Last update April 8, 2022
Combined oral contraceptive (COC) of estrogen (ethinyl estradiol) and progestogen (norethisterone) in the form of pills for oral use. Daily administration.
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)
No short-term or long-term 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)
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)
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 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)
ESTRADIOL is excreted into breast milk in clinically insignificant (Nilson 1978) or null amounts (Pinheiro 2016, Perheentupa 2004) and no problems have been observed in infants whose mothers were treated. (Reisman 2018, Pinheiro 2016)
Plasma levels of these infants were undetectable or very low. (Pinheiro 2016)
After administration in the form of transdermal patches milk levels have been undetectable. (Pinheiro 2016, Perheentupa 2004)
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)
NORETHISTERONE (norethindrone) is a progestin derivative of 19-nortestosterone.
It is excreted in breast milk in clinically significant amount (Betrabet 1987, Toddywalla 1980, Saxena 1977) and no problems have been observed in infants whose mothers took it. (WHO 1994, Shaaban 1991, Giner 1976, Karim 1971)
Plasma levels of these infants were undetectable or very low.(Betrabet 1987)
No alterations have been observed in the amount or composition of breast milk in mothers treated with norethindrone. (Giner 1976)
Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.
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e-lactancia is a resource recommended by Academy of Breastfeeding Medicine - 2006 of United States of America
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