Reviewed by a GPhC-registered Pharmacist at Newdays Pharmacy
Quick Answer: Fertility can return as early as 21 days after giving birth, even before your first period and even if you are breastfeeding. All women should discuss contraception before or soon after the birth. Progestogen only methods (mini pill, implant, injection, Mirena IUS) are safe to use from birth or within days of delivery. The combined pill is generally not recommended before six weeks postpartum and has additional restrictions for breastfeeding mothers.
When Can I Get Pregnant Again After Birth?
Ovulation can resume as early as three weeks (21 days) after delivery, before your first postpartum period. This means you can become pregnant again even before you have had a period and before you might realise your fertility has returned. The effectiveness of breastfeeding as contraception (known as the Lactational Amenorrhoea Method, or LAM) is unreliable unless specific criteria are met (fully breastfeeding, no periods, baby under six months), and even then it provides approximately 98% effectiveness rather than the near 100% of reliable contraceptive methods.
Progestogen Only Contraception After Birth
Progestogen Only Pill (Mini Pill)
The progestogen only pill is safe to start from day 21 after delivery (the day after which you are considered at risk of ovulation). It is safe to use while breastfeeding.
- Desogestrel based POP (for example Cerazette): twelve hour missed pill window; inhibits ovulation in most users
- Suitable from 21 days postpartum
- Safe for breastfeeding mothers
Contraceptive Implant (Nexplanon)
The implant can be inserted immediately after delivery (within 48 hours, before hospital discharge) or from day 21 postpartum. It is highly effective and safe for breastfeeding mothers. It lasts up to three years.
Contraceptive Injection (Depo-Provera / Sayana Press)
The injection can be given immediately after birth or at any time postpartum. It is safe for breastfeeding. Note that fertility may take twelve to eighteen months to return after stopping: this is an important consideration for women who may want to conceive again in the near future.
Hormonal IUS (Mirena, Kyleena)
The hormonal IUS can be inserted within 48 hours of birth, or after four weeks postpartum (the interval period). It is safe for breastfeeding and has the added benefit of reducing period heaviness and pain.
Combined Contraceptive Methods After Birth
Combined Oral Contraceptive Pill (COCP)
The combined pill is generally not recommended before six weeks postpartum due to the risk of blood clots (venous thromboembolism), which is already elevated in the postpartum period.
- Not recommended before six weeks postpartum in any circumstances
- Not recommended before six weeks postpartum if breastfeeding, even after that point, unless all other options are unsuitable (due to effects on milk supply)
- Can generally be started from six weeks if not breastfeeding and no other VTE risk factors
Always discuss with a clinician or pharmacist before starting the combined pill after birth.
Copper IUD
The copper IUD can also be inserted within 48 hours of birth or after four weeks postpartum. It is the most effective non hormonal reversible contraception and is safe for breastfeeding.
Barrier Methods
Condoms (male and female) can be used from the first occasion of sexual intercourse after birth and are the only contraceptive methods that also protect against sexually transmitted infections. They should be considered alongside hormonal methods if there is any risk of STI.
Emergency Contraception After Birth
If you have had unprotected sex from day 21 postpartum, you may need emergency contraception. Both levonorgestrel and ulipristal acetate (ellaOne) emergency contraceptive pills are options. Levonorgestrel is safe to take while breastfeeding. Ulipristal acetate: women should avoid breastfeeding for one week after taking ellaOne. The copper IUD inserted within five days is the most effective emergency option and is also safe for breastfeeding.
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Frequently Asked Questions
The Lactational Amenorrhoea Method (LAM) can be approximately 98% effective if ALL three criteria are met: you are fully breastfeeding (no formula supplements, feeding every four hours in the day and every six hours at night), your baby is under six months old, and your periods have not returned. If any of these conditions change, you need another form of contraception.
Yes. The IUD or IUS can be inserted within 48 hours of a caesarean section or at four weeks or more after a caesarean. Discuss with your maternity team or GP.
Current UK guidance (FSRH) recommends that contraception is discussed before discharge from hospital or at the ten day postnatal visit at the latest, given that ovulation can return from 21 days. You do not need to wait until your six week postnatal check. Speak to your midwife, GP, or pharmacist.