Postpartum – Safe Birth Control Choices

The CDC today published recommendations on use of birth control methods for non-breast feeding women after child birth (full text is here).  The key recommendations are as follows:

Combined (estrogen+progestin contraceptives)

• During the first 3 weeks after delivery women should NOT use combined (estrogen + progestin) hormonal contraceptives, because of the high risk for blood clots (DVT and PE).
• During 3-6 weeks postpartum, women without risk factors for DVT and PE generally can initiate combined hormonal contraceptives, but women with risk factors for DVT and PE (e.g., previous clots or recent C-section) generally should not use these methods.
• After 6 weeks postpartum, there are no restrictions on the use of combined hormonal contraceptives because of postpartum state.

Progestin-only contraceptives

• Progestin-only contraceptives (minipill, Depot-Provera, Implanon rod, Mirena IUD) are safe and can be initiated immediately after delivery.

Other Methods

Of course, condoms and diaphragms can be used any time, as they do not increase the risk for blood clots.

Personal Comment

The recommendations above are good for women at low or standard risk for blood clots. However, the woman with particularly strong risk factors for blood clots (strong family history, presence of a strong clotting disorder, personal history of a blood clot) may want to avoid combined estrogen-progestin and progestin-only contraceptives at any time, not just in the postpartum period, to minimize her risk of blood clots. A Clot Connect discussion on progestin-only contraceptives can be found here.

Disclosures:   I have no financial disclosures relevant to this blog entry.

Last updated: July 8th, 2011

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