Can I take medroxyprogesterone contraceptive injections while pregnant or breastfeeding?

8.1 Pregnancy Risk Summary There is no use for contraception in pregnancy; therefore, medroxyprogesterone acetate should be discontinued during pregnancy. Epidemiologic studies and meta-analyses have not found an increased risk of genital or non-genital birth defects (including cardiac anomalies and limb-reduction defects) following exposure to progestins before conception or during early pregnancy. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

Prescribing label, section “8.1 Pregnancy”: medroxyprogesterone acetate (intramuscular), REMEDYREPACK INC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

This quote is from the intramuscular formulation label.

Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as depot medroxyprogesterone acetate (DMPA) are considered the hormonal contraceptives of choice during all stages of lactation. Fair to moderate quality evidence indicates that DMPA does not adversely affect the composition of milk, the growth and development of the infant, or the milk supply.[1,2] Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.[3-5]

The timing of initiation of DMPA is controversial.[6] The product labeling states that it should be started no sooner than 6 weeks postpartum, based on data submitted for product approval; and, starting too soon theoretically could affect the newborn infant adversely because of slower metabolism of the drug than older infants. Studies of fair quality seem to indicate that concerns about immediate adverse effects on the infants is unfounded. Of concern is that no data exist on the effects of progesterone on brain and liver development at this age. A systematic review of studies using early postpartum initiation of DMPA concluded that all of the studies were of low quality and inadequate to disprove the concern about DMPA's effects on milk production if given sooner than 6 weeks after delivery.[7] A subsequent study raised the possibility of a slight reduction in breastfeeding duration in women given DMPA before hospital discharge,[8] and another study found that breastfeeding was less like to be initiated if mothers received immediate postpartum DMPA.[9] Other recent studies of variable quality have found no effect on lactogenesis-II or duration of breastfeeding.

Expert opinion in the United States holds that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[1] The World Health Organization recommends that injectable depot medroxyprogesterone acetate should not be used before 6 weeks postpartum.[2]

“Summary of Use during Lactation”, LactMed record “Medroxyprogesterone Acetate” (LM415), quoted verbatim. Everything LactMed reports about Medroxyprogesterone Acetate while breastfeeding.

8.2 Lactation Risk Summary Although medroxyprogesterone acetate is detectable in the milk of mothers receiving medroxyprogesterone acetate, milk composition, quality, and amount do not appear to be adversely affected. Effects on milk production and lactation initiation/duration remain unclear when administered before 6 weeks after delivery, therefore, in mothers who exclusively breastfeed, initiate medroxyprogesterone acetate during or after the sixth post-partum week [see Dosage and Administration (2.1) ]. No adverse effects in breastfed infants would be expected with maternal use of progestins. Neonates and infants exposed to medroxyprogesterone acetate from breast milk have been studied and no adverse effects have been noted. The developmental and health benefits of breast-feeding should be considered along with the mother’s clinical need for medroxyprogesterone acetate and any potential adverse effects on the breastfed child from medroxyprogesterone acetate or from the underlying maternal condition.

Prescribing label, section “8.2 Lactation”: medroxyprogesterone acetate (intramuscular), REMEDYREPACK INC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

This quote is from the intramuscular formulation label.