Progesterone-Only Patch for Birth Control While Breastfeeding
A progesterone-only patch does not exist—the norelgestromin patch is a combined hormonal contraceptive containing both estrogen and progestin, and should NOT be used during breastfeeding, especially in the first 6 weeks postpartum.
Critical Clarification: The Patch is NOT Progestin-Only
The contraceptive patch releases 150 μg of norelgestromin (a progestin) AND 20 μg ethinyl estradiol (an estrogen) daily, making it a combined hormonal contraceptive, not a progestin-only method 1. This is a crucial distinction that fundamentally changes the safety profile during breastfeeding.
Why the Patch is Contraindicated During Breastfeeding
Timing Restrictions for Breastfeeding Women
Breastfeeding women should NOT use combined hormonal contraceptives (including the patch) during the first 3 weeks after delivery (U.S. MEC Category 4) due to significantly increased risk for venous thromboembolism 1.
Breastfeeding women generally should NOT use combined hormonal contraceptives during the fourth week postpartum (U.S. MEC Category 3) because of concerns about potential negative effects on breastfeeding performance and milk production 1.
Breastfeeding women with other risk factors for venous thromboembolism generally should NOT use combined hormonal contraceptives during weeks 4-6 after delivery (U.S. MEC Category 3) 1.
Effects on Lactation
Combined hormonal contraceptives containing estrogen may decrease milk volume, which can lead to earlier discontinuation of breastfeeding and potential supplementation needs 1, 2. While the patch contains the same estrogen as oral contraceptives, there is limited experience with the patch specifically in women with hereditary angioedema, and there is no reason to believe patches are tolerated better than oral contraceptives 1.
Recommended Alternatives: True Progestin-Only Methods
Immediate Postpartum Options (Can Start Right Away)
Progestin-only pills (POPs) can be started at any time, including immediately postpartum (U.S. MEC Category 2 if <1 month postpartum, Category 1 if ≥1 month postpartum) 1, 3, 4. These require only 2 days of backup contraception if started ≥21 days postpartum when menstruation has not returned 1, 3.
Etonogestrel implant (Nexplanon) can be inserted immediately after delivery with no restrictions for breastfeeding women ≥1 month postpartum (U.S. MEC Category 1) 3, 5. Studies have found no effects on breastfeeding performance or infant health and growth 5.
Levonorgestrel or copper IUDs can be inserted immediately postpartum or at any time thereafter (U.S. MEC Category 2 if <1 month postpartum, Category 1 if ≥1 month) 3, 5.
DMPA (Depo-Provera injection) can be started immediately, though the ideal timing is at 6 weeks postpartum to minimize hormonal exposure to the breastfeeding infant 3, 4.
Evidence Supporting Progestin-Only Methods
Progestin-only contraceptives do not appear to affect milk volume, composition, or cause deleterious effects in the infant 2, 6. Multiple studies confirm their acceptability and lack of effect on milk production, neonatal growth, and early development 6.
Clinical Algorithm for Breastfeeding Women
If <3 Weeks Postpartum:
- Avoid ALL combined hormonal contraceptives (pills, patch, ring) - absolute contraindication 1, 3, 4
- Use progestin-only methods or IUDs immediately 3, 4
If 3-6 Weeks Postpartum:
- Still avoid combined hormonal contraceptives due to lactation concerns 1, 3
- Continue with progestin-only methods 3, 4
If >6 Weeks Postpartum:
- Combined hormonal contraceptives become acceptable (U.S. MEC Category 2), but progestin-only methods remain preferred because they have no effect on lactation 3, 5
Common Pitfalls to Avoid
Never prescribe the contraceptive patch (or any combined hormonal method) before 3 weeks postpartum under any circumstances due to venous thromboembolism risk 4. This is an absolute contraindication that applies to all women, regardless of breastfeeding status 5.
Do not confuse the patch with progestin-only methods—the patch contains estrogen and is fundamentally different from true progestin-only contraceptives 1.
Avoid waiting until the 6-week visit to initiate contraception in low-risk women when safe and effective progestin-only options are available immediately 4.