|
Recommendations for Contraceptive Use |
|
|
|
 |
Progestin-Only Pills During Breastfeeding
|
Q.1. When can progestin-only pills
(POPs) be started for breastfeeding women?
|
|
|
| a) If breastfeeding, POPs may be
started after six weeks postpartum. POPs are not
usually recommended in the first six weeks postpartum in breastfeeding women. The timing
of postpartum initiation of POPs should consider a woman's breastfeeding intentions. |
a) For breastfeeding women,
delaying POP initiation for six weeks after delivery avoids exposing the newborn to
exogenous steroids during the time of greatest neuroendocrine development. In
breastfeeding women, the risk of ovulating in the first six weeks postpartum is very low.
The timing of postpartum initiation of POPs should be dependent on the woman's preference,
her previous experience with breastfeeding and her intentions regarding the duration of
breastfeeding.
- Howie PW, McNeilly AS, Houston MJ,
Cook A, Boyle H. Fertility after childbirth: postpartum ovulation and menstruation in
bottle and breast feeding mothers. Clinical Endocrinology 1982;17:323-32.
- Diaz S, Rodriguez G, Peralta O,
Miranda P, Casado ME, Salvatierra AM, et al. Lactational amenorrhea and the recovery of
ovulation and fertility in fully nursing Chilean women. Contraception 1988;38(1):53-67.
- Visness C, Rivera R. Progestin-only
pill use and pill switching during breastfeeding. Contraception 1995;51:279-81.
|
| |
|
b) A woman who initially chooses
to rely on the Lactational Amenorrhea Method (LAM) is advised to begin POPs, or whichever
method she chooses to switch to when one of the following takes place:
- her menses return, or
- she is no longer fully or nearly fully breastfeeding, or
- six months postpartum.
Preferably, POP packets are given to the woman before her
intended start date to ensure that she is able to begin the method when she needs to.
However, if she prefers, POPs can also be started when a woman is still relying on LAM
(providing her with dual protection). |
b) While relying on LAM, a
postpartum woman has at least 98% protection from pregnancy for six months if she remains
amenorrheic and fully or nearly fully breastfeeds (perfect use effectiveness rate).
Programs sometimes encourage waiting to initiate POPs until reliance on LAM ends, because
it may be more programmatically affordable and because using POPs while breastfeeding may
potentially prolong lactational subfertility.
- Kennedy K, Rivera R, McNeilly A.
Consensus statement on the use of breastfeeding as a family planning method. Contraception
1989;39(5):477-96.
- Chaudhury RR, Chompootaweep S,
Dusitsin N, Friesen H, Tankeyoon M. The release of prolactin by medroxyprogesterone
acetate in human subjects. British Journal of Pharmacology 1977;59:433-4.
|
| |
|
| c) After the first six weeks
postpartum, POPs can be initiated any time you can be reasonably
sure a woman is not pregnant (see POP Question 7d). |
c) Based on current literature,
including studies with other progestin-only methods, it is unlikely that there is a
significant effect on the growth of breastfeeding infants whose mothers initiate POPs
after the sixth postpartum week.
- WHO Task Force on Oral Contraceptives.
Effects of hormonal contraceptives on milk volume and infant growth. Contraception
1984;30(6):505-21.
- Shaaban M, Salem H, Abdullah K.
Influence of levonorgestrel contraceptive implants, Norplant, initiated early postpartum
upon lactation and infant growth. Contraception 1985;32(6);623-35.
- Pardthaisong T, Yenchit C, Gray R. The
long-term growth and development of children exposed to Depo-Provera during pregnancy or
lactation. Contraception 1992;45:313-24.
- McCann MF, Moggia AV, Higgins JE,
Potts M, Beeker C. The effects of a progestin-only oral contraceptive (levonorgestrel 0.03
mg) on breastfeeding. Contraception 1989;40(6):635-48.
|
| |
|
| d) Even if POPs are
inadvertently initiated during pregnancy, there is no known risk to the fetus. |
d) Epidemiologic studies have
found no significant effect on fetal development or malformations due to taking hormonal
methods in early pregnancy.
- Bracken MB. Oral contraception and
congenital malformations in offspring: a review and meta-analysis of the prospective
studies. Obstetrics and Gynecology 1990;76:552-7.
- Wiseman RA, Dodds-Smith IC.
Cardiovascular birth defects and antenatal exposure to female sex hormones: a
re-evaluation of some base data. Teratology 1984;30(3):359-70.
- Simpson JL, Phillips OP. Spermicides,
hormonal contraception and congenital malformations. Advances in Contraception
1990;6:141-67.
|
| |
|
| e) Non-hormonal methods are
preferable to hormonal methods during breastfeeding because they have no effect on
breastfeeding and the infant is not exposed to exogenous steroids. However, the World
Health Organization (WHO) lists POPs as Category 1 after six weeks postpartum, and women
should be given a choice of contraceptive methods. |
e) Although the amount of
exogenous progestins in breastmilk is extremely low, it is prudent to try to minimize
infant exposures to any drug.
- Institute of Reproductive Health.
Guidelines for breastfeeding in family planning and child survival programs. Washington,
DC: IRH, 1992.
- World Health Organization. Improving
access to quality care in family planning: medical eligibility criteria for contraceptive
use. Geneva: WHO, 1996.
|
|
