(Contraceptive combined Estrogen & Progestins)

Contraceptive combination of a estrogen (ethinylestradiol, estradiol or mestranol) and a progestogen drug derived from 19-nor testosterone (desogestrel, drospirenone, etonogestrel, levonorgestrel, norelgestromin, norethindrone ...), that may be marketed as oral pills (combined oral contraceptive: COC), vaginal rings (duration 3 weeks), transdermal patches (duration 3 weeks) or subcutaneous implants (duration 3 years).

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. 

No study has found negative effects on breast milk production or infant weight gain when COC are started after the first 2, or better 6, weeks postpartum. ^{(Tepper 2015, Bahamondes 2013, Espey 2012)}. Only oe study found shorter duration of breastfeeding with the use of estrogen-progestogen combined contraceptives than with progestogen alone. ^{(Goulding 2018)}

No short-term or long-term (8 years) clinical, physical or psychomotor developmental problems have been observed in infants whose mothers were taking a COC ^{(Lopez 2015, Nilsson 1986)}, except for a few cases published years ago of transient gynecomastia. ^{(Madhavapeddi 1985, Nilsson 1978, Marriq 1974, Curtis 1964)}

Hormonal contraceptives, both combined (COC) and progestogen-only, do not alter the composition of milk, neither in minerals (Mg, Fe, Cu, Ca, P) nor in fats, lactose, proteins or calories^{. (Urzica 2013, Dórea 2000, 1999 y 1998, Costa 1992)}

During lactation progestin-only contraceptives are preferable to COC and, in this case, those with a lower dose of estrogen. ^{(Sridhar 2017, CDC 2016, 2013 y 2010, WHO/OMS 2015, Altshuler 2015, Bhardwaj 2015, Berens 2015, CLM 2012, Amir 2011, FFPRHC 2004, WHO 2002, Moretti 2000, WHO 1988)}

If a COC is taken during lactation, it is advisable not to start it before a month and a half after delivery and monitor milk production through the growth of the infant. ^{(Moretti 2000)}

For the first 4-6 weeks postpartum, non-hormonal methods are the first choice, followed by IUDs and progestogen implants. ^{(Berens 2015, Mwalwanda 2013, Rowe 2013, CLM 2012)}

The American Academy of Pediatrics states that COC are usually compatible with breastfeeding. ^{(AAP 2001)}

ESTROGENS are excreted into the breast milk in no or small amount. ^{(Nilsson 1978)}

Estrogens, alone or associated with progestogens, have been used in the treatment of excess milk production(Johnson 2020) and to suppress lactation ^{(Piya 2004, Balmer 1971)}, although with low effectiveness. ^{(Kaern 1967)}

There is low quality evidence that estrogen-containing pills may decrease milk production or the duration of breastfeeding, especially if given during the first few weeks postpartum and with a daily dose equal to or greater than 30 micrograms (0,03 mg) diarios. ^{(WHO 2002, AAP 2001, WHO 1988, Nilsson 1986, Tankeyoon 1984, Díaz 1983, Peralta 1983, Croxatto 1983, Guiloff 1974, Kaern 1967)}

PROGESTOGENS are excreted into breast milk in clinically non-significant amount ^{(Croxatto 1987, Betrabet 1987, Nilsson 1977)} and no problems have been observed in infants whose mothers were treated with this medication. ^{(Roy 2020, Bahamondes 2013, Dutta 2013, Shaamash 2005, Bjarnadóttir 2001, Díaz 1987)}

When measured, the plasma progestogen levels of these infants were very low. ^{(Bassol 2002, Patel 1994, Betrabet 1987, Diaz 1987, Nilsson 1977)}

See below the information of this related group:

• ATC G03AA & G03AB: Hormonal Contraceptives. Estrogens & Progestogens