You have the right to choose when to try for a baby and how many children you would like to have. However, it’s also important that you have the information you need to help you make these decisions. 

Many women with mental illness have healthy pregnancies but it’s important to keep using contraception and taking your usual mental health medication until you have spoken to your doctor. Stopping treatment for your mental illness without support can make your symptoms come back or get worse.

How long does it take to get pregnant?

Having a serious mental illness does not affect your fertility and pregnancy can happen much faster than you might think. 1 in 3 women who are having regular sex (every 2 to 3 days) or timing sex around ovulation (this is when your body makes an egg), will get pregnant within a month.

If a couple is having regular unprotected sex:

  • more than 8 out of 10 couples where the woman is aged under 40 will be pregnant by 1 year
  • more than 9 out of 10 couples will get pregnant by 2 years.

Regular unprotected sex means having vaginal sex every 2 to 3 days without using contraception.

Some medicines for treating psychosis can affect ovulation, making it harder to get pregnant. This is because they increase the level of a hormone called prolactin. If you’re having regular periods though, you’re likely to be ovulating. (Keep in mind though that even if you are not having regular periods you can still get pregnant.)

If you’re taking antipsychotic medication, it’s a good idea to tell your doctor that you’re trying to get pregnant.

Talk to your doctor again if you haven’t got pregnant after 6 months of trying, especially if your periods aren’t regular. They may arrange a blood test to measure the level of prolactin in your blood. If the level is too high, ask your doctor about switching to another antipsychotic medicine that doesn’t cause this problem. Other things can also affect ovulation, such as stress or being overweight.

Find out more about fertility and the causes of infertility.

When should I stop using contraception?

It’s important to use contraception that works well until you have spoken to your doctor about your mental health medication.

To give yourself the best chance of a healthy pregnancy, try to take enough time to arrange any support you may need and make sure you’re as healthy as you can be.

Your GP or a doctor at a local contraceptive clinic can help you choose the right form of contraception.

The following methods are very effective and won’t affect any medication you’re taking:

  • the copper IUD (intrauterine device or copper coil) – this doesn’t use hormones
  • the intrauterine system (IUS), such as Mirena or Jaydess – uses the hormone progestogen
  • the contraceptive implant – uses the hormone progestogen.

Contraceptives that contain the hormone oestrogen, such as the combined pill, patch or vaginal ring, won’t be suitable for you if you:

Your fertility will return to normal a few days after you stop using most types of contraception. The exception is the contraceptive injection, where it can take between 12 weeks and a year for your fertility to return to normal.

Find out more about stopping contraception.

What is pre-conception counselling?

Pre-conception counselling gives you the chance to ask questions about how your mental illness may affect a future pregnancy and your chances of getting pregnant. It is usually a single appointment with the perinatal mental health team. This team specialises in supporting women with a history of mental illness before, during and after pregnancy.

You can ask your GP or psychiatrist to refer you for pre-conception counselling.

During the pre-conception appointment, the perinatal mental health team will talk to you about:

  • any worries you may have
  • how pregnancy and childbirth may affect your mental illness
  • how your mental illness may affect you and your baby
  • the risks and benefits of taking mental health medication in pregnancy and while breastfeeding
  • your physical health
  • how your symptoms will be monitored while you are pregnant
  • what to do if you feel your mental health is getting worse
  • the care available in your area during and after pregnancy.

They will help you understand your options and make informed choices about your planned pregnancy.

Contraception after the birth

You can get pregnant 3 weeks after you’ve given birth, even if you’re breastfeeding and your periods haven’t started again.

Unless you want to get pregnant again, it’s important to use contraception every time you have sex. During your pregnancy, you can talk to your midwife about which type of contraception you’d like to use and how to make sure it’s available after you give birth. You can also talk to your GP or health visitor or visit a local contraceptive clinic after your baby is born.

If you were using the contraceptive implant before you got pregnant, you can have another implant at any time after the birth. If you used an IUS or IUD, you can have another one fitted within 48 hours of the birth. If you don’t have one fitted at this time, you may have to wait until at least 4 weeks after the birth.

More information and support

NHS contraception guide

Sources

  1. Dolman C, Jones I, Howard LM (2013) Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Womens Ment Health  16: 173–196.
  2. NHS England, NHS Improvement, National Collaborating Centre for Mental Health (2018) The Perinatal Mental Health Care Pathways. London: NHSE.
  3. National Institute for Health and Care Excellence (2013, updated 2017) Fertility problems: assessment and treatment. Clinical guideline [CG156]
  4. -Williams RH et al (2017) British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 31(5): 519-552.
  5. McAllister-Williams RH et al (2017) British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 31(5): 519-552.
  6. Faculty of Sexual and Reproductive Healthcare (2018) FSRH CEU Statement: Contraception for women using known teratogenic drugs or drugs with potential teratogenic effects www.fsrh.org/standards-and-guidance/documents/fsrh-ceu-statement-contraception-for-women-using-known/
  7. NHS (2019) Which method of contraception suits me? www.nhs.uk/conditions/contraception/which-method-suits-me/
  8. Faculty of Sexual & Reproductive Healthcare (2017, updated 2019) Clinical Guidance: Drug Interactions with Hormonal Contraception www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-drug-interactions-with-hormonal/
  9. NHS (2019) Which method of contraception suits me? www.nhs.uk/conditions/contraception/which-method-suits-me/
  10. Joint Formulary Committee. British National Formulary: Contraceptives, hormonal (2020) https://bnf.nice.org.uk/treatment-summary/contraceptives-hormonal.html
  11. National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]
  12. Pan-London Perinatal Mental Health Networks (2019) Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Services. www.healthylondon.org/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf
  13. NHS (2018) Sex and contraception after birth www.nhs.uk/conditions/pregnancy-and-baby/sex-contraception-after-birth/
  14. NHS (2017) When can I use contraception after having a baby? www.nhs.uk/conditions/contraception/when-contraception-after-baby/
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    Last reviewed on July 24th, 2020. Next review date July 24th, 2024.

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