Last update: Feb. 7, 2016
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Contraceptive combination of estrogen (usually ethinylestradiol) and a progestogen drug derived from 19-nor testosterone (desogestrel, drospirenone, etonogestrel, levonorgestrel, norelgestromin, norethindrone ...), that may be marketed as oral pills, vaginal rings (duration 3 weeks), transdermal patches (duration 3 weeks) or subcutaneous implants (duration 3 years).
Estrogen and related drugs are excreted into the breast milk in no or small amount. No problems have been observed in infants whose mothers were receiving this medication.
There is evidence (albeit inconsistent) that estrogen-containing pills may decrease milk production, especially during the first few weeks postpartum.
They may reduce the protein content of the milk.
No problems have been observed in infants whose mothers were treated, except some cases of transient gynecomastia in infants whose mothers were receiving a higher dose than usual.
Progestogen and related drugs are excreted into breast milk in clinically non-significant amount and no problems have been observed in infants whose mothers were treated. Plasma levels in these infants were usually very low.
There is some evidence, but inconsistent, that estrogen-based contraceptives may reduce milk production and that the progestin ones when administered early after birth may inhibit the initiation of lactation.
Several studies and metha-analysis have failed to find any difference on the frequency of breastfeeding or the amount of milk produced or weight gain of breastfed infants compared to other contraceptive methods (intrauterine devices, isolated progestogens). However, it would be advisable to avoid them until breastfeeding is well established (4-6 weeks).
However, most protocols on contraception and breastfeeding advised to avoid the use of them until breastfeeding is full established (4-6 weeks) with preference to progestin-only contraceptives.
When combined with estrogen, a lower dose of estrogen is recommended.
Within the first 6 postpartum weeks, non-hormonal methods are in the first line of choice.
Hormone containing contraceptives do not affect the composition of milk, minerals (Mg, Fe, Cu, Ca, P) fat, lactose and calories but only a few the proteins.
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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