Russian Journal of Woman and Child Health
ISSN 2618-8430 (Print), 2686-7184 (Online)

Postpartum contraception: optimal choice

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DOI: 10.32364/2618-8430-2020-3-1-31-38

I.V. Bakhareva

Pirogov Russian National Research Medical University, Moscow, Russian Federation

Family planning and contraception after childbirth are important medical and social issues. Reproductive health and full preconception planning (which ensure uncomplicated course of the pregnancy), the birth of healthy children, and prevention of unintended pregnancy will be provided by addressing these issues. The major goals of postpartum family planning are optimal time between the end of the first pregnancy and the conception of the next (at least 2–3 years) as well as the reduction of maternal risks, perinatal and infant morbidity and mortality, and the rate of medical abortions. All these aspects require the choice of optimal postpartum contraception for the couple. This paper discusses current views on the methods of postpartum contraception, both traditional (i.e., lactational amenorrhea, barrier contraceptives, calendar method) and contemporary (hormonal methods). Despite being relatively conservative about postpartum contraception in view of the potential effects  of hormonal agents on the child during breastfeeding, modern highly effective methods of long-acting reversible contraception immediately after childbirth (mainly intrauterine devices and implants) are being actively sought worldwide. The choice of optimal method of contraception during breastfeeding, antenatal and postpartum consultation will help decide on the potential risk of unintended pregnancy, contraception method, and the risk of breastfeeding problems.

Keywords: contraception, hormonal contraceptives, postpartum period, breastfeeding.

For citation: Bakhareva I.V. Postpartum contraception: optimal choice. Russian Journal of Woman and Child Health. 2020;3(1):–38. DOI: 10.32364/2618-8430-2020-3-1-31-38.

About the author:

Irina V. Bakhareva — MD, PhD, Professor of the Department of Obstetrics and Gynecology, ODCID iD 0000-0002-3078-0744.

Pirogov Russian National Research Medical University.
1, Ostrovityanov str., Moscow, 117997, Russian Federation.

Contact information: Irina V. Bakhareva, e-mail: Financial Disclosure: author has no a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 10.12.2019.

