Last update March 26, 2022
Combined oral contraceptive (COC) of estrogen (ethinyl estradiol) and progestogen (dienogest) 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)
DIENOGEST is a progestogen with a structure similar to levonorgestrel.
At latest update no published data on excretion into breast milk were found.
Its pharmacokinetic data (very high percentage of protein binding and wide volume of distribution) make it highly unlikely that significant quantities will pass into breast milk.
Progesterone and other related progestin drugs 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 1997)
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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