エチニルエストラジオール + エトノゲストレル

Estrogen (ethinyl estradiol) and progestogen (etonogestrel) combined hormonal contraceptive (CHC) in the form of a vaginal ring (3 of every 4 weeks).

Hormonal contraceptives, both combined (CHC) 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)}

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

No study has found negative effects on breast milk production or infant weight gain when CHC are started after the first 2, or better 6, weeks postpartum. ^{(Tepper 2015, Bahamondes 2013, Espey 2012)}

During lactation progestin-only contraceptives are preferable to those combined with estrogen and, in this case, those with a lower dose of estrogen. ^{(CDC 2016, 2013 y 2010, WHO/OMS 2015, Altshuler 2015, Berens 2015, CLM 2012)}

If a CHC is used 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 CHC are usually compatible with breastfeeding. ^{(AAP 2001)}

ETHINYLESTRADIOL is a synthetic estrogen that has a similar action as estradiol. 

Its pharmacokinetic data (high percentage of protein binding and very wide volume of distribution) explain the negligible or null passage into breast milk observed. ^{(Betrabet 1986, 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 very little success. ^{(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)}

ETONOGESTREL i a progestin, active metabolite of desogestrel. 

It is excreted in breast milk in negligible amount ^{(Reinprayoon 2000)} and no problems were observed in infants whose mothers used this medication. ^{(Carmo 2017, Bahamondes 2013, Brito 2009, Taneepanichskul 2006)}

See below the information of these related products:

• (Contraceptive combined Estrogen & Progestins) (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Ethinylestradiol (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Etonogestrel (Safe substance and/or breastfeeding is the best option.)