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FERTILITY AFTER CHILDBIRTH
Did you know?
SEXUALLY TRANSMITTED INFECTION (STIs)
If you’ve just had a baby you may not be thinking about having sex
however it is important to remember that fertility can return quickly
after childbirth. It is a good idea to think about contraception if you
do not want to get pregnant again. There are lots of contraceptive
choices available, see the Contraceptive Choices table for more
information or talk to your GP or family planning clinic about the
best option for you.
You need to use contraception to prevent a pregnancy for one
year after your periods have stopped completely (the
menopause), or two years if the menopause happens before
you are 50.
Sexually transmitted infections (STIs) are not just a worry for those in
their 20s. STIs are infections that are passed on from an infected
partner(s) during unprotected sex (vaginal, anal and oral). They are
caused by specific bacteria and viruses. In some cases, you may be
at risk even if you don’t have full sex. Kissing and touching each
other’s genitals may pass on some STIs.
IF YOU HAVE CHOSEN TO BREASTFEED
Breastfeeding is not in itself a reliable contraceptive method, but it
does reduce a woman’s fertility and delays the return of ovulation.
The lactation amenorrhea method (LAM) has been developed to
help women who wish to use breastfeeding for child spacing during
the first six months after birth.
The lactation amenorrhea method (LAM) is 98% effective only if:
◆ Used only in the first six months after giving birth and menstrual
periods have not returned; and
◆ The woman is exclusively breastfeeding day and night – at least
six feeds in 24 hours including night time feeds.
Remember, women should not wait until the return of their
menstrual period before starting contraception as ovulation occurs
before menstruation making pregnancy possible. Talk to your GP or
family planning clinic about the options available to you.
HOW YOUR BODY CHANGES OVER TIME
From the age of 35 onwards a woman’s body starts to change.
Periods can become heavier, more irregular or stop, sometimes for
weeks or months. 90% of women over 40 who have regular cycles
may still ovulate, but not in every cycle.
THE PERIMENOPAUSE & THE MENOPAUSE
The perimenopause is the time before the menopause when your
body starts to change. It usually starts in your forties and lasts up to
six years or more. 90% of women have 4-8 years of menstrual cycle
changes before their periods stop completely. Although it’s harder to
get pregnant as you get older, pregnancy is still possible at any time
until the menopause. Most doctors don’t consider that a woman has
reached the menopause until she has not had a period for a year (or
two years if her periods stop before she is 50).
Even if your periods stop or become irregular you can still get
pregnant.
PREGNANCY
Crisis and unplanned pregnancies don’t just happen to young
people. Women in their 30s and 40s have unprotected sex – often
because they assume that they are menopausal and have a low
risk of pregnancy. In fact very few women are infertile before the
age of 45.
If a woman becomes pregnant or is planning to become pregnant
it is important to start taking folic acid during the first trimester of
pregnancy and if possible before conception. For more
information, talk to your GP or family planning clinic.
It is important to get yourself, and your partner checked out
(confidentially) at your GP, family planning clinic, an STI clinic or
GUM clinic, and use condoms until you both have the all-clear.
Get advice if you are worried about STIs or are sexually active and
notice any of the following symptoms:
◆ unusual discharge from penis or vagina,
◆ pain when passing urine,
◆ unusual sores or blisters in the genital area,
◆ itching or irritation in the genital area, or
◆ pain during sex
EMERGENCY CONTRACEPTION
If your method of contraception fails or if you have unprotected sex –
emergency contraception can be used to avoid an unplanned
pregnancy. There are different emergency contraception choices
available that are effective for different lengths of time (up to three to
five days) however emergency contraception is more effective the
sooner you take it after having unprotected sex. Your emergency
contraception choice will depend on your situation – when you had
your last period and how long it has been since you had unprotected
sex. Emergency contraception is now available directly from
pharmacists so you can talk to a pharmacist, GP or family planning
clinic about the best option for you.
If you have had unprotected sex or your contraception failed, you
may be at risk of a sexually transmitted infection (STI). Talk to
your GP, family planning clinic, STI clinic or GUM clinic about
arranging an STI test.
