Recommended Birth Control Options for Breastfeeding Mothers
Progestin-only contraceptives are the preferred hormonal method for breastfeeding mothers, with non-hormonal methods like copper IUDs being excellent first-line options due to their high efficacy and lack of impact on breastfeeding. 1
First-Line Options for Breastfeeding Women
Non-Hormonal Methods
- Copper IUD: Highly effective, no impact on milk production or composition
- Lactational Amenorrhea Method (LAM): Effective for up to 6 months if:
- Woman is exclusively or nearly exclusively breastfeeding (≥85% of feeds)
- Has not had return of menses
- Baby is less than 6 months old 2
- Barrier methods: Condoms, diaphragms, cervical caps
- Fertility awareness-based methods: Can be used but may be less reliable during postpartum period
Progestin-Only Methods
- Can be started immediately postpartum with no negative effects on breastfeeding 2, 1
- Options include:
- Progestin-only pills (POPs): <1% failure rate with perfect use 1
- Etonogestrel implant: Can be inserted at any time postpartum with high efficacy 1
- Levonorgestrel IUD: Safe for breastfeeding women with added benefit of reducing menstrual blood loss 1
- Injectable contraceptives (DMPA): Effective but use with caution as some studies suggest possible impact on milk production
Timing of Contraception Initiation
Progestin-Only Methods
- Can be started immediately after delivery 1
- If started within 6 months postpartum in fully breastfeeding women, no backup contraception needed 1
Combined Hormonal Contraceptives
- Should be avoided until at least 6 weeks postpartum in breastfeeding women 1
- May reduce milk volume and should be used with caution in women who cannot obtain supplemental milk 3
- Consider only after breastfeeding is well-established or when beginning to wean 3
Special Considerations
Contraindications for Breastfeeding
- Women with HIV (in developed countries where formula is accessible) 2
- Women with active untreated tuberculosis 2
- Women positive for human T-cell lymphotropic virus types I or II 2
- Women with herpes simplex lesions on a breast (can feed from unaffected breast) 2
- Women receiving certain medications (radioactive isotopes, antimetabolites, chemotherapeutic agents, drugs of abuse) 2
Risk of Venous Thromboembolism
- Combined hormonal contraceptives increase risk of venous thromboembolism postpartum 4
- Women with additional risk factors for thromboembolism should avoid combined hormonal methods for 4-6 weeks after delivery 1
Effectiveness Comparison
| Method | Perfect Use Failure Rate | Typical Use Failure Rate |
|---|---|---|
| Copper IUD | <1% | <1% |
| Hormonal IUD | <1% | <1% |
| Implant | <1% | <1% |
| Combined OCPs | 0.3% | 7% |
| Progestin-only pills | <1% | Similar to combined OCPs |
| LAM (first 6 months) | 0.5% | 2% |
Practical Recommendations
Immediate postpartum (0-6 weeks):
- LAM if exclusively breastfeeding
- Progestin-only methods (pills, implant, IUD)
- Non-hormonal methods (copper IUD, barriers)
Established breastfeeding (6 weeks-6 months):
- Continue LAM if criteria are still met
- Any progestin-only method
- Consider combined hormonal methods only if milk supply is well-established and no issues with production
Beyond 6 months postpartum:
- Any method based on personal preference and medical eligibility
- LAM no longer reliable after 6 months
Common Pitfalls to Avoid
- Starting combined hormonal contraceptives too early: Can reduce milk supply before breastfeeding is established 3
- Overreliance on LAM: Effectiveness decreases significantly when not following all three criteria strictly 2
- Ignoring return of fertility: Ovulation can occur before first menses, especially in women who are not exclusively breastfeeding
- Discontinuing contraception due to irregular bleeding: Progestin-only methods commonly cause irregular bleeding patterns; proper counseling improves compliance 5
By following these recommendations, breastfeeding mothers can choose effective contraception that will not interfere with lactation while providing reliable pregnancy prevention.