From the Guidelines
Breastfeeding mothers should avoid combined hormonal contraceptives during the first 3 weeks after delivery and consider alternative methods such as progestin-only pills, hormonal implants, or non-hormonal options like copper IUDs or barrier methods. When considering birth control options for breastfeeding mothers, it's essential to prioritize methods that do not affect milk supply or increase the risk of venous thromboembolism. According to the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 1, postpartum women who are breastfeeding should not use combined hormonal contraceptives during the first 3 weeks after delivery due to concerns about increased risk for venous thromboembolism.
Some effective alternatives for breastfeeding mothers include:
- Progestin-only pills, such as Micronor and Nor-QD, which can be started immediately after childbirth and do not affect milk supply 1
- Hormonal implants like Nexplanon, which are safe to use while breastfeeding 1
- Injectable contraceptives like Depo-Provera, which can be used by breastfeeding mothers 1
- Non-hormonal options like copper IUDs (ParaGard), which can be inserted as soon as 4 weeks postpartum 1
- Barrier methods like condoms, which can be used at any time
It's also important to note that Lactational Amenorrhea Method (LAM) can provide temporary protection (up to 6 months) if the baby is exclusively breastfed, feeds at least every 4 hours during the day and 6 hours at night, and the mother hasn't resumed menstruation 1. However, LAM is time-limited and less reliable than other methods. Breastfeeding mothers should discuss their specific health history with their healthcare provider to determine the most appropriate contraceptive method. The CDC specifies time frames for postpregnancy contraception, and estrogen-containing methods should be deferred until at least three or up to six weeks postpartum, partly because of the risk of venous thromboembolism 1.
From the FDA Drug Label
However, to maintain effective protection against pregnancy, another method of contraception must be used as soon as menstruation resumes, the frequency or duration of breastfeeds is reduced, bottle feeds are introduced, or the baby reaches 6 months of age Lactational Amenorrhea Method: LAM is a highly effective, temporary method of contraception.
Birth Control for Breastfeeding:
- The Lactational Amenorrhea Method (LAM) is a highly effective, temporary method of contraception for breastfeeding women.
- To maintain effective protection against pregnancy, another method of contraception must be used as soon as menstruation resumes, the frequency or duration of breastfeeds is reduced, bottle feeds are introduced, or the baby reaches 6 months of age 2.
From the Research
Birth Control Options for Breastfeeding Women
- Nonhormonal methods of contraception are the preferred choice for breastfeeding women 3
- Progestin-only methods comprise a viable next option for breastfeeding women 3, 4
- Combined hormonal methods of contraception containing estrogen and progestin may be considered as a third option for birth control in breastfeeding women, but may increase the risk of venous thrombosis 3, 5
Safety of Progestin-Only Contraceptives for Breastfeeding Women
- Progestin-only contraceptive methods have been shown to be safe for breastfeeding patients 6, 7
- Studies have demonstrated no adverse effects of progestogen-only methods on lactation, infant growth, health, or development when used by breastfeeding women 7
- However, low-quality evidence supports concerns of decreased milk supply with combined hormonal contraception 6
Considerations for Contraceptive Selection
- Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences 5
- Breastfeeding women should consider the potential impact of hormonal contraception on lactation when selecting a contraceptive method 6