Did you know?
Many women believe that emergency contraception can only
be taken 3 times in their lifetimes or that emergency
contraception can cause infertility – there is no evidence to
support this.
Some STIs have no obvious symptoms, so you may not be aware
that you or your partner(s) is infected.
Once diagnosed, most STIs can be cured with medication. However,
some of them can only be treated to reduce symptoms but will stay
in your system once you have been infected. It is important to get
treatment early, as some can cause long term effects.
Did you know?
Condoms offer the best protection against most STIs but not all. If
you are using a different method of contraception you will need to
use condoms to protected yourself from STIs.
It is important to remember that you can get an STI at any age. If
you have gone through or are going through the menopause you
can still get an STI by having unprotected sex.
For a list of STI Screening Services please visit
thinkcontraception.ie/35-55
WHERE TO FIND US
Contraception, fertility and
sexual health information
for women aged 35+
IF YOU WANT TO DISCUSS YOUR CONTRACEPTIVE NEEDS
OR GET CONTRACEPTIVE OR STI SERVICES, CONTACT:
Your local GP
Bray Womens Health Centre
Adelaide Road, Bray, Co. Wicklow . . . . . . . . . . . . . . . . . . . . . 01 276 1522
www.braywomenshealthcentre.ie
Dublin Well Woman Centres
Ballsbridge, Dublin 4 . . . . . . . . . . . . . . . . . . . . . . 01 660 9860 / 668 1108
Coolock, Dublin 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 848 4511
Lower Liffey Street, Dublin 1 . . . . . . . . . . . . . . . . 01 872 8051 / 872 8095
www.wellwomancentre.ie
Femplus Clinic
Roselawn Road, Blanchardstown, Dublin 15 . . . . . . . . . . . . 01 821 0999
www.femplus.ie
Independent Family Planning Centres:
23 Tuckey Street, Grand Parade, Cork . . . . . . . . . . . . . . . . . 021 427 7906
www.corkfamilyplanning.com
Lismoyle Hse, Augustine Street, Galway. . . . . . . . . . . . . . . . . 091 562 992
27 Mallow Street, Limerick . . . . . . . . . . . . . . . . . . . . . . . . . . 061 312 026
38 Oak Park, NewcastleWest, Limerick . . . . . . . . . . . . . . . . . . 069 629 33
29 Ash Street, Tralee Co. Kerry . . . . . . . . . . . . . . . . . . . . . . 066 712 5322
Contraception
35
Irish Family Planning Association
Cathal Brugha Street, Dublin 1 . . . . . . . . . . . . . . 01 872 7088 / 874 2110
The Square, Tallaght, Dublin 24 . . . . . . . . . . . . . . . . . . . . . 01 459 7685/6
www.ifpa.ie
If you need to see a GP outside of surgery hours please visit www.hse.ie to
find a service.
If your method of contraception fails or if you have unprotected sex:
Emergency contraception can be used if you want to avoid an unplanned
pregnancy. Talk to a pharmacist, a GP or family planning clinic about the
best option for you. Emergency contraception services are also available
through out-of-hours GP services.
If you are worried about a sexually transmitted infection (STI)?
Visit thinkcontraception.ie/35-55 for a list of STI screening services
available in Ireland.
Unplanned pregnancy?
Freetext list to 50444 or visit positiveoptions.ie for a list of State-funded
crisis pregnancy counselling organisations that provide free, nonjudgemental counselling nationwide.
To re-order copies: Visit www.healthpromotion.ie
For more information on the best contraceptive choice for
you, talk to your GP – GPs are specially trained to help you
make the right choice. If they can’t provide the method you
want, they will refer you to someone who can.
The HSE Crisis Pregnancy Programme
The HSE Crisis Pregnancy Programme, which produced this resource, was set up to formulate and
implement a strategy to address the issue of crisis pregnancy in Ireland.
