From the Guidelines
The progesterone-only pill can be started immediately after birth, regardless of breastfeeding status, as it is considered safe and effective for postpartum women. According to the most recent guidelines from the CDC, as of 2024 1, there are no restrictions on starting the progesterone-only pill (POP) at any time postpartum. This is in line with the previous recommendations from the American Family Physician in 2015 1, which stated that progestin-only methods can be safely started immediately postpartum.
The key benefits of starting the progesterone-only pill immediately after birth include:
- Reduced risk of unintended pregnancy
- Convenience and ease of use
- No impact on milk production or infant development for breastfeeding mothers
- Low risk of venous thromboembolism (VTE) compared to combined hormonal contraceptives
It's essential to note that the progesterone-only pill works by thickening cervical mucus to prevent sperm from reaching an egg and, in some cases, by preventing ovulation. For maximum effectiveness, the progesterone-only pill should be taken at the same time each day, with a stricter timing window than combined pills. Common progesterone-only pills include Micronor, Nora-BE, and Camila (containing norethindrone), and Slynd (containing drospirenone).
In situations where the healthcare provider is uncertain whether the patient might be pregnant, the benefits of starting the progesterone-only pill likely exceed any risk, and a follow-up pregnancy test can be performed in 2-4 weeks 1. Overall, the progesterone-only pill is a safe and effective contraceptive option for postpartum women, and it can be started immediately after birth.
From the Research
Postpartum Contraception
- The timing of initiation of contraception postpartum is an important consideration for breastfeeding and non-breastfeeding women 2.
- In non-breastfeeding women, progestogen-only pills can be safely used at any time during the postpartum period 2, 3.
Progestogen-Only Pill Initiation
- Most patients can begin using progestin-only contraceptives immediately after childbirth 3.
- There is no restriction on the use of progestogen-only pills in non-breastfeeding women at any time postpartum 2.
- The risk of venous thromboembolism is not significantly increased with the use of progestogen-only pills, except in certain cases such as injectable depot-medroxyprogesterone acetate contraceptives 4, 5, 6.
Breastfeeding Considerations
- In breastfeeding women, combined hormonal pills are not recommended prior to 6 weeks postpartum due to effects on milk production 2.
- Progestogen-only pills do not adversely affect milk production, but the lack of data regarding possible effects on infants exposed to progestogens in breastmilk renders the timing of initiation of this method controversial 2.