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Menstruation, Sex, and Contraceptives After Pregnancy

Post Pregnancy Periods, Relations, and Protection

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Updated April 11, 2014

Q: When should women expect normal menstruation to resume?

A: This depends on whether you are breastfeeding or not. If you are not breastfeeding, your first period will occur about two months after childbirth. However, there is no way to know when you begin to ovulate again - 90 percent of women will not ovulate before their first period. So contraception is essential if you have sex soon after childbirth.

If you are breastfeeding, your period may resume at any time from about two months after childbirth. Some women only get their period back once they stop breastfeeding.

It is important to know that breastfeeding is not a form of contraception. It is the sensation of the baby sucking that send a message to the brain to suppress the hormone that stimulates ovulation. The effectiveness of this suppression depends on the strength and frequency of the sucking. For breastfeeding to work as a means of contraception, the baby would have to nurse full-time, around the clock.

Q: How long after childbirth should women wait before having sexual intercourse and/or using contraceptives? What type of contraceptive is best for a woman who has recently given birth? What type(s) of contraceptives should not be used by women who have recently given birth.

A: Most health practitioners discourage women from having sex within the first six weeks after childbirth since the genital organs usually have not healed. Most new mothers claim that sex is the furthest thing from their minds at this stage. Many women who breastfeed find that the physical contact with their baby fulfils them entirely.

Most health practitioners recommend barrier contraceptives (condoms and spermicide) for breastfeeding women. In the first few months after childbirth, the vaginal walls are enlarged and the perineal muscles are lax, which means that a diaphragm cannot act as a proper barrier. Be sure to have a new diaphragm fitted two to three months after childbirth. If you choose to have an IUD inserted, you will have to wait until the uterus is fully healed.

The only form of contraceptive pill which does not contraindicate breastfeeding is the progesterone mini-pill which works by hindering the production of cervical mucus. Ovulation can occur but the uterine lining will not be receptive to implantation of the egg. This pill has a failure rate of 1-3 percent as well as an increased risk of ectopic pregnancy and breakthrough bleeding. It must be taken every day at exactly the same time.

Some women may choose to use injectable contraceptives such as Depo-Provera which last from one to three months.

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