has decided not to have any more children. Dressing fallopian tubes can be done in the maternity hospital, before the mother and child are discharged home, or at any time after childbirth.

The postpartum period is a high risk factor for unplanned pregnancy. Therefore, the topic of which contraceptives are better after childbirth is one of the important areas in obstetrics and gynecology.

Relevance of the topic

The period after pregnancy and childbirth is unique, since the function of all systems and organs is restored. The possibility of another pregnancy as a result of restoration of the hormonal function of the ovaries is influenced by many factors - nutrition, time elapsed after childbirth, duration of breastfeeding, etc.

The processes of reverse development (involution) of the internal genital organs begin to occur almost immediately: the cervical canal is completely restored on the 10th day, and its pharynx closes by the 3rd - 4th week, by the 6th - 7th the endometrium of the cavity is restored uterus, and by the 8th week the mucous membrane in the area where the placenta is attached regenerates. During this period of involution, abstinence from sexual intercourse is recommended to prevent infection.

The period for restoration of menstrual function for women who breastfeed is on average six months, for others - from 4 to 6 months. Often menstrual cycles occur without ovulation, but in 40-80% of women the first menstruation is preceded by ovulation.

Many women, even the vast majority (95%), remain sexually active after childbirth. From 10 to 28% already during the first year go to medical institutions for the purpose of artificial termination of pregnancy, and only 35% are committed to another pregnancy.

Various methods of contraception after childbirth (by the end of the second month) become especially important. Research results indicate that the optimal period between births for a woman and fetus is 3-5 years. A shorter interval contributes to complications of the perinatal period, increasing maternal and child mortality.

Methods of contraception after childbirth

In most cases, women in the postpartum period begin to be sexually active after 1.5 months, regardless of whether it was a natural birth or by caesarean section, and regardless of the type of feeding - breast or artificial.

Without using contraceptive methods, the risk of an unplanned new pregnancy is quite high. Right choice method of contraception is very important for maintaining a woman’s health. However, the difficulty is that any type of postpartum contraception is not universal, and the onset of menstruation is not an early and reliable sign of restoration of the ovulatory period. The choice of a particular method of contraception is influenced by many factors, the main one of which is the absence or presence of breastfeeding.

Methods of contraception and contraceptives during breastfeeding (breastfeeding) differ from protection during mixed feeding or without it at all. In the latter case, the use of contraception should be started within 21 days of the postpartum period after consultation with a gynecologist, and when planning drug suppression of lactation, for example, at the request of the woman or due to HIV infection, a week after birth. This is explained by the fact that suppression of lactation is associated with the use of drugs that cause accelerated restoration of secretion by the pituitary gland gonadotropic hormones and, accordingly, ovulation.

The choice of a particular method of protection is influenced by many factors. Factors such as:

the possible impact of the selected contraceptive on the processes of lactation and child development (with breastfeeding);
the wishes and age of the woman, the presence of concomitant diseases;
the possibility of side effects or complications;
individual effectiveness of the method of protection.

The presence of a large selection of methods allows you to use them and various contraceptives after childbirth. These methods include:

Methods natural contraception taking into account the results of studies of mucus from cervical canal, calendar method, measuring the temperature in the rectum (rectal, or basal temperature).
Abstinence method, or abstaining from sexual intercourse naturally.
MLA - lactation method.
Non-hormonal methods of contraception, which are intrauterine and barrier agents.
Combined hormonal contraception.

Natural contraception

Deprived negative factors, but its effectiveness is very low (50%) even if all recommendations for its implementation are correctly followed. This is explained by the difficulty of correctly interpreting the results of studies that were carried out with the mucus of the cervical canal until the regularity of the menstrual cycle is restored, changes in basal temperature when the mother is awake during feeding periods at night or when the child is restless, the difficulty of determining by calendar the timing of the resumption of menstruation and ovulation, etc. d.

Withdrawal method

Can be used at any time. It is the most effective and does not affect breastfeeding. However, for many it is unacceptable due to the difficulty of tolerating the lack of full-fledged sexual relationships, and therefore can only be used as an intermediate method of protection.

Most safe method contraception and is quite effective under the following conditions:

The newborn is less than six months old.
Daytime intervals between feedings are less than 4 hours, nighttime intervals are up to 6 hours. According to some authors, this time should not exceed 3 hours throughout the day, due to the 3-hour half-life of the hormone prolactin.
Lack of onset of menstruation. If bleeding occurred after childbirth, ended and started again before the 56th day of the postpartum period, then it is not considered menstruation, but is considered as a separate case of postpartum recovery.
Complete or predominantly breastfeeding; the latter means that the newborn receives mother's milk in a volume of at least 85% of all products taken, which do not replace the volume of breast milk. These products can be vitamins, water, juices or other liquids.

The main mechanism of action of this method, which is quite suitable for nursing mothers, is the constant maintenance high content prolactin in the blood and a decrease in the concentration of pituitary gonadotropic hormones. This occurs due to the constant secretory function of the mammary glands, which increases as a result of regular irritation of the nipples while feeding the baby. The consequence of all this is a slowdown in the cyclic processes occurring in the ovaries, which means a slowdown in the maturation and growth of the egg.

