"Birth control implants are implants containing progesterone. It is a device which can be inserted under the skin on the upper arm in the inner aspect and it can be kept in place for 2 years, 3 years or 5 years, but it is not available in India. The mode of action is the same way as of your injections or as long as they are in place, they offer you protection. You may not have regular periods and whenever you may get spotting and whenever you may get periods, it may not be very heavy, it may be scanty. So that is how they act. But unfortunately it is not available in India yet"

"The types of postpartum contraception are as I told you earlier intrauterine device like a Copper T or a mirena. So the Copper T or mirena can be inserted 4 to 6 weeks after delivery and the next one is the injectable contraceptive which can be inserted 6 weeks after delivery and it has to be taken every 3 months. You have implants and it is not yet available in Idea and there are tablets which can be taken during lactation, which will not suppress lactation, but will offer you very good contraception and it is different from the combined oral contraceptive pills which can affect the lactation in the earlier weeks. So you can consult with your doctor and opt for a pill which will not affect your lactation and the other thing is that barrier method, which the male partner can follow, but the failure rate is very high. So the first mentioned contraceptive pills is the better option where it is the personal choice of the lady"

"Side effects of postpartum contraception are not very many. If you take for instance, intrauterine device, you may have a heavy flow for the first few months. After all, it is a foreign body that has been inserted. So it can take a few weeks or a few months for it to settle down. So you may have initially an extra bout of bleeding, but it can be taken care of or you may have intramenstrual spotting between your periods, that also can be taken care of. Or you may have some extra discharge, maybe if there is any infection. But if you have any foul smelling discharge or any discharge, then you have to consult your doctor, then you have to consult your doctor and it may a local infection that can be taken care by pessaries or oral antibiotics, but don’t remove it in haste. the mild infection can be take care of and the intrauterine device can be continued. The benefit is more than the harm. So the side effects are very less and if you want to, in the beginning you start menstruation, if you want a change or you want to remove an IUCD, it is the ideal time will be to remove it when you are in periods so that you can switch over from one method of contraception to another. For instance if you are not very happy with your intrauterine device, then you can remove it within 5 days of your periods. Remove the IUCD and then immediately start on the combined oral contraceptive pills, which is a 21 day pill pack and can be started immediately an after 21 days you will have abnormal bleeding and if you like it, you can continue. So the other side effects is with the injectable and the progesterone only pills you may go for amenorrhea. Amenorrhea means you may bot get your periods or if at all you get, the flow may be less. But please don’t discontinue it because of this one side effects. Injectables there might be a very slight weight gain, maybe upto 2 kgs, but you can keep it in check by regular diet and exercise, but if you feel that it is really helpful, and you are not very happy after 6 months of delivery or after that baby started weaning, then you can change over form the injectable contraceptive to a combined oral contraceptive which is a 21 day pill pack, which will have you regular menstruation if it is taken in the correct way. So the doctor will instruct you how to take it and how to follow this medication. Bin the same way, the progesterone only pills you may not get the periods. As such after delivery when the lady is continuously lactating, without any top up feeds she may not get her periods. So the idea of introducing postpartum contraception is that when the baby changes over from breastfeeding to top up feeds or other feeds then your ovaries suddenly wake up. So when the ovulation happens, you may not be aware of it. So at that time you will conceive. So when you conceive you may not be aware of it till the vomiting sensation and you are in for a shock that if you have not taken adequate precautions that you are pregnant again and you do not know when you have conceived. So that is the main reason why we advocate postpartum contraception because when you are lactating, you will not get your periods and even before you start menstruation, you will suddenly conceive. So that is why we advise all these precaution. So if you are not happy with one form of contraception, then you can switch over to a different form of your choice. So you can even nowadays at 6 months. Nowadays we say even within 3 months of delivery and you are lactating, and you want a contraceptive that will give you a monthly bleeding, then you can go for what is called as low dose combined contraceptive, a low dose pill. That can also be taken. It will not affect your lactation because the components are very low in the combined contraceptive. So if you actually think of side effects, you should not avoid it totally. One or two side effects may be there, but it can be tackled, and you can always change over to a different form of tour choice. So if you are not agreeable with one form then go switch over to another form. So that you are protected for 3 years for 4 years, for 5 years as long as you want the gap between the first child and the second child"

