Last update: Dec. 13, 2019
Not risky for breastfeeding or infant.
Progestin containing contraceptive drug that is used as a single dose for oral, subcutaneous implant, intrauterine device (IUD), or emergency contraception administration.
Also marketed in association with ethinylestradiol
Levonorgestrel is a progestin, and active metabolite isomer of norgestrel, both derived from nortestosterone.
It is excreted in breast milk in clinically non-significant amount (Gainer 2007, Betrabet 1987, Toddywalla 1980, Nilsson 1977, Saxena 1977), and nono short and long-term growth and development problems have been observed in infants whose mothers were treated (Shaaban 2019 y 2013, Polakow 2013, Shaamash 2005, Schiappacasse 2002, WHO 1994, McCann 1989). The plasma levels of these infants were undetectable or very low (Bassol 2002, Patel 1994, (Betrabet 1987, Nilsson 1977).
A decrease in TSH has been observed in mothers carrying 6 months of levonorgestrel implants and in their breastfed infants (Bassol 2002); TSH was not below the normal limit.
Levonorgestrel and progestogens are generally considered contraceptive drugs of choice during lactation since they neither alter the quantity and composition of milk nor cause side effects on both growth of infants and the duration of breastfeeding (Shaaban 2019, Goulding 2018, Polakow 2013, Bahamondes 2013, Shaamash 2005).
Published study results have shown protection against breast bone mass loss with the use of progestin-only contraceptives (Costa 2012).
Early insertion, postpartum versus the 4th-6th week, of an intrauterine device with levonorgestrel is associated with decreased breastfeeding duration (Chen 2011).
For the first 6 weeks postpartum, non-hormonal methods are of choise. There is a debate on the role of progestin-related drugs in decreasing milk production when used before lactation has been fully established.
Several medical societies, experts and expert consensus, consider the use of this medication to be safe during breastfeeding (CDC 2016, 2013 y 2010, Phillips 2016, Berens 2015, WHO-OMS 2015, Mwalwanda 2013, FFPRHC 2004, Halderman 2002, Díaz 2002); levonorgestrel oral pills being acceptable from the first postpartum day.
The American Academy of Pediatrics states that this medication is usually compatible with breastfeeding (AAP 2001).
WHO List of Essential Medicines 2002: rates it as compatible with breastfeeding after the 6th postnatal week (WHO 2002).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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