Concerns about future fertility, possible mistakes in taking the pill or using the spiral, but also indications for the resumption of contraceptive methods after childbirth.

Can the taking of the pill or the use of the spiral in any way affect the conception, when the couple will decide to have a child? And when is it advisable to stop contraception before starting a pregnancy? We try to answer the most frequent doubts of women with the help of Anna Maria Paoletti, associate professor of Gynaecology and Obstetrics at the University of Cagliari, director of Obstetric and Gynaecological Clinic of the University Hospital of Cagliari and member of the Board of Directors of SIGO (Italian Society of Gynaecology and Obstetrics).

1. Many women fear that taking the pill for many years may make it more difficult to conceive: is that so?

“It is an unfounded fear,” reassures the expert. “The mechanism of the pill, both estroprogestinic and progestinic, is to block the hypothalamic-pituitary axis preventing the maturation of the egg cell. This mechanism is automatically interrupted when the pill is no longer taken. Most women become pregnant within the first year of suspension.

2. Why, sometimes, do you get pregnant even if you are taking the pill?

“It happens when you are not taking it properly. Many women, for example, forget to take it even more than once in a month, and this compromises its effectiveness,” explains the gynaecologist. “But even an episode of vomiting within a few hours of taking it can cause a malabsorption of the contraceptive. Or, again, a drug has been taken – for example, certain antibiotics, which are not commonly used – which has reduced their absorption. The advice, in these cases, is to associate the pill with the use of a condom, until the end of the packaging and also during the period of suspension.

3. When planning a pregnancy, should we stop taking the pill a little earlier?

“It is not necessary. The only recommendation is to take a supplement of folic acid – vitamin B9 – at least three months earlier than when you plan to become pregnant. A deficiency of this substance could cause defects in the baby’s neural tube.

4. After giving birth, when can I start taking the pill again?

“In the months following the birth of the baby, there is a rather significant increase in thrombo-embolic risk: for this reason, the advice is to wait at least six months before starting to take the estro progestin pill again,” says the expert. “If, on the other hand, the pill is only progestogenic, i.e. it does not contain estrogen, it can be resumed 30-40 days after childbirth, even if the woman has decided to breastfeed.

5. Can having used the spiral for years make it more difficult to implant the egg?

“No. The mechanism of action of intrauterine devices is to alter the vaginal, cervical and endometrial environment in order to counteract the rise and survival of sperm. Once the device is removed, this type of action ceases.

6. Why do I sometimes get pregnant while using the spiral?

“The spiral is positioned by the gynecologist and does not require any management by the woman, so the pregnancy rates undertaken during the use of this contraceptive are very low,” reassures the expert. “If this happens, it may be because the device has moved. To avoid this inconvenience, the advice is to periodically check that the thread of the spiral, which protrudes slightly into the vagina, is well positioned.

7. Is it better to let a certain period pass between the removal of the spiral and conception? Do I need to have a check-up?

“The suggestion is to wait until the second menstruation, so as to be sure that the endometrium has returned to conditions favourable for the implantation of the egg,” explains the gynaecologist. “If there have been no particular problems, and in the absence of specific symptoms, the use of this type of contraceptive does not in itself make any examination necessary.

8. Contraception after childbirth: when can the spiral be inserted again?

“Generally, it is advisable to wait two or three weeks, as uterine contractions, natural postpartum blood loss, called ‘lochiations’, and dilation of the cervix may increase the risk of movement. Once the situation is back to normal, the device can be put back in place without any problems.

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