From the Guidelines
Combination birth control can be initiated 21-42 days postpartum in non-breastfeeding women, depending on the presence of other risk factors for venous thromboembolism (VTE), as indicated in the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1. The timing of initiation is crucial due to the naturally elevated risk of blood clots in the postpartum period, which peaks immediately after delivery and gradually decreases over the first 6 weeks.
- For non-breastfeeding women without other risk factors for VTE, combination birth control can be started between 21-42 days postpartum, with a classification of 2 or 3, indicating that the method's advantages generally outweigh its risks or its theoretical or proven risks usually outweigh its advantages, respectively 1.
- For breastfeeding women or those with additional VTE risk factors, the recommendations may vary, with some sources suggesting waiting until at least 6 weeks postpartum when milk production is well established, as estrogen-containing contraceptives may reduce milk supply 1. Some key points to consider when initiating combination birth control postpartum include:
- The risk of VTE, which is higher in the postpartum period, especially in women with other risk factors such as cesarean delivery, obesity, smoking, or history of thrombosis 1.
- The potential effects of estrogen-containing contraceptives on breastfeeding performance, which may lead to a reduction in milk supply 1.
- The importance of delaying initiation of combination birth control until the woman's coagulation system has normalized, which may take up to 6 weeks postpartum 1. Common combination options include pills containing ethinyl estradiol with progestins like norethindrone, levonorgestrel, or drospirenone, as well as the vaginal ring or transdermal patch. When starting combination contraceptives postpartum, no backup method is needed if initiated within the recommended timeframe. It is essential to consider the individual woman's risk factors and medical eligibility when determining the best time to initiate combination birth control postpartum, as indicated in the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1.
From the FDA Drug Label
The use of Kariva for contraception may be initiated 4 weeks postpartum in women who elect not to breastfeed.
Combination birth control, such as Kariva, can be initiated 4 weeks postpartum in women who choose not to breastfeed, according to the FDA drug label 2. It is essential to consider the increased risk of thromboembolic disease associated with the postpartum period when administering combination birth control during this time.
From the Research
Initiating Combination Birth Control Postpartum
- The decision to initiate combination birth control postpartum should be based on individual risk factors for venous thromboembolism (VTE) 3, 4.
- Women with a history of VTE or thrombophilia should be offered progestin-only contraceptives or other safe alternatives, such as intrauterine devices or etonogestrel implants 3.
- Combination hormonal contraceptives can be associated with a higher risk of VTE, especially in women with certain risk factors, such as preeclampsia or postpartum hemorrhage 5.
- The risk of VTE is higher during the postpartum period, and thromboprophylaxis with low molecular heparin is recommended for women with prior hormone-associated VTE during pregnancy and the postpartum period 4.
- There is no clear evidence on the ideal timing for initiating combination birth control postpartum, but it is generally recommended to wait until at least 6 weeks after delivery to minimize the risk of VTE 4, 6.
- Women who are at high risk of VTE should be carefully assessed and monitored before initiating combination birth control, and alternative methods should be considered if necessary 4, 6.