"Combined hormonal methods are combined hormonal oral contraceptives. Actually the combined hormonal methods, injectable is not again available in India. You have different forms. You have pills, you have patches, you have rings, you have oral pills and then it should be started within the first 5 days of periods or if you are switching over from one contraceptive to another, then it has to be started off immediately. Suppose if you are removing the Copper T, then you start the combined oral contraceptive immediately and then for the first one week, follow additional precautions or you can start it within the first 3 days of your periods and each pill pack will have a 21 day pills. The government supply has an extra 9 tablets of iron tablets. So at the end of it you will have a withdrawal bleeding and then you will start having a regular menstruation. So again you have to start the best pill pack within the first 3 days of the next periods. The same combined oral contraceptive is also available if you are not able to tolerate orally. Like if you are having nausea and vomiting, you don’t like it, but you want the contraception, then the same thing is available in the ring for, which can be inserted in the vagina a little high up. It is a small ring the pessary type within the 5 days of periods, kept in place for 2 weeks and then removed, then a day or two, you might start off your menstruation. So a new ring has to be fitted in place within the 5 days of periods and then the combined oral contraceptive is available as a patch, which can be applied over the skin. But unfortunately it is not available in India. But that patch if anybody is travelling abroad, then you can ask for it or ask your local doctor there and use it. It has to be changed every week for 3 weeks. Like of you are starting it on a Sunday, then you remove it and then you put a new patch the next Sunday. Like that you have to follow for 3 weeks. The once you stop it, you will have a bleeding, like a menstruation. Then you again go for a patch, 5 days after your menstruation, for 3 weeks. So the concept is the combined oral contraceptives are taken for 21 days, whether it be an oral pill or a ring or a patch, it is 3 weeks, so that at the end of it, you will have a menstruation like the regular mensuration it has to be followed every month, but you have to make sure that if you are taking oral pills not to forget it. Take it in the regular manner, say that if you are taking it in the night, take it every day in the night so that you will remember"

"Actually we do not for see any complications with any of these methods, because say once suppose you are on a Copper T. Once you remove, then the fertility returns immediately and then it is the same way. Injectables, maybe the ovulation will start taking place, maybe a few months once you stop. It may vary form 6 weeks to 3 months once you stop the injection and it is the same with the progesterone only pills that is started soon after the delivery. So there is no problem with regaining the fertility status. So if at all there is any problems then it can be taken care by consultation with your gynaecologist and it is not a major complication. If at all you might get a displaced Copper T. But if you come for a regular follow up, and that can also be picked up and taken care of. So there is not very many complications with the patients with the contraceptive methods that have been suggested to you so far"

"Postpartum contraception is very very safe. Nowadays the government recommends insertion of the copper T soon after the delivery of the placenta so that you won’t know how it is being inserted also. But ofcourse it is done with your consent. You can even opt for that, whether it is a normal delivery or a C-section. Once the placenta comes out, the Copper T, can be put in place so that it can be left there for 3 to 5 years, which is your choice. The safety wise, it is your chive. So you can opt for Copper T, Copper T, is very safe. It does not interfere with lactation and it can be that there can be Copper T available that can be inserted for upto 3 years or upto 5 years and even upto 10 years and if you are worried about bleeding for menstrual problems or a heavy flow, then you can go for a hormone containing device called as mirena. It will not cause increased flow during menstruation and a mirena can be even kept in place for upto 5 years. That is also recommended. All of the, Copper T, is called as a long acting contraceptive devices. So it can be kept in place as long as you want it to be there, say 3 years, 5 years or 10 years. Injections are also quite safe. It will also reduce the ;lactation. It can be taken once in 3 months without a break. That means you should not prolong it. Once your doctor has advised that it has to be taken on a particular date, then it has to be taken within a week of that date. Don’t prolong it, because then it will become a failure and you van conceive of you prolong the next injection. So you have to keep in mind that the injections have to be taken every 3 months and the pills that are taken after delivery, that will not compromise on the lactation is that the tablet which has to be taken everyday, for you can take it upto 1 year or 2 years and then change over to a different type of contraception. So again the choice is yours. All the 3 methods are very very safe in the post-partum period. So once the baby wean, then is it starts taking the oral other soft diet other than milk than other top up feeds, then you can opt for a different method if you feel a Copper T does not suit you. Can opt for another methods. Say after 6 months or 1 year. But follow something so that you get adequate space between the first child and then next child"