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Birth control pill that contains the combination of an estrogen (Estradiol valerate) and a progestin (Dienogest) for oral use.
Estradiol is excreted into the breast milk in no or small amount. No problems have been observed in infants whose mothers were receiving this drug.
There is evidence (albeit inconsistent) that estrogen-containing pills may decrease milk production, especially during the first few weeks postpartum with a daily dose above 30 micrograms of ethinyl estradiol.
It 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.
Dienogest is a progestin with a similar structure as levonorgestrel. A latest update no published data on excretion into breast milk were found. Progesterone and other progestins 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.
With other similar combined contraceptives no differences have been observed in 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).
During lactation, progestin-only contraceptive pills are preferred to Estrogen containing ones, otherwise, the lowest estrogen dose should be used.
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.