The advantages of using MLA are:

independence from sexual intercourse;
accessibility for all breastfeeding women;
no complications or side effects;
high percentage (98%) of contraceptive effectiveness within 6 months after childbirth;
faster processes of involution of the internal genital organs;
long-term passive immunization infant with mother's milk immunoglobulins and a decrease in the likelihood allergic reactions he has, thanks to the exclusion of foreign foods;
economic benefit.

The disadvantages of the method include:

the need to always be with the baby and strictly observe the time and volume of feeding, which causes some inconvenience if there is a lack of breast milk or if it is necessary to professional activity or study;
short duration of the possibility of protection from unplanned pregnancy: no more than six months after the birth of the child or until the menstrual cycle returns;
inability to protect against sexually transmitted infections, as well as the hepatitis B virus, immunodeficiency, etc.

In addition, MLA is a short-term way of preventing unwanted pregnancy, and a woman should always be prepared for the fact that she will have to resort to using other methods, for example, taking oral contraceptives. Pregnancy with MLA is possible in the following cases:

Restoration of menstruation. Even in cases where spotting after 56 days of the postpartum period does not completely resemble menstruation, the woman should perceive it as a sign possible restoration ability to become pregnant.
Started feeding the baby.
Any changes in feeding regimen.
The child is more than six months old even in the absence of menstruation.

The use of other methods of contraception may affect the quantity and quality of breast milk. Therefore, it requires contacting a gynecologist for advice.

Intrauterine and barrier contraceptives after childbirth

The first includes (IUD), which can be inserted no later than two days after birth. In this case, the procedure is considered quite safe. If this was not done within the specified period, then the IUD can be inserted after 6 to 8 weeks of the postpartum period. The main negative properties are the possibility of spontaneous prolapse of the IUD and high risk development inflammatory processes in the small pelvis.

Barrier methods of birth control include primarily polyurethane and latex male condoms (their effectiveness is 85%), as well as spermicidal tablets, vaginal films, gels and foams. The effectiveness of spermicides is about 70%. Female condoms, cervical caps and diaphragms are less common.

The greatest popularity of condoms is due to the lack of influence on the woman’s body, lactation and the quality of breast milk, and the prevention of infection with infections that can be sexually transmitted. In addition, condoms treated with a special sliding material (lubricant) are the method of choice for women with dry vaginal mucosa, which often occurs in nursing mothers.

high risk of HIV infection (when using a diaphragm or spermicides);
availability in the past toxic shock as a result of the use of a diaphragm;
latex allergies when using latex diaphragms or condoms.

Combined hormonal contraception (CHC)

It is based on the use of estrogens and progesterone in various ratios and doses. At the same time, they are able to change the composition and quality of milk, as well as suppress its secretion. Therefore, the use of this method is possible in cases of artificial feeding of a newborn or six months after birth.

At artificial feeding hormonal contraceptives are prescribed after three weeks of the postpartum period, when the blood coagulation system is completely restored. This is due to the fact that drugs in this group have the ability to increase blood clotting and the formation of blood clots in the veins and arteries.

KGC funds include:

Combined oral contraceptive (COC) tablets for daily use. They are sometimes used for treatment purposes (PCOS). Therefore, in rare cases of pregnancy and its successful completion with childbirth, contraception after childbirth with PCOS can be combined with its treatment by using COCs.
The weekly treatment is the “EVRA” contraceptive skin patch, which is changed once a week.
Hormonal contraceptive vaginal ring“Nuva Ring”, which a woman independently changes once a month.

For postpartum contraception, progestogen agents can also be used, the active components of which are synthetic analogues of the sex hormones of the corpus luteum. They do not suppress the ovulation process. In addition, they do not contain an estrogen component that affects the secretion of breast milk. The mechanism of their action is based on changes in the properties and composition of the mucus of the cervical canal, the morphological structure of the endometrium of the uterus and on impaired peristalsis (slowdown) fallopian tubes.

Progestogens are used from the 6th – 7th week with intermittent breastfeeding or with the introduction of complementary foods, and in the absence of breastfeeding - immediately after childbirth. These means include:

oral “mini-pill” drugs - microluti exluton;
Lactinet, or desogestrel, the effect of which, unlike the “mini-pill,” is comparable to COCs;
long-acting injectable preparations such as “Depo-Provera”;
injection implants in the form of capsules like “Norplant” (also long-acting);
hormonal intrauterine device “Mirena” containing the synthetic progestogen levonorgestrel.

Thus, the presence great variety methods and means of postpartum contraception makes it possible to use them taking into account the condition of the child, mother and lactation period.

Is it possible to get pregnant immediately after giving birth? This question interests many young mothers. On the one hand, there is such a thing as lactational amenorrhea, which in principle excludes conception. On the other hand, families raising babies of the same age prove that pregnancy is quite likely soon after birth.

What is lactational amenorrhea?

Nature has decreed it in such a way that reproductive functions Women after the birth of a child recover gradually and not immediately. The fact is that when a baby is born, the female body intensively produces a hormone that promotes the production of breast milk and at the same time suppresses ovulation processes. The hormonal background of the young mother changes, which is accompanied by the absence of menstruation. Doctors call this condition lactational amenorrhea.

