Is Contraceptives, Oral, Combined safe while breastfeeding?

Effects on the breastfed infant

Bilateral breast enlargement was reported in a 3-week-old male breastfed infant whose mother began taking an oral contraceptive containing norethynodrel 2.5 mg and mestranol 100 mcg on day 3 postpartum. On the second cycle, she began taking norethynodrel 5 mg and mestranol 75 mcg in error and the breast enlargement became more pronounced. After discontinuation of breastfeeding, the breasts returned to normal within 2 to 3 weeks.[ 8 ] The contraceptive probably caused the breast enlargement. Bilateral breast enlargement occurred in an otherwise normal 3-month-old male infant whose mother began a combination contraceptive containing 100 mcg of ethinyl estradiol for 21 days with the last 6 days also containing 5 mg of norethindrone. The woman stopped the contraception and the gynecomastia disappeared completely in about 4 weeks.[ 9 ] The contraceptive possibly caused the breast enlargement. In a study of women given a combination of 50 mcg of ethinyl estradiol and 250 mcg of levonorgestrel, an infant (sex not stated) developed transient gynecomastia after 3 months of maternal therapy.[ 5 ] The contraceptive possibly caused the breast enlargement. An 18-month old partially breastfed girl developed bilateral breast enlargement 3 months after her mother began taking an oral contraceptive containing ethinyl estradiol 30 mcg and levonorgestrel 150 mcg. Breastfeeding was discontinued and breast enlargement decreased over the next 6 months. The girl was growing and developing normally at 7 years of age.[ 10 ] The contraceptive possibly caused the breast enlargement. A 10-month-old male infant presented after 3 weeks of vomiting, diarrhea and deterioration in nutritional status. Laboratory evaluation found folic acid deficiency and macrocytic anemia which responded well to folic acid. The mother had been taking a combination oral contraceptive (ingredients not specified) for 3 months. The authors attributed the folic acid deficiency to maternal contraceptive use.[ 11 ] The con

Effects on milk supply

High-dose estrogens, alone or in combination with an androgen, were formerly used to suppress lactation in women who did not wish to breastfeed.[ 13 ] Combination oral contraceptives containing mestranol 100 mcg daily has also been used as a method for decreasing postpartum breast engorgement in women who did not breastfeed.[ 14 , 15 ] In a randomized, double-blind study, 2 tablets twice daily for 5 days of a combination oral contraceptive containing 50 mcg of ethinyl estradiol had similar efficacy to bromocriptine (dosage not stated) in suppressing postpartum breast engorgement and lactation.[ 16 ] Changes in milk composition of breastmilk (total and nonprotein nitrogen, alpha-lactalbumin, lactoferrin, and albumin) have been observed in women taking various combination contraceptives containing 30 to 50 mcg of ethinyl estradiol and levonorgestrel 150 to 250 mcg or megestrol acetate 4 mg. However, the changes were generally within the normal range of values for healthy women.[ 17 ] Similar results were reported by another group with similar combined contraceptives.[ 18 ] Another study found no clinically important changes in the composition in the milk of mothers taking a combination contraceptive containing 150 mcg of levonorgestrel and 30 mcg of ethinyl estradiol starting at 6 weeks postpartum. However, milk volume was decreased compared to women who used no hormonal contraception.[ 19 , 20 ] In a partially randomized study, 25 postpartum women who wanted to breastfeed their infants were given an oral contraceptive containing mestranol 80 mcg and norethindrone 1 mg daily starting 6 weeks postpartum. The duration of lactation and the weight gain of the breastfed infants was reduced among the mothers who received the contraceptive compared to 25 mothers randomized to receive a placebo or who took no tablets.[ 21 ] In a double-blind trial (randomization not stated), mothers were given either placebo (n = 218) or a combination oral contraceptive containing mestranol 5

Levels in milk

Combination contraceptives contain an estrogen and a progestin. Ethinyl estradiol is the most commonly used estrogen. Mestranol is an ethinyl estradiol pro-drug; 80 mcg of mestranol is equivalent to 50 mcg of ethinyl estradiol. The progestins are primarily 19-nor testosterone derivatives such as levonorgestrel, norgestrel, norethindrone and norethynodrel. They have varying degrees of androgenic activity. Maternal Levels. Studies that measured ethinyl estradiol in breastmilk are reported here. Studies that reported progestin levels in milk (e.g., levonorgestrel, norethindrone) can be found in the records of those drugs. Four women who were fully nursing their infants were given a contraceptive containing ethinyl estradiol 50 mcg and megestrol acetate 4 mg beginning at 2 months postpartum. Another 4 women who were 6 to 18 months postpartum were given a single dose of 500 mcg of ethinyl estradiol. After 10 days of therapy, ethinyl estradiol was undetectable ( 50 ng/L) in the milk of women who received the 50 mcg dose at several times after the dose. In those who receive 500 mcg, peak milk levels usually were found in the 3-hour sample although the peak was found in the 7-hour sample in one. Peak milk levels ranged from about 170 to 300 ng/L; levels dropped rapidly and were usually undetectable by 23 hours after the dose. Based on the higher dose, the authors estimated that a fully breastfed infant whose mother was taking 50 mcg of ethinyl estradiol daily would receive a dose of about 10 ng daily.[ 5 ] Milk was collected and pooled from 2 groups of women who were taking ethinyl estradiol 100 mcg 3 times daily either immediately postpartum or after 1 to 6 months postpartum. Milk samples were collected 2 hours after the dose. Pooled milk was bioassayed for estrogenic activity and compared with the milk from lactating mothers taking no exogenous estrogens whose milk was collected at various times postpartum. No estrogenic activity was detected ( 10 ng/80 mL of pooled milk

Alternatives LactMed lists

• Etonogestrel
• Intrauterine Copper Contraceptive
• Oral Levonorgestrel
• Intrauterine Levonorgestrel
• Levonorgestrel Implant
• Medroxyprogesterone Acetate
• Progesterone