Norplant Use During Breastfeeding
Yes, Norplant (levonorgestrel implant) is recommended and safe for breastfeeding women, and can be inserted immediately postpartum or at any time thereafter without negatively affecting lactation or infant health.
Timing of Insertion
Norplant can be inserted at any time postpartum, including immediately after delivery, with no restrictions for breastfeeding women beyond 1 month postpartum 1.
For breastfeeding women less than 1 month postpartum, the U.S. Medical Eligibility Criteria classifies levonorgestrel implants as Category 2, meaning advantages generally outweigh theoretical risks 2.
After 1 month postpartum, levonorgestrel implants are Category 1 for breastfeeding women, meaning there are no restrictions and advantages clearly outweigh any theoretical risks 2.
Effects on Breastfeeding and Infant Health
The Society for Maternal-Fetal Medicine explicitly recommends that women considering immediate postpartum LARC (including levonorgestrel implants) be encouraged to breastfeed, as current evidence suggests these methods do not negatively influence lactation 1.
Studies evaluating Norplant use during breastfeeding have found no negative effects on breastfeeding performance, milk production, or infant growth and development 3.
A six-year follow-up study of 220 infants whose mothers used Norplant during breastfeeding found that breastfeeding patterns and infant growth from birth through age 6 years were similar to controls using copper IUDs 4.
Infant Steroid Exposure Considerations
The estimated daily infant intake of levonorgestrel from breast milk during the first month of Norplant use ranges from 90 to 100 ng, which is considered minimal 3.
To minimize steroid transfer to newborns, some experts recommend waiting until 6 weeks postpartum before inserting implants that deliver orally active steroids like levonorgestrel, though this is a conservative approach rather than an absolute contraindication 3.
However, current U.S. guidelines support earlier insertion (even immediately postpartum) based on the overall safety profile and the critical importance of preventing unintended pregnancy 1.
Contraceptive Efficacy
Norplant provides highly effective contraceptive protection with a failure rate of less than 0.05% 2, 3.
Breastfeeding women initiating Norplant use in the second postpartum month experience significantly longer periods of amenorrhea than untreated women or IUD users 3.
Backup Contraception Requirements
If Norplant is inserted 21 days or more postpartum when the woman is amenorrheic, 7 days of backup contraception is needed 2.
If inserted within 6 months postpartum while the woman is amenorrheic and fully or nearly fully breastfeeding (≥85% of feeds), no backup contraception is needed 2.
Clinical Advantages Over Combined Hormonal Contraceptives
Unlike combined oral contraceptives, which are contraindicated during breastfeeding (especially in the first 6 months postpartum due to potential negative effects on milk production), progestin-only implants like Norplant have no such restrictions 5.
Combined hormonal contraceptives are classified as U.S. MEC Category 4 in the first 3 weeks postpartum and Category 3 from 4 weeks to 6 months postpartum for breastfeeding women 5.
Common Pitfalls to Avoid
Do not delay contraception until the 6-week postpartum visit – this is a common error, as safe and effective options like Norplant should be available immediately 2, 6.
Do not confuse Norplant (levonorgestrel implant, no longer marketed in the U.S.) with currently available implants like Nexplanon (etonogestrel implant), which have similar safety profiles during breastfeeding 1.
Be aware that while minor side effects like bleeding irregularities and headaches may occur, these do not contraindicate use during breastfeeding 7.