Contraception After Abortion
Fertility returns very quickly after completing an early medical or surgical abortion and you may ovulate again within 7 days of completing the process, meaning that you are at risk of falling pregnant within a week!
It is possible to get pregnant before your period returns and therefore it is not recommended to wait until your next period before starting contraception. We recommend starting contraception as soon as possible.
Regardless of the contraception method chosen, it is important to remember to do your urine pregnancy test 4-5 weeks after the abortion process. If your period hasn't returned after 6 weeks, or you are experiencing pregnancy symptoms such as nausea or breast tenderness after 4 weeks, you may need to do 2 x blood tests to ensure that you do not have an ongoing pregnancy.
Long acting reversible contraception (LARC) such as the contraceptive implant or rod, (Implanon) and intrauterine devices (IUDs) offer the greatest protection against pregnancy. Further information about each contraception method can be found here.
Timing for different contraception options
1. Contraceptive Implant (Implanon NXT) aka "The ROD"
The contraceptive implant, or rod, (Implanon NXT) can be inserted at any time during the medical or surgical abortion process, including prior to taking medication or having the procedure.
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When inserted within 5 days of completing an abortion it will be effective immediately.
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If the implant is inserted more than 5 days after having an abortion it will take 7 days for it to be effective. Another form of contraception (such as abstinence or condoms) will be required during this time.
2. Intrauterine Devices (IUDs)
Intrauterine Devices (IUDs) can be safely inserted once the pregnancy has been expelled. They can be inserted at the same time as a surgical abortion.
If you wish to have an IUD as quickly as possible, and you have access to a surgical abortion service, you may wish to consider a surgical abortion instead.
Different IUD inserters have different preferences in terms of timing after an early medical abortion. All inserters will want to know that you are not still pregnant, or have retained products of conception. Therefore, it is generally recommended that an IUD is inserted once you have had a negative pregnancy test following the abortion process. An ultrasound may also be required.
After the medical abortion, the IUD inserter will want to know that you have not had sex or used another reliable method of contraception (condoms, depot injection, contraceptive pill) in order to exclude a new pregnancy.
It is important to talk to your healthcare provider about the timing of insertion after a medical abortion. .
The copper IUD is effective immediately after insertion.
A hormonal IUD (the Mirena or Kyleena) will take 7 days to become effective. You will need to use another form of contraception during those 7 days. If you have the IUD inserted during the first 7 days of your period, it will be effective straight away.
.3. Contraceptive Injection (DPMA) aka: Depo)
The contraceptive injection can be started as soon as the medical or surgical abortion is commenced.
If it is generally given just prior to a medical abortion there may be a slightly higher risk of a failed abortion (a continuing pregnancy).
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If the injection is given within 5 days of having an abortion, it is considered effective immediately.
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If it is given after 5 days, it takes 7 days to become effective.
Another form of contraception (such as no sex or condoms) will be required during this time.
4. Combined Oral Contraceptive Pill (aka: The Pill)
The combined oral contraceptive pill (commonly referred to as the pill) can be started immediately after an abortion. It is important to start on an active hormonal containing pill and not an inactive ‘sugar’ pill.
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If it is started within the first 5 days after the abortion it will be effective immediately.
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If the pill is started more than 5 days after an abortion you need to have taken7 days of active hormonal tablets before “the pill” becomes effective.
5. Progesterone Only Mini Pill (POP)
Progestogen Only Pills (the “mini-pill” and Slinda) can be started immediately after an abortion.
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If it is started within the first 5 days after the abortion, it will be effective immediately.
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If started more than five days later it takes 7 days of hormonal tablets before it is effective.
6. The Vaginal Ring (aka: the Ring)
The vaginal ring can be inserted as early as one day after an abortion, though waiting two to three days may be preferable if you have heavy bleeding.
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If it is started within the first 5 days after the abortion it will be effective immediately.
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If it is inserted more than 5 days after an abortion it is important to wait at least 7 days before relying on it for contraception i.e. use another method such as a condom in addition to the ring.
7. Barrier Methods
Barrier methods can be used from the start of sex after an abortion.
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Condoms (male or female) can be used from resumption of sex
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Diaphragms can be used from resumption of sex after a first trimester abortion (<12 weeks), though delayed use is recommended if there is ongoing heavy bleeding.
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After a 2nd trimester abortion use should be delayed for 6 weeks - rechecking of the diaphragm fit may be required as the uterus returns to normal size.
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See a doctor who is experienced with diaphragm use to discuss this form of contraception.
Please note - these do have a relatively high failure rate
8. Fertility Awareness Methods
Fertility awareness methods, such as cycle tracking, can be used after abortion. However, because it relies on signs and symptoms of ovulation, it may be difficult to use until a cycle has been re-established. After a medical abortion, it may take more than 3 months.
Fertility awareness methods are less effective than other methods of contraception and you do need to be aware of all of the factors that can influence signs of fertility, such as illness.
9. Emergency Contraception
There are two types of emergency contraception available over the counter at pharmacies - 1.5mg Levonorgestrel (LNG-EC) pill or 30mg Ulipristal acetate pill.
Both of these medications are options for unprotected sex (ie sex without contraception from 5 days after an abortion). They can only prevent a pregnancy if ovulation has not already occurred and do have a relatively high failure rate compared to regular contraception.
The Copper IUD is the most effective form of emergency contraception if inserted within 5 days of unprotected sex. Women will often then keep their copper IUD for ongoing contraception.
