Is Yazz (drospirenone and ethinyl estradiol) safe to use while breastfeeding?

Yazz Should Not Be Used While Breastfeeding

Yazz (drospirenone 3mg/ethinyl estradiol 20mcg) is contraindicated during breastfeeding, particularly in the first 6 months postpartum, due to concerns about decreased milk production and increased thromboembolism risk.

Timing Restrictions for Combined Hormonal Contraceptives During Breastfeeding

The CDC's U.S. Selected Practice Recommendations provides clear guidance on when combined oral contraceptives like Yazz should be avoided:

• First 3 weeks postpartum: Absolute contraindication (U.S. MEC Category 4) due to significantly elevated venous thromboembolism risk 1
• Week 4 postpartum: Generally should not be used (U.S. MEC Category 3) due to potential negative effects on breastfeeding performance and milk production 1
• Weeks 4-6 postpartum with additional VTE risk factors: Generally should not be used (U.S. MEC Category 3) 1

Impact on Milk Production and Infant Nutrition

Combined oral contraceptives containing estrogen have documented adverse effects on lactation:

• Decreased milk volume: Combined OCs cause significant reductions in breast milk output and total energy content 2
• Altered milk composition: Widespread changes in milk constituents occur with combined hormonal contraceptives 2
• Critical timing: These effects are most concerning during the first few weeks or months of lactation when breastfeeding is being established 2

The estrogen component in Yazz (ethinyl estradiol) is the primary culprit, as it suppresses prolactin and interferes with milk production mechanisms.

Safer Contraceptive Alternatives During Breastfeeding

Progestin-Only Options (Preferred)

• Progestin-only pills (norgestrel): No significant changes in milk volume and only minor shifts in milk composition 2
• Depot medroxyprogesterone acetate (DMPA): No significant changes in milk volume with minimal compositional changes 2
• Progestin IUD or implant: Long-acting reversible contraceptives that don't contain estrogen 1

Non-Hormonal Options

• Copper IUD: Highly effective with no hormonal effects on lactation 1
• Barrier methods: Condoms, diaphragms when appropriate 1

Clinical Decision Algorithm

If currently breastfeeding and considering contraception:

1. <3 weeks postpartum: Use non-hormonal methods only; combined OCs are absolutely contraindicated 1
2. 3-6 weeks postpartum: Avoid combined OCs; choose progestin-only or non-hormonal methods 1
3. >6 weeks postpartum: Progestin-only methods remain preferred; if combined OCs are considered, ensure breastfeeding is well-established and supplemental feeding is acceptable 1

If already taking Yazz and planning to breastfeed:

• Discontinue Yazz before delivery 1
• Switch to progestin-only or non-hormonal contraception postpartum 1
• Wait minimum 6 weeks before considering any combined hormonal method, though progestin-only remains preferable throughout breastfeeding 1

Common Pitfalls to Avoid

• Assuming low-dose estrogen is safe: Even the 20mcg ethinyl estradiol in Yazz can significantly impact milk production 2
• Starting too early postpartum: The thromboembolism risk is highest in the first 3 weeks and remains elevated through 6 weeks 1
• Ignoring individual VTE risk factors: Women with additional risk factors (obesity, thrombophilia, cesarean delivery) face even higher risks with combined OCs in the early postpartum period 1
• Not counseling about alternatives: Progestin-only methods provide equivalent contraceptive efficacy without the lactation concerns 2