For more information visit www.crisispregnancy.ie
FOR MORE INFORMATION VISIT:
FOR MORE INFORMATION VISIT:
FOR MORE INFORMATION VISIT:
thinkcontraception.ie/35-55
thinkcontraception.ie/35-55
thinkcontraception.ie/35-55
Disclaimer
The information in this leaflet has been supplied by the HSE Crisis Pregnancy Programme. The Programme
has made every effort to ensure that the information is accurate, including medical proofing before going to
print. The information contained in this leaflet must not, however, be taken to be a substitute for medical
advice, diagnosis or treatment. If you have questions or concerns or require further information, visit your
GP or local family planning clinic for professional advice.
crisispregnancyprogramme
YOUR HEALTH
◆ Do you have symptoms such as irregular/heavy periods or vaginal
dryness? Some contraceptive methods can help these
symptoms, others may make them more severe.
◆ Do you have any health issues such as being overweight,
smoking, having high blood pressure/diabetes that may make
some methods unsuitable? Are you taking hormone replacement
therapy (HRT)?
◆ Oestrogen-based contraceptives can relieve hot flushes, vaginal
dryness and irregular periods; progestogen-based methods can
help reduce heavy periods.
COST
Some methods of contraception such as long acting methods of
contraception (see table) have higher up-front costs than others but
are better value for money in the long term. Many of the methods
with high upfront costs are subsidized by the Drugs Payment
Scheme. Ask your GP about all of the contraceptive options
available. Talk to your pharmacist about enrolling on the Drugs
Payment Scheme.
Did you know?
MEDIUM TERM
CONTRACEPTION
There are lots of contraceptive choices available, and what suited
you in the past may no longer be best for you. Your choice will
depend on if you want to have (more) children, your health, your
personal preference and whether you need protection from sexually
transmitted infections (STIs).
LONG TERM
CONTRACEPTION
CONTRACEPTIVE
CHOICES
SHORT TERM CONTRACEPTION
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FOR MORE INFORMATION VISIT:
thinkcontraception.ie/35-55
NATURAL
PERMANENT
Condoms offer the best protection against most sexually
transmitted infections (STIs) but not all. If you are using one of
the other methods of contraception outlined in the table you
will need to use condoms to protected yourself from STIs.
CHOICES
HOW OFTEN
YOUR HEALTH
IS IT FOR YOU?
MALE AND FEMALE CONDOMS
Barrier methods that can help prevent
pregnancy and STIs
Every time you have sex
Male condoms are 99% effective and female condoms are 98% effective with careful and
consistent use > No side-effects (unless allergic to latex in the male condom) >
Spermicides/lubrication will increase effectiveness and help if vaginal dryness is a problem
Good for single people, or people who don’t know if their partner is free from STIs > Female condom can be put in
any time before sex > No prescription required > Can be used with hormonal contraceptives for added protection
> Female condom may slip during sex
COMBINED ORAL CONTRACEPTIVE PILL
Tablet contains two female hormones oestrogen
and progestogen
Take a pill every day three weeks per
month
Over 99% effective if used properly > Can help to control heavy periods and premenstrual
symptoms > Not advised for smokers over 35, women who are breast-feeding or those who
have medical conditions, such as high blood pressure
Useful for women who can reliably take pills on a daily basis > Vomiting, diarrhoea, antibiotics and some other
prescribed drugs can interfere with its effectiveness
PROGESTOGEN ONLY PILLS
(Mini Pill) Tablet containing only the female
hormone progestogen
Take a pill every day
96-99% effective with very careful use > May cause irregular bleeding
Can be used by women who cannot take oestrogen in the combined oral contraceptive pill, such as women over 35
who smoke or breast-feeding mothers > Must be taken at the same time every day > Additional contraception may
be required if pills are taken late > Vomiting, diarrhoea, and certain medication can interfere with its effectiveness
THE PATCH
A patch (similar to a small bandage), which
contains the female hormones oestrogen and
progestogen
Each patch is worn for seven days, for
three consecutive weeks, followed by a
patch-free week
99% effective if used properly > Same as for the combined oral contraceptive pill
Useful for women who forget to take their pill daily > May be seen on the skin
THE VAGINAL RING
The ring contains the female hormones
oestrogen and progestogen
Flexible ring inserted by the woman
into her vagina for three weeks of every
month
