Is there a safe contraception patch for breastfeeding women?

Contraception Options for Breastfeeding Women

The progestin-only contraceptive patch is the safest and most appropriate contraceptive patch option for breastfeeding women, as combined hormonal patches containing estrogen may decrease milk production and are not recommended during lactation. 1

Understanding Contraceptive Options During Breastfeeding

Hormonal Contraceptive Hierarchy for Breastfeeding Women

1. Progestin-only methods (first choice)

   • Progestin-only pills (POPs)
   • Progestin implants
   • Progestin IUDs
   • Progestin-only patch (if available)

2. Non-hormonal methods (excellent alternatives)

   • Copper IUD
   • Barrier methods
   • Lactational Amenorrhea Method (LAM) for first 6 months

3. Combined hormonal methods (last resort)

   • Should be avoided until milk supply is well-established (at least 6 weeks postpartum)
   • May decrease milk production 1, 2

Timing Considerations

• Immediate postpartum (0-6 weeks): Progestin-only methods or non-hormonal methods are preferred 1
• Established breastfeeding (6 weeks-6 months): Continue with progestin-only or non-hormonal methods; consider combined hormonal methods only if milk supply is well-established 1
• Beyond 6 months: Any method based on medical eligibility 1

Evidence on Contraceptive Patches

Combined Hormonal Patches

• The combined hormonal patch containing ethinyl estradiol and norelgestromin is not recommended during breastfeeding 3
• Evidence indicates that estrogen-containing contraceptives (including patches) can decrease milk volume 2
• Combined hormonal patches have similar safety profiles to combined oral contraceptives with similar hormone formulations 3

Progestin-Only Options

• Progestin-only methods are preferred for breastfeeding women as they:
  • Do not negatively impact milk production 1, 4
  • Do not affect infant growth or development 4
  • Can be started as early as 6 weeks postpartum (ideally) 2
  • Have perfect use failure rates of <1% 1

Important Considerations and Caveats

Safety Profile

• Small amounts of hormones may transfer into breast milk, but studies show these amounts are typically too low to affect the infant 4
• Progestin-only methods have been widely used postpartum with good safety profiles 4

Potential Side Effects

• Combined hormonal patches may cause:
  • Decreased milk production 2
  • Application site reactions 5
  • Higher risk of venous thromboembolism compared to oral contraceptives (though absolute risk remains low) 5

Special Situations

• Women with certain conditions (HIV, active untreated tuberculosis, herpes simplex lesions on breast) should consider their breastfeeding options carefully 1
• Women receiving certain medications (radioactive isotopes, antimetabolites, chemotherapeutic agents) should discuss alternatives with their healthcare provider 3

Practical Recommendations

1. First-line option: If a contraceptive patch is strongly desired, seek a progestin-only patch formulation

2. Alternative options if progestin-only patch unavailable:

   • Progestin-only pills
   • Progestin implant
   • Progestin IUD
   • Non-hormonal methods (copper IUD, barriers)

3. Last resort: If combined hormonal patch must be used, wait until:

   • At least 6 weeks postpartum
   • Milk supply is well-established
   • Be vigilant for any decrease in milk production

Remember that while the combined hormonal patch is effective for contraception, its use during breastfeeding may compromise lactation success. The progestin-only patch represents the safest patch option for breastfeeding women who prefer a transdermal delivery system.