However, there are times when menstrual cycle in a young mother it returns to normal immediately after childbirth, and the first menstruation occurs within a month. If the spouses had intimate intimacy during the period, then the onset of pregnancy soon after childbirth is very likely!

Important! No doctor can guess the timing of normalization of the menstrual cycle in a young mother, since everything depends on the individual characteristics of the body. In some women, ovarian function remains suppressed for 2 years, while others can conceive already in the first weeks after the birth of the baby!

Gynecologists say that pregnancy can be prevented during breastfeeding if the time interval between feedings is no more than 6 hours. But even this method is not a 100% guarantee of protection against possible pregnancy!

If a young mother nevertheless decides to lead an unprotected intimate life during breastfeeding, she is recommended to follow the following rules:

Feed your baby regularly, without replacing periodically breast milk for artificial mixtures.
During feeding, place the baby directly on the breast. The method of expressing milk is not suitable for these purposes.
Strictly observe the time intervals between feedings (no more than 5–6 hours).
Try to feed your baby at night, because it is during these hours that prolactin is produced most intensively in the body.

note: With frequent and regular feeding, a woman’s ability to conceive is restored within 1-2 years. Otherwise, ovulation may occur several months after birth. If a woman's menstrual cycle has returned, breastfeeding as a method of contraception loses its effectiveness!

When pregnancy occurs with artificial feeding

If a woman does not breastfeed her baby, the chances of becoming pregnant during the first weeks after birth are more than 95%! The fact is that the hormone prolactin, which suppresses ovulation processes, is produced exclusively during lactation. And if the baby is bottle-fed, then the young mother’s menstrual cycle is restored, usually within 4 weeks.

note: If you are not breastfeeding, start using protection at the very first intimacy after childbirth!

Pregnancy during lactation

If a young mother is breastfeeding, then doctors do not recommend conception earlier than a year after the end of the lactation process. Breastfeeding costs most of resources female body, vitamins, microelements and nutrients. For this reason, when a new pregnancy occurs, even special vitamin and mineral complexes will not help to adequately provide the fetus with all the substances necessary for normal, full intrauterine development.

In this case, the woman herself, in most cases, suffers from vitamin deficiency, weakening immune system, which is very dangerous. A new pregnancy that occurs during breastfeeding is difficult, accompanied by severe manifestations and high pregnancy rates. In addition, during breastfeeding, stimulation of the nipples occurs, which increases and can cause premature termination of pregnancy.

It is for this reason that if a young mother becomes pregnant again, then to reduce possible risks, doctors recommend that she take it at least in the 5th–6th month of pregnancy. However, this is also an undesirable option. After all, breast milk is the best stimulant for a baby. And weaning from the mother’s breast will be a great psycho-emotional shock for a small child.

Important! If you become pregnant again, wean your baby off the breast smoothly and gradually so as not to injure the baby. A qualified specialist will tell you how to do this correctly, and what timing of cessation of lactation will be most relevant!

What are the dangers of early pregnancy after cesarean section?

According to gynecologists, pregnancy after artificial childbirth () is possible already in the first months after the birth of the baby. However, conception in such a situation is not only undesirable, but also extremely dangerous for a young mother. The fact is that after a difficult artificial birth process, the female body is especially weakened, the vaginal muscles and abdominal wall cannot yet hold the fetus in correct position, which is fraught with the threat of miscarriage.

In addition, after a cesarean section, the woman in labor is required to have stitches, and with a rapid repeat birth, the likelihood of the postoperative scar diverging is very high.

Why is pregnancy after childbirth undesirable?

Even if the first birth went well, according to experts, pregnancy during the first two years is extremely undesirable. Carrying a child and the birth process itself greatly weaken the female body and undermine its strength.

If a woman is not given the opportunity to fully recover after childbirth, then another pregnancy may be associated with the following risks:

note: If pregnancy occurs soon after childbirth, it is important that the woman pays special attention to her health and is under constant supervision of her doctor!

We must not forget about psychological aspect. According to psychologists, repeated postpartum pregnancy that occurs within two years is extremely severe and can cause the development of disorders mental nature! In addition, it will be extremely difficult for a young mother to manage two children of the same age, both physically and psychologically!

If pregnancy occurs

But what to do if a second pregnancy occurs much earlier than the recommended period? The opinion of experts on this issue is unanimous: give birth! Abortion can be recommended only in exceptional situations, in the presence of certain clinical indications.

A woman needs to pay special attention to her health, eat well and rationally, and take specialized vitamin and mineral complexes prescribed by her doctor.

A young mother expecting a new addition to the family should rest well and get enough sleep. You cannot do this without the help of loved ones. Daily walks are also recommended. fresh air, which will be useful both for the baby and for the pregnant woman herself.

With insufficient tone of the vaginal muscles and muscle groups abdominal wall The risks of possible miscarriage can be minimized by using a special prenatal bandage, which is recommended to be worn regularly.

How can breastfeeding mothers protect themselves?

The issue of contraception among nursing mothers is quite acute. If a woman’s menstrual cycle has returned to normal, then it is simply necessary to take precautions to avoid early re-pregnancy. However, what contraceptive method will be effective and extremely safe?