99% effective if used properly > Same as for the combined oral contraceptive pill
Useful for women who forget to take their pill daily
DIAPHRAGMS / CAPS
A flexible rubber or silicone device, used with
spermicide, that the woman fits inside her
vagina
Every time you have sex
> Must stay in place for at least six
hours after sex but not more than 30
hours > Fittings should be checked by
a doctor every year
92-98% effective with very careful use > Few side-effects as no hormones are needed >
Urinary tract infections (cystitis) can be a problem for some users
An initial consultation with the doctor is needed to select the correct size and type > Insertion takes practice > Can
be put in any time before sex (if more than three hours before extra spermicide may be needed) > It can be re-used
INJECTABLE CONTRACEPTIVE
An injection containing the female
hormone progestogen
An injection is given approximately
every 12 weeks
Over 99% effective once injective is given regularly > May cause irregular bleeding, although
bleeding stops completely after 1 year for 50% of users > Cannot be immediately reversed in
the event of side effects > May decrease bone density > May protect against cancer of the
womb > Side-effects include weight gain, headaches and depression
Can be used by women who cannot take oestrogen in the combined oral contraceptive pill, such as women over 35
who smoke or breast-feeding mothers > Must be given by a health care professional
INTRAUTERINE SYSTEM (IUS)
A small plastic device, which releases the
hormone progestogen, is put into the womb
Lasts approximately five years
99% effective > Reduces or stops heavy bleeding for most women > May cause irregular
bleeding > Lasts 5 years > May cause uterine perforation
It is effective immediately > Very reliable long-term, reversible method > Insertion and removal must be done by a
specially trained doctor – no anaesthetic is required
INTRAUTERINE CONTRACEPTIVE DEVICE
(IUCD) – ‘THE COIL’
A small plastic and copper device is put into the
womb to stop the normal actions of the egg and
the sperm
Lasts 5-10 years > If inserted after the
age of 40 may stay in until the
menopause
98-99% effective > May cause uterine perforation
It is effective immediately > Very reliable long-term, reversible method > Insertion and removal must be done by a
specially trained doctor – no anaesthetic is required
THE IMPLANT
Rod containing the female hormone
progestogen, which is placed just under
the skin on the inside of your upper arm
Rod inserted approximately every three
years by a specially trained doctor
99% effective > May reduce painful periods and heavy bleeding > May cause irregular
bleeding or stop bleeding altogether > May cause acne or weight gain > May have heavy
bleeding and moodiness
Can be used by women who cannot take oestrogen in the combined oral contraceptive pill, such as women over 35
who smoke > Useful for women who forget to take their pill daily
FEMALE STERILISATION (TUBAL LIGATION)
A surgical procedure that involves cutting
or blocking a woman’s fallopian tubes
One procedure, usually under general
anaesthetic and requiring a short
hospital stay
Over 99% effective > There are risks related to surgical complications
Useful for women who have completed their families > It is effective immediately
MALE STERILISATION (VASECTOMY)
A procedure that involves cutting the
tubes carrying sperm, so that sperm are not
present in the semen that is ejaculated
One procedure, lasting approximately
15-20 minutes > Can be done in
a doctor’s surgery or clinic
Over 99% effective > The man can have discomfort and swelling for a short time after the
procedure > There are risks related to surgical complications
It is effective after 16 – 20 weeks, if there have been 2 negative sperm counts > Useful for men who have completed
their families and who don’t need STI protection
NATURAL METHODS
Involves recording the fertile and infertile times
of your cycle to plan when to avoid sex or take
extra measures to avoid pregnancy
Record body temperature, changes in
cervical mucus and other signs of
ovulation every day
80-98% effective however depends on careful use and commitment to the method > No sideeffects as no hormones or devices are needed > Becomes less reliable as you get older due to
cycle changes
Requires keeping a daily record > Needs the cooperation of both partners > Some methods require a few days’
abstinence from intercourse each month > Lack of knowledge and events which disturb the woman’s cycle
e.g. stress, illness, childbirth may make the method less reliable > Natural methods are less reliable for use in older
women > Disagreement as to whether natural methods can be safely used during the perimenopause