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Recommendations for Contraceptive Use |
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Progestin-Only Injectables |
Q.2. When can the first
progestin-only injection be given postpartum?
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| For Breastfeeding Women: |
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| a) If the woman chooses to rely
on the Lactational Amenorrhea Method (LAM), start injectable progestins when her menses*
return, or when the woman is no longer fully or nearly fully breastfeeding or at 6 months
postpartum, whichever comes first (see "Relying on
Lactational Amenorrhea Method"). * NOTE:
In breastfeeding women, bleeding in the first 56 days (8 weeks) postpartum is NOT
considered "menstrual" bleeding, because it is not preceded by ovulation. |
a) Risk of pregnancy during
lactational amenorrhea is very low: less than 2% in first 6 months postpartum if fully
breastfeeding; less than or equal to 7% in first 12 months. If the fully or nearly-fully
breastfeeding woman remains amenorrheic, her risk of pregnancy is about the same as her
risk with other modern contraceptive methods.
- Bellagio Consensus Conference on
Lactational Infertility. Bellagio consensus statement on the use of breastfeeding as a
family planning method. Contraception 1989;39(5):477-496.
- Kennedy KI, Visness CM. Contraceptive
efficacy of lactational amenorrhea. The Lancet 1992;339:227-230.
- Perez A, Labbok MH, Queenan JT.
Clinical study of the lactational amenorrhea method for family planning. The Lancet
1992;339:968-970.
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| b) If she does not want to rely
on LAM, ideally wait at least 6 weeks postpartum to initiate injectable progestins. |
b) Based on animal studies and
observed fluctuations of human sex hormones in the first 6 weeks of life, plus the
immaturity of the neonatal liver for the metabolism of exogenous steroids, it is
considered prudent to wait to initiate progestin-only contraceptives until a breastfeeding
woman is at least 6 weeks postpartum.
- Harlap S. Exposure to contraceptive
hormones through breast milk -are there long-term health consequences? International
Journal of Gynaecology and Obstetrics 1987;25(Suppl):47-55.
- Ward RM. Pharmacologic principles and
practicalities, in Taeusch HW, Ballard RA, Avery ME (eds). Diseases of the Newborn.
Philadelphia, WB Saunders Company, 1991.
Studies have detected no clinically measurable effects on
the health or growth of breastfed babies of women who begin using progestin-only
injectables at 6 weeks postpartum.
- WHO Task Force on Oral Contraceptives.
Effects of hormonal contraceptives on milk volume and infant growth. Contraception 1984;30(6):505-521.
- WHO Task Force on Oral Contraceptives.
Special Programme of Research, Development, and Research Training in Human Reproduction.
Effects of hormonal contraceptives on breast milk composition and infant growth. Studies
in Family Planning 1988;19(6):361-369.
- Karim M, Ammar R, El Mahgoub S, EL
Ganzoury B, Fikri F, Abdou I. Injected progestogen and lactation. British Medical
Journal 1971;1:200-203.
- Pardthaisong T, Yenchit C, Gray R. The
long-term growth and development of children exposed to Depo-Provera during pregnancy or
lactation. Contraception 1992;45:313-324.
- Zacharias S, Aguilera E, Assenzo JR,
Zanartu J. Effects of hormonal and non-hormonal contraceptives on lactation and incidence
of pregnancy. Contraception 1986;33(3):203-213.
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| For Non-Breastfeeding Women:
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| a) The first progestin-only
injection can be given immediately postpartum and whenever the service provider can be reasonably sure that the woman is not pregnant. |
a) While there may be a
theoretical concern of increased thrombogenic effect with COC use in the first week
postpartum, there is no known clinical thrombogenic effect of progestin-only
contraceptives; therefore injectable progestins can be safely used immediately postpartum,
for non-breastfeeding women.
- Injectable Contraceptives: Their
Role in Family Planning Care. Geneva, World Health Organization, 1990.
- Fotherby K. The progestin-only pill
and thrombosis. The British Journal of Family Planning 1989;15:83-85.
- Chi I. The safety and efficacy of
progestin-only oral contraceptives -An epidemiological perspective. Contraception
1993;47:1-21.
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