Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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When to start minipill postpartum

21 July, 2015

Question:

Thank you for your useful site and all of the wonderful work you do.

I gave birth around 6 weeks ago. I went to the mikvah but my husband and I didn't have relations, as we were waiting till the doctor checked that I was properly healed.

Before my doctor's appointment I got my period so I am now in niddah. I am currently near the end of my period and hoping to start 7 nekiim.

I just got a prescription for the mini pill – cerazette. I am trying to figure out when's best to start it in terms of 1) not lengthening niddah or starting another niddah right when I finally make it to the mikvah and 2) being able to be with my husband while using effective contraception.

My doctor said it can cause bleeding so I should start now. She also said it takes 2 weeks to be effective.

1. Should I start now while I am in niddah already or wait until after the shiva nekiim? (Does it cause actual bleeding or just staining? If it causes bleeding is it right at the beginning or randomly?)

2. If I wait until after I go to the mikvah to start, is there another form of contraception we could use while waiting the 2 weeks for the pill to work? What would you recommend? (We live in Israel.)

Thanks for your help.


Answer:

Mazal tov on the recent birth of your baby!

1) Since the minipill often causes irregular staining, it can interfere with completing the clean days. Therefore, we recommend starting the pill after you immerse.  

You may experience actual bleeding (which would render you niddah) or staining (from which you may take precautions against becoming niddah – see our article on stains for details). The staining is usually irregular, and may last for the entire time you are taking the minipill. Different women have different reactions to the minipill – some women have little to no staining, other women have frequent light staining, and yet other women have heavy staining or actual bleeding. You will only know how your body reacts to the minipill once you start taking it. However, despite the staining, many women are able to manage using the strategies described in the article linked above.

2) You can use spermicide as a backup contraceptive method until you start the minipill and until the minipill takes full effect. In Israel the commonly used form is vaginal suppositories called Glovan, which are available over the counter at the pharmacy. While spermicide on its own is not a very effective form of birth control, if you are fully nursing, use of spermicide in addition to any natural protection you have from breastfeeding would be reasonably effective. If you are not fully breastfeeding, you may wish to use a contraceptive sponge (available over the counter) which is slightly more effective than spermicide alone. If there is a medical reason that even a small risk of pregnancy would be dangerous, then you might wish to discuss the use of a diaphragm with your physician.

Please feel free to get back to us with any further questions.

B'Hatzlacha!

Postscript: As of fall 2017, Glovan is no longer sold in Israel. However, Vaginal Contraceptive Film (VCF), a particularly effective form of spermicide, is increasingly available. A list of Israeli pharmacies that carry VCF can be found at https://www.safevcf.co.il/copy-of-1.


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