What are the best options for contraception while breastfeeding postpartum?

From the Guidelines

The best contraceptive options while breastfeeding postpartum include progestin-only methods, such as the hormonal IUD or the implant, which can be started immediately after delivery. These methods are preferred because they don't contain estrogen, which can potentially reduce milk supply in some women. The copper IUD is also an excellent option as it's hormone-free and provides up to 10 years of protection. Key considerations for choosing a contraceptive method while breastfeeding include:

• The method's effect on milk supply
• The risk of venous thromboembolism
• The need for backup contraception
• The woman's individual circumstances and medical history According to the Society for Maternal-Fetal Medicine 1, immediate postpartum long-acting reversible contraception (LARC) is recommended for women at high risk for medical complications, and current evidence suggests that these methods do not negatively influence lactation. Additionally, the American College of Obstetricians and Gynecologists (ACOG) supports the use of progestin-only methods during breastfeeding 1. It's essential to discuss the timing and choice of contraceptive method with a healthcare provider, as some methods can be started immediately after delivery while others should wait until milk supply is established. Lactational Amenorrhea Method (LAM) can be effective for up to 6 months if exclusively breastfeeding, but requires strict adherence to exclusive breastfeeding 1. Barrier methods like condoms are also safe options, but may not provide the same level of convenience and efficacy as LARC methods. Overall, the choice of contraceptive method while breastfeeding should prioritize the woman's individual needs and circumstances, while also considering the potential effects on milk supply and overall health.

From the FDA Drug Label

Following delivery or second trimester abortion The use of NuvaRing® for contraception may be initiated four weeks postpartum in women who elect not to breast-feed. Women who are breast-feeding should be advised not to use NuvaRing® but to use other forms of contraception until the child is weaned.

The best options for contraception while breastfeeding postpartum are not NuvaRing®, as it is advised not to use it in breastfeeding women until the child is weaned.

• Other forms of contraception should be used by breastfeeding women until the child is weaned.
• The FDA label does not specify which other forms of contraception are suitable for breastfeeding women, so no conclusion can be drawn about the best alternative options. 2

From the Research

Best Options for Contraception while Breastfeeding Postpartum

The best options for contraception while breastfeeding postpartum include:

• Nonhormonal methods of contraception, which are the preferred choice for breastfeeding women 3
• Progestin-only methods, which comprise a viable next option and do not appear to affect milk volume, composition, or cause deleterious effects in the infant 4, 5
• Barrier methods, such as condoms or spermicides, which have no adverse effects on lactation, the condition of the infant, or on maternal ovarian function 6
• Progestogen-only hormonal methods, such as pills, implants, and injectables, which are also safe for use during breastfeeding 6

Considerations for Contraceptive Methods

When choosing a contraceptive method while breastfeeding, consider the following:

• Combined hormonal methods of contraception containing estrogen and progestin may be considered as a third option for birth control in breastfeeding women, but may decrease milk supply 3, 7
• Combined oral contraceptives are not recommended during lactation as they diminish milk production 6
• Sterilization is only a good alternative if the family wants a permanent method of contraception 6
• Intrauterine devices (IUDs) can be inserted immediately postpartum, but require special training and expertise to minimize the risk of expulsion 5

Timing of Contraceptive Initiation

The timing of contraceptive initiation while breastfeeding is important:

• Progestin-only contraceptives can be started at six weeks postpartum if the woman is fully breastfeeding, to decrease infant exposure to exogenous hormones and decrease the incidence of irregular postpartum bleeding 4
• Nonhormonal methods of contraception can be initiated immediately postpartum 3
• Combined hormonal methods of contraception should be avoided for 2-3 weeks postpartum to avoid elevating the risk of thromboembolism 5