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Postpartum Contraception — MRCGP AKT MCQ

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EasyWomen's HealthPostpartum ContraceptionMRCGP AKTUKMLAPARA

A 28-year-old woman requests the combined oral contraceptive pill 4 weeks after an uncomplicated vaginal delivery. She is breastfeeding, has a BMI of 23 kg/m² and has no additional risk factors for venous thromboembolism or other contraindications to combined hormonal contraception. What is the most appropriate advice?

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Correct answer: B — Start the combined pill from 6 weeks postpartum

The correct answer is B. A breastfeeding woman should wait until at least 6 weeks postpartum before starting combined hormonal contraception. At 4 weeks, the postpartum venous thromboembolism risk remains increased, and the oestrogen component may also affect milk production. An alternative method, such as a progestogen-only pill, implant or condoms, can be used meanwhile. Starting now is therefore inappropriate. Breastfeeding does not require delaying the combined pill until 6 months or until complete weaning, and it is not a permanent contraindication. At 6 weeks, suitability should still be reassessed against the usual contraindications to combined hormonal contraception.

Reference: NHS, Who can take the combined pill, section ‘Taking the combined pill after birth or when breastfeeding’, reviewed 15 February 2024. https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/who-can-take-it/