Postpartum (amenorrhoeic and wishing medical contraception)

Some doctors insist on the arrival of a period before a medical method of contraception is used - however this risks an iatrogenic conception.

A protocol for this situation might utilise the fact that pregnancy tests sensitive to 50 IU/l of human chorionic gonadotrophin (hCG e.g. Clearwiew) are available. A pregnancy can be diagnosed before the 14th day after ovulation.

Thus one protocol may be to:

• ask that the woman agrees to avoid risk of conception for the next 14 day period e.g. abstinence, use of barrier methods
• an early morning urine is then tested after that period (avoidance of conception is undertaken until the result)
• record in the notes the protocol agreed. There is still a very tiny risk that a very early conception may have occurred. The agreed form of contraception can then be started
• If hormones are to be used then there is a need for extra contraceptive protection for the next 7 days. A follow-up visit in 3-4 weeks MUST be planned so that pregnancy can be excluded

Reference:

• Guillbaud J, Contraception - your questions answered, 2012.