Is Depo-Provera (medroxyprogesterone acetate) safe while breastfeeding?

From the Guidelines

Depo-Provera is generally considered safe to use while breastfeeding, as the small amount of hormone that passes into breast milk has not been shown to have harmful effects on nursing infants. This injectable contraceptive can be started immediately after childbirth or at the six-week postpartum visit, providing effective birth control for three months per injection. Studies indicate that Depo-Provera does not negatively impact milk production or infant growth and development 1. Some women may even experience a slight increase in milk supply since progestin-only contraceptives like Depo-Provera don't contain estrogen, which can sometimes reduce milk production.

Key Considerations

• Common side effects for the mother may include irregular bleeding, weight gain, headaches, and mood changes, but these don't affect the nursing infant.
• If you're concerned about maintaining your milk supply, it's advisable to establish breastfeeding before starting Depo-Provera, typically waiting until 4-6 weeks postpartum, although it can be given earlier if needed.
• The U.S. Selected Practice Recommendations for Contraceptive Use, 2013, suggest that postpartum women who are breastfeeding can use progestin-only contraceptives like Depo-Provera, as they do not affect milk production or infant growth and development 1.

Benefits and Risks

• Benefits of using Depo-Provera while breastfeeding include effective birth control and potential increase in milk supply.
• Risks associated with Depo-Provera use include irregular bleeding, weight gain, headaches, and mood changes, but these do not affect the nursing infant.

Clinical Guidance

• Healthcare providers should counsel patients about the benefits and risks of using Depo-Provera while breastfeeding, and monitor them for any potential side effects.
• Patients should be advised to establish breastfeeding before starting Depo-Provera, and to report any concerns or side effects to their healthcare provider.

From the FDA Drug Label

Detectable amounts of drug have been identified in the milk of mothers receiving Medroxyprogesterone Acetate Injectable Suspension, USP In nursing mothers treated with Medroxyprogesterone Acetate Injectable Suspension, USP, milk composition, quality, and amount are not adversely affected. Neonates and infants exposed to medroxyprogesterone from breast milk have been studied for developmental and behavioral effects through puberty. No adverse effects have been noted.

Medroxyprogesterone Acetate Injectable Suspension, USP is considered safe while breastfeeding. The drug label states that the milk composition, quality, and amount are not adversely affected in nursing mothers treated with Medroxyprogesterone Acetate Injectable Suspension, USP, and no adverse effects have been noted in neonates and infants exposed to medroxyprogesterone from breast milk through puberty 2.

From the Research

Depo Prevara Safety While Breastfeeding

• The safety of Depo Prevara (medroxyprogesterone acetate) while breastfeeding has been studied in several research papers 3, 4, 5, 6, 7.
• A study published in 2021 found that postpartum administration of Depo Prevara to mothers of preterm very low-birth-weight infants delayed secretory activation, but had no detrimental effect on milk production or lactation duration 3.
• Another study published in 1997 found that medroxyprogesterone acetate, when given to mothers immediately postpartum, had no detrimental effect on the duration of lactation, frequency of lactation, and timing of introduction of formula within the first 16 weeks postpartum 4.
• A systematic review published in 2012 found that the current evidence on the effect of early postpartum medroxyprogesterone use on breastfeeding outcomes is methodologically weak and provides an inadequate basis for inference about a possible causal relationship 5.
• A study published in 2016 found that postpartum predischarge depot-medroxyprogesterone acetate was associated with decreased rates of breastfeeding initiation, particularly among non-African American mothers 6.
• A retrospective cohort study published in 2013 found that the use of immediate postpartum depot medroxyprogesterone may have a minimal effect on the duration of any breastfeeding, but the difference did not achieve statistical significance 7.

Key Findings

• Depo Prevara may delay secretory activation in breastfeeding mothers 3.
• Depo Prevara has no detrimental effect on milk production or lactation duration in mothers of preterm very low-birth-weight infants 3.
• The current evidence on the effect of early postpartum medroxyprogesterone use on breastfeeding outcomes is limited and inconclusive 4, 5, 7.
• Postpartum predischarge depot-medroxyprogesterone acetate may be associated with decreased rates of breastfeeding initiation, particularly among non-African American mothers 6.