Note: application birth control pills hormonal nature is strictly contraindicated for nursing mothers!

A means of preventing unwanted pregnancy such as spermicidal vaginal suppositories (Patentex, Pharmatex and others) will be quite effective and safe for nursing mothers. According to statistics, protection in in this case is about 90%, and at the same time, unlike condoms, the degree of sensitivity during intimate intercourse practically does not decrease.

The installation of an intrauterine device provides a good effect and maximum comfort. However, young mothers can only be given the IUD after preliminary consultation with a specialist.

note: Only a woman can choose the right means of contraception individual consultation with a gynecologist! This rule especially applies to breastfeeding mothers!

Signs of pregnancy after childbirth

Pregnancy that occurs shortly after childbirth has rather vague symptoms. Possible changes Women’s well-being and behavior are often attributed to the peculiarities of the postpartum period. However, gynecologists still point to a number of specific signs indicating the onset of a second pregnancy.

These include the following factors:

Swelling or increased sensitivity mammary glands.
Changed consistency of breast milk, which is due to hormonal changes that occur in the female body during pregnancy.
Decreased breast milk supply.
Absence critical days(if the young mother’s menstrual cycle has already stabilized).
Soreness of the mammary glands, with a tendency to intensify during feeding.
Increased fatigue.
Increased body temperature.

In addition, the young mother has early stages pregnancy, all the signs characteristic of pregnancy may appear, namely: in the morning, changes in taste preferences, excessive sensitivity to odors, attacks, etc.

Important: When the above symptoms appear, a woman is recommended to consult a gynecologist to determine the timing of pregnancy and obtain specialist advice!

Is it possible to get pregnant immediately after giving birth? According to obstetricians and gynecologists, pregnancy can occur within the first month after the baby is born. However, plan next pregnancy It is recommended no earlier than 2-3 years after the birth of the first child, in order to allow the female body to fully recover. In case of imminent reconception, it is extremely important that the pregnancy takes place under the strict supervision of a specialist, in order to avoid the development possible complications and premature birth!

Not every young mother plans her next pregnancy immediately after giving birth. In addition, pregnancy in the near future is undesirable for a woman’s health. Therefore, the need to control sexual activity and contraception becomes obvious.

The need for contraception after childbirth

After the birth of a long-awaited baby, many mothers are completely immersed in the atmosphere of household chores and caring for the child, sometimes forgetting about contraception. But the onset of a new pregnancy in postpartum period Young families most often do not plan. And gynecologists recommend refraining from another pregnancy for 2–3 years after childbirth. Only after this period will the woman’s body fully recover and she will be able to easily endure the next pregnancy without complications for herself or the fetus.

A young mother may not notice the onset of pregnancy, because there are no periods when breastfeeding. This is how children of the same age appear. According to experts, more than 85% of such pregnancies in Russia are the result of ignorance or careless attitude families to protection during the postpartum period.

Sometimes it happens that due to an unplanned pregnancy, a woman decides to have an abortion, which negatively affects her health. Young parents should pay more attention to pregnancy protection after childbirth. However, not all contraceptives are suitable for a nursing mother, as some pass into the milk and affect its quantity or can harm the baby.

Lactational amenorrhea

Many mothers are sure that it is impossible to get pregnant while breastfeeding. However, gynecologists warn about the need for contraception when breastfeeding immediately after the start of sexual activity. Every woman's body is individual. And, indeed, the lactational amenorrhea method works in 99% of cases in the first six months of breastfeeding.

The lactational amenorrhea method is natural way pregnancy protection, which is based on the absence of ovulation in a woman during breastfeeding.

A 6-month-old baby begins to be introduced to complementary foods, which means that breastfeeding becomes less and less. The level of hormones responsible for a woman’s ovulation gradually increases, and the chance of getting pregnant becomes several times greater. The lactational amenorrhea method is recommended to be used only until the child is 6–7 months old and subject to the following conditions:

refusal to supplement and complementary foods;
breastfeeding at night;
feeding on demand;
absence of menstruation.

Even if all the rules are followed, breastfeeding cannot be considered 100 percent contraceptive method in the postpartum period. His contraceptive effect It's getting smaller every month. The likelihood of pregnancy in the future depends on the characteristics of the body of each individual woman.

Methods of contraception after childbirth

The basic rule when choosing contraceptives is that they should not pass into milk in large quantities and affect the baby. Some of them are also unsafe for a woman’s body that is fragile after childbirth. Having familiarized yourself with various methods of contraception, it is still worth consulting with a specialist. The gynecologist will help the nursing mother choose the option that will be safe, affordable and convenient for her.

Hormonal methods of contraception

Hormonal contraceptives against pregnancy act on endocrine system women, excluding the possibility of conception.

Subcutaneous implant

The contraceptive is inserted under the skin into the woman's shoulder. This manipulation is simple - it is carried out by the doctor within a few minutes. The implant size is approximately 4 cm. The hormonal implant works for about three years and provides a guarantee of 99–100% protection. Its action is based on the daily uniform release of artificially created hormones into a woman’s blood. They block the release of eggs from the ovaries. This contraceptive can be installed 3 weeks after the baby is born. If more time has passed since childbirth, then it is necessary to use other means of protection against pregnancy (uterine caps, suppositories) for seven days after installation of the hormonal implant. The contraceptive does not negatively affect the quantity and quality of milk, therefore it can be used by nursing mothers.

The implant protects against unplanned pregnancy for about 3 years

Contraceptive injections

They begin their action after one injection. The effect lasts for three months. Then the procedure must be repeated.

Most women in Russia have not yet encountered contraceptive injections, while abroad they have already gained great popularity. Over the past 15 years, more than 8 million people around the world have used such injections.

The action of the injections is based on the introduction to the woman of a substance obtained from the natural hormone progesterone. The hormone suppresses ovulation, causing a thickening of the cervix and an increase in the amount of cervical mucus, which interferes with the movement of sperm. The injection is highly effective and protects against unwanted pregnancy by 99–100%. A woman is given a contraceptive injection in a medical facility once every three months on the fifth day monthly cycle. The drug is injected intramuscularly into the buttock or shoulder. It does not contain estrogen, which means it does not have negative influence for lactation.

A contraceptive injection must be given once every three months.

Intrauterine device (IUD)

This is a small plastic device, T-shaped or otherwise shaped, that contains hormones or copper. It inhibits the entry of sperm into the egg and reduces its lifespan, and in the case of fertilization, it prevents the zygote from attaching to the walls of the uterus.

The intrauterine device has an abortive effect, that is, in many cases, fertilization occurs, but due to the presence of the device, the egg cannot be placed in the uterus and dies. The IUD is installed only gynecologically healthy women with a regular menstrual cycle. Only a gynecologist can insert or remove it. With absence side symptoms or discomfort In a woman, the spiral can perform its function for 5 to 7 years. For nursing mothers, the installation of such a contraceptive is possible 5-6 weeks after birth. For women who have had C-section, installation of the IUD should be postponed until 6 months after birth. This method of protection against unwanted pregnancy does not affect lactation.

The intrauterine device can last from 5 to 7 years

Mini-pill

Mini-pills are hormonal tablets that contain no a large number of progestin (300–500 mcg). Progestin also serves as an alternative to progesterone, which is produced by a woman's ovaries. However, mini-pills differ from combined oral contraceptives (COCs) in their small dose of active ingredient and single-component composition. They are gentler on the body and do not contain estrogen. The active ingredient of the tablets passes into the baby through breast milk in small quantities, but does not have any effect on him. Also, such contraceptives do not in any way affect the amount of milk produced.

The action of the mini-pill is based on the ability of the drug to change the consistency of cervical mucus. The discharge becomes thicker and more stringy, thereby preventing sperm from penetrating into the uterus. The drug also reduces the ability of the egg to move through the fallopian tubes towards the sperm. The substances contained in the mini-pill contribute to changes in the endometrium: even if fertilization has occurred, the zygote cannot attach to the walls of the uterus. But most often, this effect is achieved only when taking the mini-pill for several months.

Mini-pills do not affect lactation

Mini-pills include the following drugs:

Combined oral contraceptives (COCs)

COCs, unlike mini-pills, contain estrogen. Their use after childbirth is permissible only in a few cases:

if there was no lactation initially;
if lactation is already completed.

Combined contraceptives have a two-component composition and, in addition to protection against conception, can treat any gynecological diseases women. You cannot make a decision about taking COCs on your own. Must pass full examination, after which the doctor will be able to prescribe contraceptives that are suitable for you. When taking properly selected combined oral contraceptives daily, following the instructions, you can achieve a 99-100% contraceptive effect.

Emergency contraception during breastfeeding

Emergency protection against unwanted pregnancy is used infrequently, as it contains a huge dose of hormones and has a strong effect on the body. You can use the tablets within three days after sexual intercourse, when other methods of protection (candles, condoms, caps, etc.) were not used or did not help. During this time, it is advisable to consult a gynecologist.

Emergency contraception after sexual intercourse is contraindicated in women who are breastfeeding. This is due to the fact that such preparations contain a very large amount of substances that affect the quality of milk and pass along with it to the baby. IN emergency situations The drug Postinor 2 may be relatively safe for nursing women. However, after taking it, you must stop feeding for 10 hours.

According to studies conducted in which nursing mothers took part, it was found that maximum amount active component Postinora 2 is achieved three hours after administration. The half-life shows different time: from 10 to 48 hours.

The active substance of Postinor 2 is levonorgestrel. It has the following features:

inhibits the growth of the endometrium, which does not allow the zygote to gain a foothold in the uterus;
helps inhibit ovulation, which is why the mature egg does not enter the fallopian tube;
promotes thickening of cervical mucus, which prevents sperm from moving towards the egg.