1. Прилепская В.Н. Руководство по контрацепции. М.: МЕДпресс-информ; 2006. [Prilepskaya V.N. Guide to contraception. M.: MEDpress-inform; 2006 (in Russ.)].
2. Cleland J., Bernstein S., Ezeh A. et al. Family planning: The unfinished agenda. The Lancet, 2006;368(9549):1810–1827. DOI: 10.1016/S0140-6736(06)69480-4.
3. Da Vanzo J., Hale L., Razzaque A., Rahman M. Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab. Bangladesh. BJOG. 2007;114(9):1079–1087. DOI: 10.1111/j.1471-0528.2007.01338.x.
4. Rutstein S.O. Further evidence of the effects of preceding birth intervals on neonatal, infant and under-five-years mortality and nutritional status in developing countries: evidence from the Demographic and Health Surveys. DHS Working Papers, Demographic and Health Research 2008; 41. (Electronic resource). URL: (access date: 25.09.2019).
5. Ross J.A., Winfrey W.L. Contraceptive use, intention to use and unmet needs during the extended postpartum period. International Family Planning Perspectives. 2001;27:20–27. DOI: 10.2307/2673801.
6. Прилепская В.Н., Межевитинова Е.А., Назарова Н.М., Бостанджян Л.Л. Гормональная контрацепция. М.: ГЭОТАР-Медиа; 2011. [Prilepskaya V.N., Megevitinova E.A., Nazarova N.M., Bostanjyan L.L. Hormonal contraception. M.: GEOTAR-Media; 2011 (in Russ.)].
7. Чернуха Е.А. Нормальный и патологический послеродовой период: руководство. М.: ГЭОТАР-Медиа; 2006. [Chernukha E.A. Normal and pathological postpartum period: a guide. M.: Geotar-Media; 2006 (in Russ.)].
8. WHO Library Cataloguing-in-Publication Data Programming strategies for postpartum family planning; ISBN 978 92 4 150649 6 (NLM classification: WA 550). World Health Organization. 2013. (Electronic resource). URL:;jsessionid=1492C8F2A1F76AA97EAFDA3FBF5C7530?sequence=1 (access date: 17.09.2019).
9. Labbok M., Hight-Laukaran V., Peterson A. et al. Multicenter study of the lactational amenorrhea method (LAM) I. Efficacy, duration, and implications for clinical application. Contraception. 1997;55:327–336. DOI: 10.1016/S0010-7824(97)00040-1.
10. Bouchard T., Fehring R.J., Schneider M. Efficacy of a new postpartum transition protocol for avoiding pregnancy. J Am Board Fam Med. 2013;26:35–44. DOI: 10.3122/jabfm.2013.01.120126.
11. Kennedy K.I. Efficacy and effectiveness of LAM. Adv Exp Med Biol. 2002;503:207–216. DOI: 10.1007/978-1-4615-0559-4_24.
12. Van der Wijden C., Kleijnen J., van den Berk T. Lactational amenorrhea for family planning. Cochrane Database Syst Rev. 2003;(4):CD001329. DOI: 10.1002/14651858.CD001329.
13. Доброхотова Ю.Э. Боровкова Е.И. Персонализиваронный подход к выбору контрацептива: взвешиваем все за и против. Гинекология. 2017;19:40–44. DOI: 10.26442/2079-5696_19.3.40-44. [Dobrokhotova Yu.E. Borovkova E.I. A personalized approach to choosing a contraceptive: weigh the pros and cons. Ginekologiya. 2017;19:40–44 (in Russ.)]. DOI: 10.26442/2079-5696_19.3.40-44.
14. Tankeyoon M., Dusitsin N., Chalapati S. et al. Effects of hormonal contraceptives on milk volumes and infant growth. WHO Special Programme of Research, Development and Research Training in Human Reproduction Task force on oral contraceptives. Contraception. 1984;30:505–522. DOI: 10.1016/0010-7824(84)90001-5.
15. Bahamondes L., Bahamondes M.V., Modesto W. et al. Effect of hormonal contraceptives during breastfeeding on infant’s milk ingestion and growth. Fertil. Steril. 2013;100:445–450. DOI: 10.1016/j.fertnstert.2013.03.039.
16. Truitt S.T., Fraser A.B., Grimes D.A. et al. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev. 2003;(2):CD003988. DOI: 10.1002/14651858.CD003988.
17. Kennedy K.I., Short R.V., Tully M.R. Premature introduction of progestin-only contraceptive methods during lactation. Contraception. 1997;55:347–350. DOI: 10.1016/S0010-7824(97)00042-5.
18. Kapp N., Curtis K., Nanda K. Progestogen-only contraceptive use among breastfeeding women: A systematic review. Contraception. 2010;82:17–37. DOI: 10.1016/j.contraception.2010.02.001.
19. Brownell E.A., Fernandez I.D., Howard C.R. et al. A systematic review of early postpartum medroxyprogesterone receipt and early breastfeeding cessation: Evaluating the methodological rigor of the evidence. Breastfeed Med. 2012;7:10–18. Erratum in Breastfeed Med 2012;7:129. DOI: 10.1089/bfm.2011.0105.
20. Dozier A.M., Nelson A., Brownell E.A. et al. Patterns of postpartum depot medroxyprogesterone administration among low-income mothers. J Womens Health (Larchmt). 2014;23:224–230. DOI: 10.1089/jwh.2012.4016.
21. Singhal S., Sarda N., Gupta S. et al. Impact of injectable progestogen contraception in early puerperium on lactation and infant health. J Clin Diagn Res. 2014;8:69–72. DOI: 10.7860/JCDR/2014/7775.4110.
22. Mwalwanda C.S., Black K.I. Immediate postpartum initiation of intrauterine contraception and implants: a review of the safety and guidelines for use. Aust N Z J Obstet Gynaecol. 2013;53(4):331–337. DOI: 10.1111/ajo.12095.
23. Brito M.B., Ferriani R.A., Quintana S.M. et al. Safety of the etonogestrel-releasing implant during the immediate postpartum period: A pilot study. Contraception. 2009;80:519–526. DOI: 10.1016/j.contraception.2009.05.124.
