Is Nexplanon (etonogrel) safe during breastfeeding?

From the Guidelines

Nexplanon is generally considered safe to use while breastfeeding, as the amount of hormone that passes into breast milk is very small and has not been shown to have negative effects on infant growth, health, or development. This contraceptive implant, which contains the hormone etonogestrel, can be inserted as early as 21 days after childbirth and provides effective birth control for up to 3 years 1. The progestin-only nature of Nexplanon makes it a preferred option for breastfeeding mothers since it doesn't contain estrogen, which can potentially reduce milk supply in some women. Some women may experience changes in their milk supply when using hormonal contraceptives, but this is less common with progestin-only methods like Nexplanon compared to estrogen-containing contraceptives.

Key Points to Consider

• The American College of Obstetricians and Gynecologists (ACOG) and the CDC both support immediate postpartum insertion of implants as a safe and effective practice that removes barriers to care 1.
• Nexplanon offers the advantage of being highly effective (with a failure rate of 0.2%) without requiring daily attention, which can be particularly helpful during the demanding postpartum period when caring for a newborn 1.
• If you notice any changes in your milk production after insertion, contact your healthcare provider.

Important Considerations for Healthcare Providers

• Providing contraceptive counseling and a full range of contraceptive options, including immediate postpartum LARC, is a means of overcoming barriers to contraceptive use for medically complex women 1.
• The long-acting nature of LARC allows women to optimize chronic health conditions prior to conception, but LARC methods remain easily reversible when pregnancy is desired 1.

From the FDA Drug Label

Small amounts of contraceptive steroids and/or metabolites, including etonogestrel and ethinyl estradiol are transferred to human milk. Harmful effects have not been observed in breastfed infants exposed to CHCs through breast milk. CHCs can reduce milk production in breastfeeding mothers This is less likely to occur once breastfeeding is well-established; however, it can occur at any time in some women. When possible, advise the nursing mother to use non-estrogen-containing contraception until she has completely weaned her child

Nexplanon (etonogestrel) safety during breastfeeding:

• Key points:
  • Small amounts of etonogestrel are transferred to human milk
  • No harmful effects have been observed in breastfed infants
  • May reduce milk production in breastfeeding mothers
• Clinical decision: Nexplanon (etonogestrel) is considered safe during breastfeeding, but may affect milk production. It is recommended to use non-estrogen-containing contraception when possible, until the child is weaned 2

From the Research

Safety of Nexplanon during Breastfeeding

• The safety of Nexplanon (etonogestrel) during breastfeeding has been evaluated in several studies 3, 4, 5.
• According to a study published in Contraception in 2002, the use of Implanon, which releases etonogestrel, does not affect breastfeeding or infant growth and development 3.
• The study found that the infant's daily intake of steroids from maternal milk during the first month of use ranges from 75-120 ng of etonogestrel 3.
• Another study published in Thrombosis research in 2011 notes that progestogen-only pills, such as those used in Nexplanon, do not adversely affect milk production in breastfeeding women 4.
• However, the study also mentions that there is a lack of data regarding the possible effects on infants exposed to progestogens in breastmilk, which may render the timing of initiation of this method controversial 4.
• A more recent study published in International journal of gynaecology and obstetrics in 2024 notes that guidelines agree on the prescription of progestin-only implants, such as Nexplanon, postpartum in non-breastfeeding women, but differences are found in women who breastfeed 5.
• The study suggests that implants are considered safe for use in breastfeeding women, but the guidelines give different indications regarding the timing of insertion 5.

Recommendations for Use

• The American College of Obstetricians and Gynecologists recommends that progestin-only implants, such as Nexplanon, can be used in breastfeeding women, but it is essential to consider the individual woman's circumstances and medical history 5.
• A study published in Primary care in 2021 notes that Nexplanon is the only contraceptive implant currently available in the United States and is the most effective method of long-acting reversible contraception 6.
• However, another study published in Breastfeeding medicine in 2023 suggests that combined hormonal contraceptives may be a better alternative to progestogen-only pills, such as Nexplanon, in breastfeeding women who experience breakthrough bleeding 7.