Family planning and preconception care

Contraceptive methods

Long-acting methods (coil, implant) have the highest effectiveness, because they do not depend on daily use. Combined pills, patches and the ring contain estrogen and progestogen; the progestogen-only pill is an alternative. The condom is the only one that also protects against sexually transmitted infections. The choice takes into account age, smoking, blood pressure, history of thrombosis, migraine with aura, liver and heart disease and the woman’s preferences. Estrogen is not recommended in women at high thrombotic risk or with migraine with aura.

Emergency contraception

It is not a regular method and does not protect against infections. The emergency pill reduces the risk of pregnancy when taken as soon as possible. The copper coil is more effective and can continue as a long-term method. If there has been unprotected sex, seek prompt consultation.

Choosing a contraceptive method: effectiveness, benefits and side effects

The effectiveness of methods is measured with typical use: the implant and coils have fewer than 1 pregnancy per 100 women a year; pills, patches and the ring about 7 per 100 with typical use; the condom about 13 per 100; cycle-based methods and withdrawal are less reliable. So the right method is the one you use regularly and without difficulty. Besides preventing pregnancy, some methods have benefits: the combined pill regulates the cycle, reduces dysmenorrhea and heavy periods and lowers the risk of ovarian and endometrial cancer; the hormonal coil markedly reduces bleeding.

Common side effects, such as spotting in the first months, breast tenderness or mood changes, often settle within three months; if they do not, changing the method or dose is possible. Pills have not been shown to cause weight gain. The risk of thrombosis with combined methods is small but real, and increases with smoking over 35, overweight, hypertension, a personal or family history of thrombosis and migraine with aura, so prior assessment is important. For breastfeeding women and after childbirth, estrogen-free methods are used. After stopping methods, fertility returns quickly, except for the injection, where delay may last longer.

When to plan a pregnancy and what to do beforehand

Conception most often happens within a year: about 80–85% of couples without problems become pregnant within 12 months with regular intercourse every two to three days, especially in the days around ovulation. A preconception check includes assessing vaccines (rubella, varicella, hepatitis B, influenza, COVID-19 as recommended), basic tests (blood count, glucose, TSH when at risk, blood group), reviewing medicines unsuitable in pregnancy and checking chronic diseases. Balanced nutrition, activity and a healthy weight reduce complications. Alcohol, smoking and drugs are not recommended at any stage of pregnancy.

The mother’s age influences fertility, which falls gradually after age 35, so assessment in this group is done after six months of trying. Men play a role in about half of cases of infertility, so the assessment is of the couple, not only the woman. Couples with chronic diseases, such as diabetes, lupus or hypertension, should plan pregnancy with disease control and adjustment of medicines before conception. Bring to the visit the cycle calendar, vaccines, medicines and family history.

Preparing for pregnancy

Before conception, folic acid in the dose advised by the doctor is recommended to reduce the risk of neural tube defects, along with stopping smoking and alcohol, a healthy weight and review of medicines. Chronic diseases should be controlled beforehand: diabetes, hypertension, thyroid and autoimmune disease (lupus). An irregular cycle, polycystic ovary syndrome or a year without conception (six months over age 35) calls for assessment (endocrine infertility).

Care at Tirana Polyclinic: we offer gynecology consultation, counselling on methods, assessment of coexisting diseases and interpretation of tests. Coil insertion and other procedures may be performed at specialized centers. Reviews are every 6 months to a year or sooner when the doctor considers it reasonable.