When to Start Hormonal Contraception Postpartum?
Hello. I'm Andrew Kaunitz, Professor and Associate Chair of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville, Florida. Today I'd like to discuss "When to Start Hormonal Contraception Postpartum: New Guidelines From the CDC."
After childbirth, women are often highly motivated to begin birth control and are already accessing the healthcare system, making this an important time to initiate contraception. Because ovulation in women who are not breastfeeding can occur prior to 4 weeks postpartum, starting contraception early after childbirth is important.
However, the immediate postpartum period is characterized by a markedly elevated risk for venous thromboembolism (VTE). Risk factors including recent cesarean delivery, obesity, smoking, postpartum hemorrhage, preeclampsia, age 35 years or older, or known thrombophilia further elevate this risk. Combination estrogen-progestin contraceptives including oral, transdermal, and vaginal ring methods also increase the risk for VTE. Accordingly, the US Centers for Disease Control and Prevention (CDC) has updated recommendations in regard to when to initiate hormonal contraceptives postpartum.
For all women, use of combination contraceptives is considered unacceptable in the first 3 weeks postpartum. Between 3 and 6 weeks postpartum, combination methods are discouraged if any of the risk factors mentioned earlier are present.
When additional risk factors are not present, initiating combination contraceptives following 3 weeks postpartum is acceptable in women who are not breastfeeding and at 1 month postpartum in women who are breastfeeding. Six or more weeks postpartum, combination contraception can be initiated without any restriction on the basis of postpartum status.
Of note, recommendations for postpartum initiation of progestin-only contraceptives including minipills, injections, and implantable and intrauterine contraception remain unchanged. These methods are appropriate to initiate immediately postpartum, regardless of lactation status.
This new guidance from the CDC should clarify the do's and don'ts with regard to when to start hormonal contraceptives postpartum while minimizing the risk for VTE.
Thank you. I am Andrew Kaunitz.
- Centers for Disease Control and Prevention (CDC); Tepper NK, Curtis KM, Jamieson DJ, Marchbanks PA. Update to CDC's US Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. MMWR Morb Mortal Wkly Rep. 2011;60:878-883. Available at: http://www.medscape.com/viewarticle/746237 Accessed August 23, 2011.
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