Is Nexplanon (etonogrel) safe during breastfeeding?

From the Guidelines

Nexplanon is safe for use during breastfeeding, as studies have found no significant effects on breastfeeding performance or infant health and growth. The main theoretical concern about contraceptive implant use in the postpartum period is whether the progestin might have some effect on breastfeeding; however, research has generally found no effects on breastfeeding performance or infant health and growth 1.

Key Points to Consider

• Nexplanon contains etonogestrel, a progestin hormone, which does not contain estrogen, making it a good option for breastfeeding mothers.
• 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.
• Some studies suggest that progestin-only contraceptives like Nexplanon may actually have a neutral or slightly positive effect on milk production.
• Nexplanon can be inserted any time after childbirth, including immediately postpartum, providing highly effective contraception for up to 3 years.
• Side effects for the mother may include irregular bleeding patterns, headaches, or mood changes, but these do not affect the nursing infant.

Clinical Considerations

• When starting an implant, patients should be counseled that a backup method should be used for at least the first week for contraceptive efficacy and that a condom should be used at all times for protection against STIs.
• 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.

Recommendations

• Nexplanon can be safely used in breastfeeding mothers without concerns about harming the baby or affecting milk supply.
• Healthcare providers should counsel patients on the benefits and potential side effects of Nexplanon use during breastfeeding.

From the FDA Drug Label

Small amounts of contraceptive steroids and/or metabolites, including etonogestrel 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 The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Etonogestrel and any potential adverse effects on the breastfed child from Etonogestrel or from the underlying maternal condition.

Nexplanon, which contains etonogestrel, may be safe in breastfeeding. However, it is recommended to consider the developmental and health benefits of breastfeeding and the mother's clinical need for the medication, as well as potential adverse effects on the breastfed child. Additionally, CHCs can reduce milk production in breastfeeding mothers, although this is less likely to occur once breastfeeding is well-established. It is advised to use non-estrogen-containing contraception until the child is weaned, if possible 2. Key considerations include:

• Small amounts of etonogestrel are transferred to human milk
• Harmful effects have not been observed in breastfed infants
• Potential reduction in milk production
• Developmental and health benefits of breastfeeding should be considered

From the Research

Safety of Nexplanon in Breastfeeding

• Nexplanon, a progestin-only contraceptive implant, has been evaluated for its safety during breastfeeding in several studies 3, 4, 5, 6, 7.
• The majority of the evidence suggests that progestin-only contraceptive methods, including Nexplanon, are safe for use during breastfeeding and do not adversely affect lactation or infant growth 4, 5, 6.
• A study published in 2002 found that contraceptive implants, including Implanon (which is similar to Nexplanon), had no negative effect on breastfeeding or infant growth and development 4.
• Another study published in 2023 found that progestin-only contraceptive methods continue to demonstrate safety in breastfeeding patients, while low-quality evidence supports concerns of decreased milk supply with combined hormonal contraception 3.
• A 2024 review of the literature on the safety of progestogen hormonal contraceptive methods during lactation found that these methods can be considered a relatively safe solution for women desiring to continue breastfeeding while using hormonal contraception 5.
• A 2015 systematic review of combined hormonal versus nonhormonal versus progestin-only contraception in lactation found that progestin-only methods, including implants like Nexplanon, did not adversely affect breastfeeding performance or infant growth 7.

Key Findings

• Progestin-only contraceptive methods, including Nexplanon, are safe for use during breastfeeding 4, 5, 6.
• Nexplanon does not adversely affect lactation or infant growth 4, 5, 6.
• The evidence suggests that progestin-only methods of contraception do not interfere with lactation or infant development 3, 5, 6.
• Women should be informed of the potential risks and benefits of using Nexplanon during breastfeeding and allowed to make their own decision based on the latest medical knowledge 5.