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Recommendations for Contraceptive Use |
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Combined Oral Contraceptives (COCs) |
Q.3. May COCs be started immediately
post-abortion?
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| a) Yes, COCs are appropriate for
use immediately post-abortion (spontaneous or induced), in either the first or second
trimester, and should be initiated within the first seven days post-abortion (or anytime
you can be reasonably sure the woman is not pregnant). |
a) Ovulation returns almost
immediately post-abortion (spontaneous or induced): within 2 weeks for first trimester
abortion and within 4 weeks for second trimester abortion. Within 6 weeks of abortion, 75%
of women have ovulated.
- Lähteenmaki P, Ylöstalo P, Sipinen
S, Toivonen J, Ruusuvaara L,Pikkola P, Nilsson CG, Luukkainen T. Return of ovulation after
abortion and after discontinuation of oral contraceptives. Fertility and Sterility 1980;34(3):
246-249.
Immediate use of COCs post-abortion (spontaneous or
induced) does not affect return to fertility following discontinuation of COCs.
- Lähteenmaki P. Oral contraception and
immediate postabortion pituitary-ovarian function. Acta Obstetricia et Gynecologica
1978;76(Suppl):9-43.
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| b) If a client has a history or
current indication of excessive clotting (coagulopathy), COCs should not be
recommended. |
b) COCs may be safely started
within the first week post-abortion (spontaneous or induced). Hypercoagulability of
pregnancy probably does not become clinically significant until the third trimester.
However, some experts recommend starting COCs exactly one week post-abortion, as there is
a suggestion of a slight increase in coagulation factors measurable in the first few days
after first trimester abortion in women initiating COCs immediately post-abortion. If
started later than one week, COCs may not be immediately effective because the ovary
resumes follicular development as soon as one week after first trimester (spontaneous or
induced) abortion.
- Lähteenmaki P. Postabortal
contraception. Annals of Medicine 1993;25: 185-189.
- Lähteenmaki P, Toivoneh J, Rasi V,
Luukkainen T, Myllyä G. Coagulation factors in women using oral contraceptives or
intrauterine contraceptive devices immediately after abortion. American Journal of
Obstetrics and Gynecology 1981;141:175-179.
Incomplete abortion may also result in a condition of
excessive blood clotting (disseminated intravascular coagulation), in which estrogens
should be avoided. |
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