Этинилэстрадиол + Левоноргестрел

Combined oral contraceptive (COC) of estrogen (ethinyl estradiol) and progestogen (levonorgestrel) 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)}

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)}

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. ^{(Hopelian 2021,Gainer 2007, Betrabet 1987, Toddywalla 1980, Nilsson 1977, Saxena 1977)}

No short and long-term growth and development problems have been observed in infants whose mothers were treated. ^{(Polakow 2013, Shaamash 2005, Schiappacasse 2002, McCann 1989)}

The plasma levels of these infants were undetectable or very low. ^{(Bassol 2002, Patel 1994, Betrabet 1987, Nilsson 1977)}

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.)
• Levonorgestrel (oral, implant, IUD) (Safe substance and/or breastfeeding is the best option.)