Efficacy of a new postpartum transition protocol for avoiding pregnancy

J Am Board Fam Med. Jan-Feb 2013;26(1):35-44. doi: 10.3122/jabfm.2013.01.120126.


Introduction: The postpartum period is a challenging time for family planning, especially for women who breastfeed. Breastfeeding delays the return of menses (lactational amenorrhea), but ovulation often occurs before first menses. For this reason, a protocol was developed to assist women in identifying their return of fertility postpartum to avoid pregnancy.

Methods: In this prospective, 12-month, longitudinal cohort study, 198 postpartum women aged 20 to 45 years (mean age, 30.2 years) were taught a protocol for avoiding pregnancy with either online or in-person instruction. A hand-held fertility monitor was used to identify the fertile period by testing for urinary changes in estrogen and luteinizing hormone, and the results were tracked on a web site. During lactational amenorrhea, urine testing was done in 20-day intervals. When menses returned, the monitor was reset at the onset of each new menstrual cycle. Participants were instructed to avoid intercourse during the identified fertile period. Kaplan-Meier survival analysis was used to calculate unintentional pregnancy rates through the first 12 months postpartum.

Results: There were 8 unintended pregnancies per 100 women at 12 months postpartum. With correct use, there were 2 unintended pregnancies per 100 women at 12 months.

Conclusion: The online postpartum protocol may effectively assist a select group of women in avoiding pregnancy during the transition to regular menstrual cycles.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amenorrhea / urine*
  • Breast Feeding
  • Clinical Protocols
  • Estrogens / urine
  • Female
  • Fertile Period / urine*
  • Humans
  • Internet
  • Kaplan-Meier Estimate
  • Longitudinal Studies
  • Luteinizing Hormone / urine
  • Middle Aged
  • Natural Family Planning Methods / instrumentation
  • Natural Family Planning Methods / methods*
  • Outcome and Process Assessment, Health Care
  • Ovulation Detection / instrumentation
  • Ovulation Detection / methods*
  • Patient Acceptance of Health Care
  • Postpartum Period / urine*
  • Pregnancy
  • Pregnancy, Unplanned
  • Prospective Studies


  • Estrogens
  • Luteinizing Hormone