Q: How are you doctor. Can l ask? Which contraceptive can l take so that l can see my menstruation while breastfeeding. Here in South Africa after birth they inject depo and l heard many people saying it’s not right. Which one should l opt for?

A: Well, a breastfeeding mother should definitely not be taking any medication without speaking to her doctor. That’s for sure! 😀 This is because drugs that you take will also end up in breast milk. Most times, the concentration of these medicines in breast milk is so small that it hardly causes any problems in the baby but in some instances, they could get very concentrated in breast milk, putting the baby at risk. So, all medication choices, be they contraceptives or otherwise, must pass through your doctor.

A very common question I get asked is if breastfeeding mums can get pregnant. The answer is yes. If you’re exclusively breastfeeding, feeding your baby on demand (every 4 hours), you’re within 6 months of your baby’s birth and your menstrual period has not returned after the birth of your baby, you stand a better chance of not getting pregnant during this period. However, this is not a reliable method.

Birth control pills can help prevent pregnancy at this time. Pills that contain estrogen may lead to reduction in breast milk supply (PS: recent research suggests otherwise and yes, combination pills contain estrogen). Therefore, it’s a good idea to avoid such pills at this time or better still be guided by your doctor. Pills that contain only progestin (like the minipill) is a better idea as it does not affect breast milk supply. Depo is a type of minipill but it’s all about the timing of the medications. It’s usually taken at the same time daily. It’s best to start this discussion about your suitability for this contraceptive before you have your baby or immediately after so that your doctor can advise as to when you should start taking the pills. Don’t go starting on the pills without your doctor’s say-so because started too early, it could have adverse effects. Barrier contraceptives like condoms, diaphragms etc can also serve the purpose of preventing pregnancy before you start on the minipill.

There are, of course, other methods of birth control available eg Intra Uterine Device (IUD), implants, patches etc also exist and you may want to discuss these other options with your doctor as you conclude breastfeeding.

Return of menses following delivery is varied between individuals. Some women would see theirs a few weeks after, some others after a few months or even a year, while in others there is no return of menses before another pregnancy begins.

Different women also report different changes with their menstrual periods after childbirth. Some report longer periods. Others report shorter periods; some others report less pain and others observe absolutely no change at all 😀

However, the pattern of your menstrual cycle prior to your previous pregnancy (if it was regular or irregular) also plays a role. The duration of your labor and the presence of complications like bleeding after delivery could all play a part in the return of your period.

Exclusive breastfeeding and presence of underlying infection could also delay the return of menses. Breastfeeding women are less likely to have frequent or prolonged bleeding on the minipill but taking the pills might delay the return of your period even longer.

Have a great week ahead 😀