Dear Doctor,

I would like to get on a family planning method as soon as possible. I had my first baby who is about five months old now. The thing is, every method I have read about has strange side effects to it. Like the contraceptive implant. I’ve read that it can move around and be found in another part of your body. Is this true? What is the safest method? Will it interrupt my menstrual cycle?

Linda

Dear Linda,

Afterchild birth, usually for six months or so, chances of pregnancy are less, due to high levels of prolactin, the hormone responsible for production of breast milk. However, this is not a hard and fast safe period.  A woman may conceive as early as three to four months after delivery or may not become pregnant till 12 months. Therefore, it is prudent to use some contraceptive method to prevent pregnancy.

Barrier methods include using male and female condoms, female diaphragm, hormone coated vaginal ring. They are easiest to use; no assistance is needed in inserting it and it is successful. However, there is risk of condom being of poor quality and bursting during erection.

Intrauterine device(IUD), is a very good option for family planning in women who have given birth and want to delay arrival of another child.  They are either of copper or hormone coated. Inserted by expert hands, they remain in place and effectively prevent child birth from two to five years. There is no risk of infection either, if an IUD is put in hygienically.

Hormonal contraceptive methods can also be used. They are available in various forms like pills, skin patches, intradermal injection, emergency contraception. These contain either estrogen or combination of estrogen and progesterone or progesterone alone in low or high doses.  One must pick a form most suitable. However, estrogen alone pills are not recommended till four weeks after delivery, because now, risk of clotting in blood vessels is enhanced, due to post delivery, which may be augmented by estrogen.  Estrogen also tends to diminish breast milk production, which is not desirable.   There should be no other medical condition like hypertension or heart problems, where use of hormonal pills is not desirable.  If one forgets to take a pill in the night, another morning, next pill can be taken or one can keep emergency contraceptive pills handy, to take after an unprotected intercourse.  Hormonal pills can also interrupt menstrual cycles. 

Avoiding intercourse on days of ovulation (about 14th-21st day of menstrual cycle) can also be tried, if one can judge day of ovulation by BBT (basal body temperature) or changes in cervical mucous. However, the day of ovulation can be variable and one can commit mistakes.

If a couple can put it into practice, early withdrawal is one of the safest and most effective methods of preventing pregnancy. It means, withdrawal of the male partner before ejaculation. However, he needs to be careful to see that not even a small quantity of semen falls over vagina.

You can adopt a method of contraception of your choice from the various methods available. As per the needs and suitability, a nurse from the family planning centre can give correct advice.

Dr Rachna is a specialist in internal medicine  at Ruhengeri Hospital

rachna212002@yahoo.co.uk