Contraceptives after Medical Abortion

This table gives an overview of contraceptive methods, which are described in more detail below. Please note that fertility returns 7 days after medical abortion and most forms of contraception can begin immediately after the procedure. 

DAILY PILLS

Birth Control Pill

How: Take one pill everyday and take any missed pills as soon as possible. Missing pills risks pregnancy and will make some side effects worse.

Side Effects:

Changes in bleeding patterns

Headaches, dizziness, nausea, breast tenderness, weight change, mood changes, acne (it can improve or worsen, but usually improves)

How to use it after a medical abortion: You can use daily pills immediately after medical abortion.

Common misunderstandings:

  • Daily pills (or any other contraceptive method) do not strain your body after medical abortion
  • Women lose some blood during abortion, but not too much to stop you from using the daily pills, given that bleeding is a possible side effect
  • Daily pills do not build up hormones in a woman’s body. Women do not need a “rest” from taking daily pills
  • Must be taken everyday whether or not you are having sex
  • Do not make women infertile after they stop taking it
  • Do not cause birth defects or multiple births
  • Do not change women’s sexual behaviour

 

3 MONTH INJECTION:

Injection

How: It is given by injection into the muscle. The hormone is then released slowly into the bloodstream.

Side effects:

  • Changes in monthly bleeding
  • First 3 months (irregular bleeding or prolonged bleeding)
  • At one year (no monthly bleeding or infrequent bleeding)
  • Weight gain, dizziness, headaches, abdominal bloating, mood changes, less sex drive

How to use it after a medical abortion: You can receive the injection immediately after medical abortion.

Correcting misunderstandings:

  • The injection (or any other contraceptive method) does not strain your body after abortion
  • Can stop monthly bleeding (but this is not harmful, and could prevent anaemia)
  • Blood is not building up inside the woman
  • Does not disrupt an existing pregnancy
  • Does not make women infertile

ARM IMPLANTS:

Implant

Types of implants:

Jadelle: 2 rods containing levonorgestrel, highly effective for 5 years.

Implanon NXT: 1 rod containing etonogestrel, labeled for upto 3 years of use.

Levoplant: 2 rods containing levonorgestrel, highly effective for 4 years.

How: A specifically trained provider performs a minor surgical procedure to place one or 2 rods under the skin. You do not need to take any further action after the placement of the rods.

Side Effects:

  • Changes in bleeding patterns (lighter bleeding, prolonged bleeding, irregular bleeding, infrequent bleeding, no monthly bleeding). If this is bothersome, contact your pharmacist or CHV.
  • Headaches, Abdominal pain, Acne (which can improve or worsen), Weight change, Breast tenderness, Dizziness, Mood changes, Nausea

How to use it after an abortion: You can use an arm implant immediately after a medical abortion.

Correcting misunderstandings:

  • Implants do not work once they are removed
  • Their hormones do not remain in a woman’s body
  • They do not cause any harm if they stop monthly bleeding
  • Blood does not build up inside the woman
  • They do not make women infertile

COPPER-BEARING IUD:

IUD

How: A specifically trained health care provider inserts the IUD into the uterus through the vagina and cervix. You do not require to do anything after the insertion. It offers long-term pregnancy protection. It can be effective for up to 12 years and is immediately reversible.

Side Effects:

  • Changes in bleeding patterns, especially in the first 3-6 months (prolonged and heavy monthly bleeding, irregular bleeding, more cramps and pain during monthly bleeding). If this is bothersome, contact your pharmacist or CHV.

How to use it after an abortion: Go to a trained provider immediately after the bleeding stops (or within seven days after a medical abortion). The provider will examine you and rule out any possibility of infection on the genital tact, before inserting the IUD.

Common misunderstandings:

  • Some women lose blood during abortion, but not too much to prevent them from starting to use the IUD immediately after the abortion
  • Can be used by women of any age including adolescents
  • Does not increase the risk of miscarriage after the IUD is removed
  • Does not make women infertile
  • Does not cause birth defects
  • Does not cause cancer
  • Does not move to the heart or brain
  • Does not cause discomfort for the man or woman during sex

CONDOMS:

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How:

  • Use a new condom each time you have sex (use a new one for every new round)
  • Before any physical contact, place the condom on the tip of the erect penis with the rolled side out
  • Unroll the condom all the way to the base of the erect penis
  • Immediately after ejaculation, hold the rim of the condom in place and withdraw the penis while it is still erect
  • Dispose safely

Side Effects:

  • They have no side effects
  • They may dull the sensation of sex

How to use it after medical abortion: Your fertility returns within seven days after the abortion. You can start using condoms immediately after an abortion. The condom does not have any harmful effect after the abortion.

Common misunderstandings:

  • Condoms are safe for use immediately after abortion
  • Male condoms do not make men sterile, impotent or weak
  • Do not increase men’s sex drive
  • They cannot get lost in the woman’s body
  • They do not have holes that HIV can pass through
  • They do not cause illness in a woman
  • They are not only for use outside marriage – they are also used by married couples
  • They do not cause cancer or contain cancer-causing chemicals

EMERGENCY PILLS (‘morning after’ pills or ‘ECPs’)

E Pill

How: They should be used as soon as possible after unprotected sex. The sooner the pills are taken after unprotected sex, the better they prevent pregnancy. They can help to prevent pregnancy when taken up to 5 days after unprotected sex.

Side effects:

  • Changes in bleeding patterns, including: slight irregular bleeding for 1 – 2 days after taking ECPs, monthly bleeding that starts earlier or later than expected
  • In the first several days after taking ECPs: nausea, abdominal pain, fatigue, headaches, breast tenderness, dizziness, vomiting

How to use it after an abortion: You can start to use emergency contraceptive pills immediately after a medical abortion.

Common misunderstandings:

  • Can be used by women of any age, including adolescents
  • Do not cause abortion
  • Do not prevent or affect implantation
  • Do not cause birth defects if pregnancy occurs
  • Are not dangerous to a woman’s health
  • Does not increase risky sexual behaviour
  • Does not make women infertile
  • Can be used more than once in a woman’s cycle

Source: Family Planning Handbook – 2018 Edition

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