The drug is not suitable for regular use. Frequent use of Postinor 2 can cause pain and bleeding in a woman. Emergency contraceptive drugs also include:

Emergency contraceptives are not suitable as a primary contraceptive because they carry heavy load on the body. These medications have an abortifacient effect, but the time to stop breastfeeding is different for each drug:

Escapelle, according to some experts, is absolutely safe for infants. It contains levonorgestrol, which is quickly eliminated from the body. If you do not put the baby to the breast for 5–7 hours, the substance will enter the child’s body in a safe amount. Escapelle is taken 1 tablet until 3 days after unprotected sexual intercourse.
Contraceptives Zhenale and Ginepriston are very strong hormonal drugs, the entry of which into the baby’s body can cause serious violations in the functioning of his body. Therefore, after taking such contraceptives, it is necessary to stop breastfeeding for 14 days.
When taking Miropriston, experts recommend stopping breastfeeding for three days.

Photo gallery: emergency contraception drugs

The active ingredient of Ginepristone - mifepristone Escapelle is quickly eliminated from a woman's body
After taking Zhenale, you must stop breastfeeding for two weeks.
If you had to take Miropriston, then for the safety of the baby it is recommended to cancel lactation for three days. After taking Postinor 2, it is recommended to stop breastfeeding for at least 10 hours

Barrier method

Barrier methods of contraception include condoms and silicone caps. These means of protection against unwanted pregnancy mechanically prevent sperm from entering the uterus, where fertilization can occur.

Condoms

A condom is placed immediately before sexual intercourse on the male genital organ in an erect state. It retains the male seed inside itself and prevents it from entering the female body. The effectiveness of protection against unwanted pregnancy is 96–99%. Disadvantage - the possibility of rupture when strong impact on him. Unlike many other contraceptives, a condom protects both the woman and the man from various diseases sexually transmitted diseases. A condom is the simplest and available method protection against pregnancy, which has no contraindications when used during breastfeeding.

Uterine cap

It is most often made of silicone or latex and has the shape of a cup or hemisphere. The cap is a reusable product, the service life of which can reach from one to two years. The contraceptive cap is put on the woman’s own cervix and closes the passage for sperm. It does not protect against sexually transmitted infections. The effect of a cap in protecting against pregnancy depends on the correct selection and insertion of it.

The contraceptive cap can be reused multiple times

Without harm to health, the contraceptive cap can be left inside for 35–45 hours; after this time, an unpleasant odor may appear.

Before inserting the cap into the vagina, you must check it for cracks and tears, then wash your hands thoroughly. For the greatest effect, it is recommended to use spermicidal gel, which fills the cap a little less than halfway. The contraceptive is then inserted deep into the vagina, where it attaches to the cervix. It is most convenient to do this with a medium or index finger, squatting or lying on the bed.

The advantage of the cap is the possibility of repeated use. After sexual intercourse, you need to leave the cap in for at least another six hours: quick removal can allow the remaining sperm to penetrate the uterus. You also need to remove the cap with pre-washed hands, taking a position that is comfortable for you. After removing the contraceptive, rinse thoroughly and dry. The uterine cap has no contraindications for use during breastfeeding and does not have a negative effect on the condition of mother and child. However, after giving birth, you should refrain from using such a remedy for at least 4 months, until the cervix takes a permanent shape.

The cap must be inserted and removed with previously washed hands.

Sterilization

Sterilization is a surgical, irreversible method of contraception in 99% of cases. Its essence lies in the mechanical effect on the fallopian tubes, as a result of which their obstruction is created. They do this in one of four ways:

Removal of part of the fallopian tube.
Cauterization of the fallopian tubes using an electric current, resulting in scarring in the tube that prevents the movement of the egg and sperm towards each other.
Tubal ligation - tying the tubes and securing them with a clamp, which subsequently dissolves on its own.
Pipe clamping - blocking pipes using clamps. The advantage of this method is that such clamps can be removed later.

If the operation is performed correctly, protection from pregnancy is 100% guaranteed. Since in most cases such an effect is irreversible, before using it, a woman needs to weigh the pros and cons of this procedure. Usually the operation is performed on women who already have and do not want to have more children. It is also indicated in cases where pregnancy can cause harm to health. The woman must be consulted about the methods of sterilization and given an explanation about the irreversibility of the method, after which she must sign documents indicating her consent to sterilization.

If necessary, the clamp can be removed from the pipe using an operation

Conditions for sterilization:

full examination of physiological and psychological state women;
no health contraindications for performing surgical intervention, for example, sexually transmitted diseases, oncology, psychological instability, etc.;
woman's age over 18 years;
a healthy woman must have at least one child;
the woman must not be pregnant;
written consent of the woman to perform the operation.

Natural Family Planning Methods

The calendar method of family planning is the cheapest and most natural way to avoid unwanted pregnancy. It consists of monitoring the menstrual cycle and calculating the days when conceiving a child is possible and when it is impossible. On days when a woman cannot become pregnant, she can have unprotected sex. On the days of ovulation or the days closest to it, you can avoid pregnancy by excluding sexual intercourse or using contraception. This method of birth control is not contraindicated for nursing mothers, but is only suitable for women who have a regular and stable cycle, otherwise the calculations of non-fertile days will be incorrect. For correct calculation safe days An ovulation calendar will help.

In addition to the ovulation calendar, body signals can help determine fertile days, such as:

daily body temperature readings increase by 0.4 - 0.6 degrees;
daily vaginal discharge becomes very profuse, sometimes one-time discharge may occur slight highlight blood;
increased libido;
pain in the lower abdomen;
prolapse and opening of the cervix;
breast tenderness.

