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Textbook/Obstetrics and gynaecology/Postpartum, post-abortion and perimenopausal contraception/Rapid
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Postpartum, post-abortion and perimenopausal contraception

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Fertility returns before expected bleeding

Ovulation can precede the first period after birth, abortion or pregnancy loss; unprotected intercourse from day 21 postpartum or from day 5 after pregnancy ends may require emergency contraception.

Action: Establish the pregnancy-end and intercourse dates immediately, offer a copper IUD or appropriate oral emergency contraception within its window, then quick-start or insert ongoing contraception with correct backup.

Synopsis

Provide contraception across rapid fertility transitions after birth, abortion or pregnancy loss and through perimenopause, using correct start windows, thrombosis assessment and stopping rules.

  • Discuss postpartum contraception antenatally and provide the chosen method before discharge where possible; fertility intention and consent must be revisited after birth rather than assumed.
  • The implant and POP can start immediately after childbirth. DMPA can also be provided postpartum when medically eligible, with bleeding, bone and fertility-return counselling.
  • Insert a copper or levonorgestrel IUD within 48 hours of birth, including at caesarean, or wait until at least four weeks postpartum if that immediate window is missed.

Key red flags

Heavy bleeding, fever, offensive discharge, severe pelvic pain or systemic illness after birth or abortion may indicate haemorrhage, retained tissue, endometritis or sepsis and needs urgent assessment before routine contraceptive care.

Investigation priorities

01
Pregnancy and intercourse chronologyFirst step

Determine immediate initiation, emergency contraception and repeat-testing requirements after pregnancy.

Management branches

Postpartum first lineProvide before fertility returns

Contraception is requested antenatally or after childbirth.

  1. Reconfirm reproductive intention and medical eligibility after birth, including breastfeeding, VTE factors, bleeding and whether the patient still wants the antenatal choice.
  2. Offer immediate POP, implant or eligible DMPA, or intrauterine placement within 48 hours; if that IUD window is missed, arrange insertion from four weeks.
Post-abortion first lineStart at completion

An abortion, miscarriage or ectopic pregnancy has been managed and contraception is wanted.

Key medicines

Desogestrel 75 microgram progestogen-only pill postpartumTake one tablet orally at the same time every day without a hormone-free interval; it may be started immediately after childbirth with start and missed-pill precautions given for the exact timing.
Levonorgestrel 52 mg intrauterine device for contraception and HRTInsert one 52 mg device at a valid postpartum or interval time; document separate replacement dates when it provides contraception and when it supplies endometrial protection with systemic oestrogen HRT.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom