From the Guidelines
The best contraceptive option for this patient is a progestin-only method, specifically the progestin-only pill (POP), also known as the minipill. This is an appropriate choice for a breastfeeding woman at 2 weeks postpartum who desires immediate contraception, as it does not affect milk production or infant development 1. The progestin-only pill contains only progestin (no estrogen) and is safe for breastfeeding women. Common progestin-only pills include norethindrone 0.35 mg taken daily at the same time each day with no pill-free intervals.
This method is particularly suitable for this patient because she has a history of conceiving while breastfeeding previously and wants reliable contraception immediately. Additionally, progestin-only methods can reduce menstrual bleeding, which would benefit her iron deficiency anemia from heavy menstrual bleeding. Other progestin-only options that could be considered include the etonogestrel implant (Nexplanon) or the levonorgestrel intrauterine system (Mirena, Liletta), which provide longer-term contraception and may further reduce menstrual bleeding.
Key considerations in choosing a contraceptive method for this patient include:
- Her desire for immediate and reliable contraception
- Her breastfeeding status
- Her history of iron deficiency anemia due to heavy menstrual bleeding
- Her lack of other chronic medical conditions or medications that may interact with contraceptive methods
- The need to avoid estrogen-containing contraceptives in the early postpartum period, especially in breastfeeding women, due to increased thrombosis risk and potential effects on milk production 1.
Given these factors, a progestin-only method is the best choice for this patient, with the progestin-only pill being a convenient and effective option.
From the Research
Contraceptive Options for a Breastfeeding Woman
The patient is a 25-year-old woman who is breastfeeding exclusively and seeking reliable contraception. Considering her situation, the following points are relevant:
- She has a history of conceiving while breastfeeding after her first pregnancy, indicating a need for effective contraception 2.
- She is taking daily iron supplementation for iron deficiency anemia due to heavy menstrual bleeding, which may influence the choice of contraceptive method 2.
- The patient has no other chronic medical conditions and takes no other medications, making her a suitable candidate for various contraceptive options 2.
Characteristics of Progestin-Only Contraceptives
Progestin-only contraceptives (POCs) are a suitable option for breastfeeding women, as they do not contain estrogen, which can affect milk production. The characteristics of POCs include:
- They are available in various forms, such as pills, injections, implants, and intrauterine systems 3, 4.
- POCs have specific advantages and disadvantages, and clinicians should provide adequate information and counseling to women considering their use 3.
- The efficacy of POCs varies, but they are generally safe and well-tolerated by women, including adolescents 4, 5, 6.
Suitable Contraceptive Options
Based on the patient's situation and the characteristics of POCs, the following options may be suitable:
- Progestin-only pills, which are a convenient and reversible option, but may have variable efficacy and bleeding patterns 5, 6.
- Intrauterine devices (IUDs), such as the levonorgestrel-releasing IUS, which have high efficacy and are suitable for breastfeeding women 3, 4.
- Implants, such as the etonogestrel-releasing implant, which have high efficacy and are convenient, but may have specific advantages and disadvantages 3, 4.