It is important to be guided by both the ovulation calendar and body symptoms in order to natural method family planning worked 99 and 100%. Given the fact that people can make mistakes, be forgetful or inattentive, natural family planning provides only 75-80% protection against unwanted pregnancy.

The PPA method, or coitus interruptus, is another type of natural contraception. Its essence lies in the fact that the man manages to remove the penis from the woman’s vagina before the moment of ejaculation. This method is unreliable. Doctors do not recommend using it, since sperm are often present in the discharge even before ejaculation, or the man may not have time to remove the penis. Of course, using this method is better than not using any. However, it is worth knowing that in addition to the unreliability of pregnancy protection, it can bring psychological discomfort to both partners and the fear that the man will not have time to reach his penis before ejaculation.

Chemical contraception

Chemical means of protection against pregnancy include gels, suppositories, creams and aerosols. Due to their active substance, such contraceptives destroy sperm, bacteria and viruses. Chemical contraceptives are non-hormonal contraceptives; their action is based on the destruction of sperm and increasing the viscosity of cervical mucus, which prevents the passage of damaged sperm into the uterus. Chemical contraceptives should be used only before sexual intercourse. Introducing suppositories or cream after sex does not make any sense, since sperm have already managed to penetrate the uterus.

Chemical contraceptives include:

Erotex;
Benatex;
Evitex;
Pharmatex;
Gynekotex.

Contraceptive suppositories and creams do not provide 100% protection against pregnancy. It is advisable to combine such contraceptives with other means of protection (condoms, caps). Using only chemical contraceptives provides 75–90% protection against unwanted pregnancy. Therefore, women who are sexually active should choose other methods of protection.

Because contraceptive suppositories and creams are non-hormonal agents that provide local action and do not pass into breast milk, their use is possible during lactation. They are suitable for women if:

rare sexual intercourse, in cases where installing an IUD or taking hormonal pills does not make sense;
breastfeeding;
the presence of contraindications for the use of hormonal pills or installation of an IUD;
perimenopause (the period before menopause, when the production of sex hormones gradually decreases);
additional protection when using a uterine cap or skipping a hormonal birth control pill.

To achieve 100% protection against pregnancy, contraceptive suppositories should be combined with other means of contraception.

The suppository must be administered 10–20 minutes before sexual intercourse in a comfortable position (lying or squatting). During this time, it will have time to melt, distribute evenly throughout the vagina and begin its action. For 3 hours after using the candle, you should not wash yourself with soap, as soap can neutralize the spermicide and its effect will be ineffective.

Contraceptive creams, gels and aerosols have the same properties and protection parameters as a candle. Their significant difference from each other is only in the form of release.

Most often, the cream comes with a tube with a special tip. The cream must also be administered in advance - 10–15 minutes before sexual intercourse. With frequent use, it can cause vaginal dryness and lead to dysbiosis, so regular use of the cream is not recommended. Another disadvantage of the cream is that when interacting with water and soap, its protective properties are lost. Cleaning up immediately after sexual intercourse or having sex in a pool can neutralize its effects.

Pharmatex contraceptives are available in the form of cream, tablets, suppositories

Before the birth of the baby, the body was “tuned” to the nutrition of the child inside the mother, after birth hormonal balance is being rebuilt again - now it adjusts the mother’s body to breastfeeding.

Natural hormonal changes in the body occur, so not all methods of preventing pregnancy while breastfeeding are allowed. However, today enough is known effective methods, which will help you choose what to use for protection after childbirth for a nursing mother. We’ll talk about this on the women’s website “Beautiful and Successful”.

Methods of protection against pregnancy while breastfeeding

LLA – method of lactational amenorrhea.
Barrier method (use of condoms, diaphragms, caps, etc.)
Spermicides.
Intrauterine non-hormonal device - IUD.

In the second group we will include drugs that contain hormones that are acceptable for breastfeeding.

Mini-pills, injections, implants.
IUD with progesterone hormones.

Lactational amenorrhea

Wise Mother Nature took care of women's health after childbirth and made sure that during the period of active breastfeeding the body does not produce hormones that cause ovulation. Therefore, a woman should not become pregnant during this period.

What changes occur in the body during lactation?

During breastfeeding, the body begins to produce prolactin, a hormone that is not only responsible for the production of breast milk, but also affects the functioning of the ovaries. As a result of this effect, the work of the ovaries is inhibited, and women do not ovulate. If there is no ovulation, then there can be no pregnancy.

The absence of menstruation during lactation is called lactational amenorrhea in medicine, and the method of contraception is called the lactational amenorrhea method.

The method is certainly convenient for women, but the following must be taken into account:

You need to breastfeed your baby systematically and often - at least every 3 hours, and also feed the baby at night. Only in this mode will prolactin be produced in the body in sufficient quantity to avoid getting pregnant.
The child must be exclusively breastfed. No mixtures or complementary foods. Consequently, after 5-6 months (it is at this age that the first ones are recommended), the likelihood of pregnancy increases.

