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Recommendations for Contraceptive Use |
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Progestin-Only Pills During Breastfeeding
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Classification of Selected
Procedures for Progestin-only Pills (POPs) during Breastfeeding
| Procedure |
Class |
Rationale |
| Pelvic examination (speculum and
bimanual) |
C |
- A pelvic exam is not necessary to ensure safe use of POPs
as a contraceptive method1.
- In some cases, a pelvic exam may help evaluate the question
of pregnancy if a menstrual history suggests the possibility beyond six weeks duration. In
this case it is Class A.
- Conditions which would restrict use of POPs should be
identified by the client's history before method initiation.
|
| Blood pressure |
C |
Current evidence does not
demonstrate any notable effect of POPs on blood pressure2, 3. |
| Breast examination |
C |
POPs do not cause breast cancer4,
5. Lumps that are suspicious as cancer should be evaluated. While any hormonal
treatment may in theory cause such lumps to grow, pregnancy causes much higher hormonal
levels; therefore, potential malignancies of the breast should not be a reason to delay a
woman's access to the use of this contraceptive method. |
| Sexually transmitted disease
(STD) screening by lab tests (for asymptomatic persons) |
C |
The presence of an STD will not
affect the safe use of POPs. Clients at risk of STDs (by personal history or
socio-demographic risk factors) should be offered STD screening where possible. |
| Cervical cancer screening |
C |
POPs have no known relation to
risk of cervical cancer6. |
| Routine, mandatory lab tests
(e.g., cholesterol, glucose, liver function tests) |
D |
The effect of POPs on
cholesterol, blood glucose and normal liver function are slight, and of no demonstrated
clinical significance6-8. |
| Proper infection prevention
procedures |
C |
Proper infection prevention
procedures are not applicable to POP use. |
Specific counseling points for
POP use:
- efficacy
- common side effects, including alterations in bleeding
patterns (e.g. frequent or irregular bleeding, extended amenorrhea)
- correct use of method (including instructions for missed
pills)
- signs and symptoms for which to see a health provider
- STD protection (when/as appropriate)
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A |
- Accurate client education is essential for maximum quality
of family planning services.
- Appropriate counseling about common contraceptive side
effects at the time of method selection can lead to improved client satisfaction and
contraceptive continuation.
- Irregular or absent menstrual bleeding is the single most
common side effect of POPs, and the chief complaint leading to discontinuation9.
- POPs are highly effective if taken correctly and
consistently. However, POPs are less effective than COCs after weaning.
- The woman should be encouraged to return if she has any
problems or at any time she has questions or concerns.
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KEY:
Class A = essential and mandatory or otherwise
important in all circumstances, for safe and effective use of the contraceptive method
Class B = medically/epidemiologically rational in
some circumstances to optimize the safe and effective use of the contraceptive method, but
may not be appropriate for all clients in all settings
Class C = may be appropriate for good preventive
health care, but not materially related to safe and effective use of the contraceptive
method
Class D = not materially related to either good
routine preventive health care or to the safe and effective use of the contraceptive
method
Citations for Procedures Table:
- Huber DH, Huber SC. Screening oral
contraceptive candidates and inconsequential pelvic examinations. Studies in Family
Planning 1975;6(2):49-51.
- Ball MJ, Ashwell E, Gillmer MDG.
Progestagen-only oral contraceptives: comparison of the metabolic effects of
levonorgestrel and norethisterone. Contraception 1991;44(3):223-33.
- Wilson ESB, Cruickshank J, McMaster M,
Weir RJ. A prospective controlled study of the effect on blood pressure of contraceptive
preparations containing different types and dosages of progestogen. British Journal of
Obstetrics and Gynaecology 1984;91:1254-60.
- Stanford JL, Thomas DB. Exogenous
progestins and breast cancer. Epidemiologic Reviews 1993;15(1):98-107.
- UK National Case-Control Study Group.
Oral contraceptive use and breast cancer risk in young women. Lancet 1989;1:973-82.
- World Health Organization. Improving
access to quality care in family planning: medical eligibility criteria for contraceptive
use. Geneva: WHO, 1996.
- Miale JB, Kent JW. The effects of oral
contraceptives on the results of laboratory tests. American Journal of Obstetrics and
Gynecology 1974;120(2):264-72.
- Korba VD, Paulson SR. Five years of
fertility control with microdose norgestrel: an updated clinical review. Journal of
Reproductive Medicine 1974;13(2):71-5
- Belsey EM, WHO Task Force on
Long-acting Systemic Agents for Fertility Regulation. The association between vaginal
bleeding patterns and reasons for discontinuation of contraceptive use. Contraception
1988;38(2):207-25.
For further information see McCann MF, Potter LS. Progestin-only oral
contraception: a comprehensive review. Contraception 1994;50(6).
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