I was recently asked by a breastfeeding mama if checking basal body temperatures while breastfeeding would help her know when to avoid sex and another (too soon!) pregnancy.  Unfortunately for women who have no periods while breastfeeding, aka lactational amenorrhea, the body mimics a sort of menopausal state.  Hormonally, the fluctuations that would trigger ovulation and a menstrual period are not happening.  So while not having a period during this phase of motherhood is wonderful, not knowing when or if you ovulated makes natural family planning by checking basal body temperatures every morning unreliable for preventing another pregnancy.  But the tricky thing is that sometimes we can ovulate without all of the usual signs or symptoms, which can lead to an unplanned pregnancy.  I imagine we all know someone who has kids that are 10-14 months apart in age.  Listen, that pregnancy may not have been planned.

So, if you just want to bond with your current baby and not be thinking about pregnancy again right now, here are some options to consider.  If you want to avoid everything hormonal and an office procedure, the most reliable contraception method is the male condom.  Condoms are old school, but pretty effective at preventing pregnancy when you use them regularly, with approximately 87% effectiveness at pregnancy prevention.  My guess is your partner will be grateful for the sex, even if condoms are not his favorite.

Other methods for preventing pregnancy that are compatible with breastfeeding include progesterone only birth control options.  These include a progesterone only (not estrogen + progesterone) “mini pill,” the depo-medroxyprogesterone injection (Depo-Provera), the implant such as Nexplanon, and intrauterine devices (IUD’s) such as Mirena or Kyleena.  Once breastfeeding is well established, the progesterone only hormonal birth control options are safe and effective at preventing pregnancy without decreasing your milk supply. 

If you are pretty good at taking a pill at a routine time daily, the pill might be a great option for you to consider, as it prevents ovulation, is easy to start and stop and has few side effects.  It is not the most effective birth control option when you stop breastfeeding, though.  So you might want to switch to another option as you begin to wean the baby off of breastmilk.

If you favor going to the office for an injection every 3 months, the Depo-Provera may be a great option for you.  The down side with this, in my opinion, is that it can be associated with irregular bleeding and, for some women, weight gain. 

Maybe you and your partner don’t want another baby for a couple of years.  The Nexplanon implant and the progesterone releasing IUDs such as Mirena could be great options to consider.  The Nexplanon implant is the most effective method of birth control on the market these days.  So when you stop breastfeeding, the implant is still doing a great job at preventing pregnancy for a total of three years.  Unfortunately, Nexplanon is also associated with the irregular menstrual bleeding.

My personal favorite (and statistically the favorite method among female OB/GYN’s in the US) is the Mirena IUD.  This device is inserted into the womb in the office setting and is very effective at preventing pregnancy for eight years.  An added bonus?  It minimizes your periods, decreasing menstrual blood flow by 80% within the first three months!  It has also been validated to help treat pelvic pain.  There are lots of wins for this device in my book.  As always, though are a couple of down sides.  The insertion procedure in the office can be really crampy for some women.  (For me after my second baby, it was not painful at all.)  There can also be light but irregular bleeding for the first few months that the device is in place.  While the weird-o bleeding usually resolves once the device has been in place for 4-6 months, you may be wearing period panties most days in the early phase of having the device.

Another reliable contraception method that is hormone free is the Paragard copper IUD.  Now, this device is effective at preventing pregnancy but by the nature of the way that it works, it can make your periods heavier and more painful.  Additionally, it can be associated with pain or cramping discomfort with the office insertion procedure.  But this is a hormone-free birth control method that is effective for 10 years and, like the implant and other IUD’s does not require any maintenance.

So, ladies, keep up the great work at breastfeeding, and know that you have some pregnancy prevention options that won’t thwart your efforts.

Be Empowered!  Be Encouraged!