The effectiveness of this method varies from 94 to 98%. Some women claim that they became pregnant by trusting the lactational amenorrhea method.

Firstly, such contraception for nursing mothers is acceptable for a very short period - a maximum of six months after childbirth.
Secondly, this method cannot work reliably if women had an irregular menstrual cycle before giving birth or had gynecological or endocrine disorders.
Third, MLA does not protect against sexually transmitted diseases.

It is imperative to take into account that the restoration of menstruation in a woman occurs individually. For some, the first period after childbirth may come as early as the next month, while others wait until the baby is 1.5 years old for menstruation.

You cannot know exactly when your cycle will return. And since ovulation precedes the onset of menstruation, it is quite possible that you can become pregnant while breastfeeding during your first cycle.

It is for this reason that a woman is often unaware of her situation, hoping that she does not have periods due to breastfeeding.

Therefore, this method cannot be called a very reliable method of contraception for nursing mothers. Experts say that if you combine MLA with other methods of contraception, the percentage of protection against unwanted pregnancy increases to 100%. Let us further consider how a nursing mother can protect herself after childbirth.

Barrier methods

The simplest and most affordable method of protection when breastfeeding is the use of condoms for men or cervical caps, diaphragms and sponges for women.

Not everyone likes to use condoms, and some are allergic to latex. Many note that childbirth affects the tone of the vaginal muscles, so the first time sensations during sexual intercourse may not be the same as they were before childbirth.
Diaphragms and caps are selected by the doctor individually for each woman. The diaphragm is placed by the doctor for a long time, and the caps can be inserted by the woman immediately before PA. This suitable method contraception for nursing mothers, it is especially effective for the first six months in combination with the lactational amenorrhea method.

If you used barrier method contraception before childbirth, you can opt for a diaphragm or a cap. Just be sure to keep in mind that the size of your ring and cap is now different, so be sure to consult a gynecologist.

Spermicides are single-use preparations

Spermicides in the form vaginal suppositories, gels, tablets and creams are approved for use during lactation, as they have local impact and are not absorbed into breast milk.

The most popular drugs are Erotex, Patentex Oval, Pharmatex. Their main thing active substance– benzalkonium hydrochloride, which has a detrimental effect on sperm. It is imperative to follow the rules for using spermicides, which are indicated in the instructions:

Use only clean water for washing.
The drug must be administered strictly on time. For example, suppositories are administered 5 minutes before the act.
Remember the rule: 1 candle (tablet) = only 1 act.

Intrauterine device

Non-hormonal intrauterine device is also allowed during breastfeeding. This method is considered very effective if you have no contraindications for inserting an IUD.

The doctor must prescribe an examination after childbirth to determine whether it is possible to protect yourself while breastfeeding with a spiral.

Contraception for nursing: hormonal drugs

Breastfeeding is best combined with taking those hormonal drugs, which do not contain estrogen. If the drugs contain this hormone, then the woman’s breast milk production will be reduced.

Minipill tablets

Special pills for nursing mothers have a cute name - mini-pills. Most often prescribed are Exkluton, Ovret, Microlut, Micronor. Ideally, a doctor should select the drug. These birth control pills contain only one hormone - progestogen. It does not pass into breast milk, which is the most important thing for those who are looking for how to protect themselves while breastfeeding.

One of the main features of using this method of contraception is that mini-pills must be taken strictly by the hour.

Therefore, the site advises those who decide to protect themselves with these pills to set a reminder on their mobile phone. With the active pace of life of a young mother, it is quite possible to forget about the time of taking the pill.

Mini-pills compared with COCs (combined oral contraceptives), which are not recommended for breastfeeding, are less effective. Therefore, mini-pills will be reliable only when their use is combined with breastfeeding. After completion of lactation, it is necessary to immediately switch to more reliable contraceptive methods.

Subdermal implants and injections

Special capsules or plates containing hormones are sewn subcutaneously. Every day, a minimum dose of hormones is released into the bloodstream, which prevents pregnancy. Since the capsules do not contain estrogen, they can be recommended to those who are looking for ways to protect themselves for a nursing mother.

Injections are similar in effect to implants; only one injection protects against pregnancy for 3 months, while a sewn-in subcutaneous implant protects for up to 5 years.

Intrauterine device with hormones

Not all hormonal IUDs are approved while breastfeeding. Only those containing progesterone (Mirena) are allowed.

You can insert an IUD immediately after childbirth, but if this is not done immediately, you must wait until 2 months have passed if you had a natural birth, and six months after.

There is an opinion that in women taking medications that are acceptable during feeding (mini-pills, implants, injections), their own hormonal background. It will be difficult for an accustomed body to live without artificial hormones.

Also, some doctors say that a microscopic dose of hormones is still absorbed into breast milk, so hormonal contraception for nursing women is not a safe method.

Methods of preventing pregnancy during breastfeeding also include coitus interruptus and sterilization of women and men. The most reliable contraception for breastfeeding women is (tubal ligation in women and vasectomy in men), but this method has its pros and cons. We have already talked about them on the “Beautiful and Successful” website.

When choosing contraception for nursing mothers, it is better to consult a doctor rather than be guided by advertising or information from the Internet.