Contraception for adolescents
Appropriate contraception after giving birth and during breast-feeding
Midlife contraception
Before their first sexual intercourse most young people think about contraceptive methods. Which method is really safe? How can I get contraceptives and how much do they cost? In our experience, these are frequently asked questions of teenage boys and girls. Many young people decide to use either the pill or condoms. The pill is easy to use and does not interfere with sex. The condom has no side effects and is the only contraceptive method to protect also against sexually transmitted diseases. If correctly used, they are very safe contraceptives. However, there are still a lot of questions and uncertainty relating especially to their correct use. For more detailed information concerning condoms and the contraceptive pill, visit our page for youths.
After the birth of a child, a couple may need some time to adjust to the new beautiful but also exhausting situation; however, sexual desire may return after some time. The time, until your interest in sex will come back, may be very different, and it is completely normal if it takes quite some time. With the returning sexual desire, the question arises as to how long after childbirth you should start using contraception.
If you are breast-feeding, you also need to consider which contraceptive methods can be used by nursing mothers. During breast-feeding, condoms are a good method; they can already be used during the postnatal period. After the postnatal period other barrier methods can be used, e.g. the diaphragm, the cervical cap or Lea’s shield. After childbirth the cervix changes in size and shape. Women who have already used these methods before the pregnancy, should have them refitted. It is possible to fit the diaphragm 3 months after childbirth; the Lea’s shield can be fitted after approximately 2 months. After childbirth, the IUD is a frequently chosen contraceptive. It can usually be inserted without problems 6 weeks after the delivery. There are two types of IUDs: the copper IUD and the progestogen-releasing IUD. The latter is particularly suitable for women who have very strong and/or very painful menstrual bleedings. Both variants offer a five-year contraceptive protection. Moreover, progestogen-only contraceptives can be used during breast-feeding. Progestogens can be found in the breastmilk, but studies did not show any harm to the baby’s health. The progestogen-only pill, an implant and a three-monthly injectable are available. They can be started 6 - 8 weeks after delivery.
If you are not breast-feeding, you can use all of the hormonal methods. Couples who have completed their family, may think about sterilization. In men, the spermatic duct can be blocked under local anaesthesia. To sterilize a woman the tubes are blocked during a surgical procedure of laparoscopy under general anaesthesia. In case of a planned Caesarean section, the sterilization can be carried out at the same time. In this situation, you will be informed in detail in the maternity hospital about the sterilization procedure. After vaginal delivery, a sterilization can be performed during the postnatal period through a small cut underneath the belly button. Should sterilization be an option for you, we offer the necessary information on where the procedure can be done. The health insurance companies cover for sterilization only in special cases .
Around the age of 40, fertility is declining; women can experience changes of their menstrual cycles, which can be the first signs of the menopause that usually comes 10 years later. These changes can give reason to think about how long a woman should use contraception and what kind of changes she will experience during the menopausal transition. During this time, some women also deal with the question whether they would like to have (more) children. The preferred contraceptive methods change during lifetime. While more young women are using the pill, many women change on to the IUD in later years, or get sterilized.
How long am I supposed to use contraception?
Which contraceptive methods can be recommended during midlife?
Which contraception can I use, if I am on hormone therapy because of menopausal symptoms?
A very important issue is how long a woman should use contraception. The chance of getting pregnant after having completed 45 years of age is very low; but since the fertility of individual women is extremely variable, it is very difficult to estimate the individual risk of pregnancy. The activity of the ovaries may vary widely; and even after the menstruation has been missing for some months, it can come regularly again, sometimes with an ovulation. Particularly because of this changing activity of the ovaries, hormone analysis is not reliable, since it refers only to the time the blood sample was taken.
No contraception is necessary if a woman hasn’t had her period for more than one year without using hormones. If three blood tests at intervals of some weeks show equally high values for FSH and low values for estradiol, and the monthly bleeding has been missing for some months, one can assume the end of the fertile time.
If women do not have natural cycles because of hormonal contraception or hormone therapy for the menopausal symptoms, they should use contraception, until the age of 50.
With use of hormonal contraception, the risk of cardiovascular diseases has to be considered, which increases with age and is also increased with use of hormonal contraceptives. If women are at low risk of cardiovascular diseases, and other contraceptive methods are not suitable, the use of low-dose combined hormonal contraceptives can be continued until menopause. The progestogen-only pill as well as the progestogen implant, which contain low-dose progestogens, have probably less influence on the risk of cardiovascular diseases, and should therefore be preferred. However, these agents may cause irregular bleeding.
Women who gave birth can use an IUD usually without problems. But the IUD can also be used by women who did not give birth. If a women has strong periods, the copper IUD is not suitable, since it usually enhances the bleeding. In this case the hormone-releasing IUD can be a good choice because it considerably reduces menstrual bleeding. The released dose of progestogen is small enough not to rise the risk of cardiovascular diseases.
Barrier methods such as condoms, the diaphragm or the cervical cap are more frequently used by older women. The sexual experience and the confidence with one’s body facilitate the use of these methods.
Natural family planning by taking the basal temperature before getting up and observing the cervical mucus can be used as long as there are fairly regular cycles with ovulations. If a women has frequent cycles without ovulation, or if the cycles are becoming very long, the infertile days can no longer be determined with the symptom-thermal method, or the potentially fertile periods are very long. Therefore this method is not very reliable in such a situation.
Sterilization may also be a good choice for midlife women. By that time, they don’t wish to have (more) children and after the procedure, the woman doesn’t have to worry about contraception. However, many women consider whether the high costs for the procedure pay off for the last years during which they still need contraception.
Only few women get such troublesome symptoms during their transition that they decide to use hormone therapy. Since hot flushes are no reliable sign for the end of fertility, women still have to consider using contraceptives.
Combined contraceptive pills also relieve hot flushes; however, their use is associated with a higher risk of cardiovascular diseases, compared to so-called natural hormones as used for the treatment of menopausal symptoms.
The hormone releasing IUD and the three-monthly injectable can be combined with the use of estrogens; additional progestins are not necessary for protection against endometrial cancer. It has not been studied yet whether the dose of progestogen in the progestogen-only pill and in the implant offers sufficient protection. Hormone therapy can be combined with the use of copper IUDs and barrier methods without problems. Natural family planning is not possible when using hormone therapy because the hormones change the mucus and the body temperature.