24. Gurtcheff S.E., Turok D.K., Stoddard G. et al. Lactogenesis after early postpartum use of the contraceptive implant: A randomized controlled trial. Obstet Gynecol. 2011;117:1114–1121. DOI: 10.1097/AOG.0b013e3182165ee8.
25. Макацария А.Д., Саидова Р.А., Бисадзе В.О. и др. Гормональная контрацепция и тромбофилические состояния. М.: Триада-Х; 2004. [Makatsaria A.D., Saidova R.A., Bisadze V.O. Hormonal contraception and thrombophilic conditions. M.: Triad-X; 2004 (in Russ.)].
26. Oladapo O.T., Fawole B. Treatments for suppression of lactation. Cochrane Database Syst Rev. 2012;9:CD005937. DOI: 10.1002/14651858.CD005937.pub3.
27. Kapp N., Curtis K.M. Combined oral contraceptive use among breastfeeding women: A systematic review. Contraception. 2010;82:10–16. DOI: 10.1016/j.contraception.2010.02.001.
28. Gallo M.F., Grimes D.A., Lopez L.M. et al. Combination injectable contraceptives for contraception. Cochrane Database Syst Rev. 2008;(4):CD004568. DOI: 10.1002/14651858.CD004568.pub3.
29. Espey E., Ogburn T., Leeman L. et al. Effect of progestin compared with combined oral contraceptive pills on lactation: A randomized controlled trial. Obstet Gynecol. 2012;119:5–13. DOI: 10.1097/AOG.0b013e31823dc015.
30. Cheng L., Che Y., Gulmezoglu A.M. Intervensions for emergency contraception. Cochrane Database Syst Rev. 2012:8:CD001324. DOI: 10.1002/14651858.CD001324.pub4.
31. Gainer E., Massai R., Lillo S. et al. Levonorgestrel phar macokinetics in plasma and milk of lactating women who take 1.5 mg for emergency contraception. Hum Reprod. 2001;22:1578–1584. DOI: 10.1093/humrep/dem034.
32. Polakow-Farkash S., Gilad O., Merlob P. et al. Levonorgestrel used for emergency contraception during lactation — а рrospective observational cohort study on maternal and infant safety. J Matern Fetal Neonatal Med. 2013;26:219–221. DOI: 10.3109/14767058.2012.722730.
33. Saay I., Fiala C., Hamalainen J.M. et al. Medical abortion in lactating women — low levels of mifepristone in breast milk. Acta Obstet Gynecol Scand. 2010;89:618–622. DOI: 10.3109/00016341003721037.
34. Jones J., Mosher W.D., Daniels K. Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995. Natl Health Stat Rep. 2012;(60):1–25.
35. The ESHRE Capri Workshop Group. Intrauterine devices and intrauterine systems. Hum Reprod Update. 2008;14:197–208. DOI: 10.1093/humupd/dmn003.
36. Shaamash A.H., Sayed G.H.., Hussien M.M et al. A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development. Contraception. 2005;72:346–351. DOI: 10.1016/j.contraception.2005.04.004.
37. Chen B.A., Reeves M.F., Creinin M.D. et al. Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration. Contraception. 2011;84:499–504. DOI: 10.1016/j.contraception.2011.01.022.
38. Taub R.L., Jensen J.T. Advances in contraception: new options for postpartum women. Expert Opin Pharmacother. 2017;18(7):677–688. DOI: 10.1080/14656566.2017.1316370.
39. Brunson M.R., Klein D.A., Olsen C.H. et al. Postpartum contraception: initiation and effectiveness in a large universal healthcare system. Am J Obstet Gynecol. 2017;217(1):55.e1–55.e9. DOI: 10.1016/j.ajog.2017.02.036.
40. Harney C., Dude A., Haider S. Factors associated with short interpregnancy interval in women who plan postpartum LARC: a retrospective study. Contraception. 2017;95(3):245–250. DOI: 10.1016/j.contraception.2016.08.012.
41. Holden E.C., Lai E., Morelli S.S. et al. Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey. Contracept Reprod Med. 2018(8);3:23. DOI: 10.1186/s40834-018-0078-5.
42. Sonalkar S., Kapp N. Intrauterine device insertion in the postpartum period: A systematic review. Eur J Contracept Reprod Health Care. 2015;20(1):4–18. DOI: 10.3109/13625187.2014.971454.
43. Goldstuck N.D., Steyn P.S. Intrauterine contraception after cesarean section and during lactation: A systematic review. Int J Womens Health. 2013;5:811–818. DOI: 10.2147/IJWH.S53845.
44. Ti A., Curtis K.M. Postpartum hormonal contraception use and incidence of postpartum depression: a systematic review. Eur J Contracept Reprod Health Care. 2019;24(2):109–116. DOI: 10.1080/13625187.2019.1569610.
45. Heinemann K., Westhoff C.L., Grimes D.A. et al. Intrauterine devices and the risk of uterine perforations: Final results from the EURAS-IUD Study. Obstet Gynecol. 2014;123(Suppl 1):3S. DOI: 10.1097/AOG.0000000000000209.
46. Федеральный закон от 21 ноября 2011 г. № 323-ФЗ «Об основах охраны здоровья граждан в Российской Федерации», статья 57. (Электронный ресурс). URL: (дата обращения: 20.10.2019). [Federal Law of November 21, 2011 Nо 323-ФЗ “On the Basics of Protecting the Health of Citizens in the Russian Federation”, Article 57. (Electronic resource). URL: (access date: 20.10.2019) (in Russ.)].
47. Committee on Health Care for Underserved Women. Committee opinion no. 530: Access to postpartum sterilization. Obstet Gynecol. 2012;120:212–215. DOI: 10.1097/AOG.0b013e318262e354.
48. Male and female sterilisation. Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Guidance (September 2014). (Electronic resource). URL: (access date: 10. 09.2019).
49. Bouchard T., Fehring R.J., Schneider M. Efficacy of a new postpartum transition protocol for avoiding pregnancy. J Am Board Fam Med. 2013;26:35–44. DOI: 10.3122/jabfm.2013.01.120126.

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