Family Planning – Questions & Answers

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Readers are invited to send in their questions about Family Planning, we will try to respond to these where possible and appropriate.

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Question:

Which oral contraceptive can I prescribe to a woman who is afraid to gain weight while on the pill?

Answer:

The bottom line: Long and well designed epidemiological studies have all shown that there is no weight gain during the use of any contraceptive pill, both combined and estrogen-free pills.

Of course young women under 20, who are still growing, will experience the normal growth for their age, but that has nothing to do with the pill.

The only exception may be for depot medroxy progesterone acetate, in which women did show an increase in body weight.

Question:

If a woman wants contraception immediately after giving birth, and if she wants to breastfeed her baby, what is then the best method?

Answer:

First it is very important that the mother, and her partner, make a well informed decision. Condoms are of course a good choice. However, if she wants a more reliable method, then an IUD can be inserted immediately after the delivery of the placenta. Due to the position of the uterus immediately post partum and due to the relative weakness of the uterine wall, the insertion must be done by someone who knows the risks and preferably has received special training. Although the WHO advises to wait for six weeks with hormonal contraception, it is now well known, that estrogen free hormonal methods can safely be used, directly post partum and even when breastfeeding. So most experts now agree that a contraceptive implant, an estrogen free pill (POP) or a progestin loaded IUD are also excellent choices.

Question:

I read recently that a morning-after pill does not work optimally in obese women. What is the advice?

Answer:

There are indeed data to show that a levo-norgestrel based emergency contraceptive is less effective in women over 80 kgs. More data are presently being collected and studied. As long as a definite answer is not available, my suggestion would be to insert an IUD as emergency contraceptive if a woman weighs more than 80 kgs.

Question:

How many pills can a woman forget in the middle of her pill cycle, since that is supposed to be the most risky period?

Answer:

First: A pill cycle (or a Nuvaring cycle, or a contraceptive patch cycle) is an artificial cycle. There is no oocyte maturation, and therefore no risk of pregnancy if a woman forgets pill number 10, 11 or 12 of the "cycle".
Secondly: Forgetting pills at the beginning or the end of the pill strip is much more risky, since that lengthens the pill free interval! In case a pill in the beginning of the strip is forgotten, the woman or the man should use additional contraception during at least seven days. In case a pill at the end of the strip is forgotten, the woman should start the next pill after a normal pill-free interval. So if she forgets pill 20 and 21 of a 21 days strip, she should start the new strip seven days after the last pill she took.