Breastfeeding While Using Xulane Patches
You should consider an alternative method of birth control until you are ready to stop breastfeeding, as Xulane (a combined hormonal contraceptive patch) may decrease milk production and small amounts of hormones pass into breast milk. 1
Key Concerns with Combined Hormonal Contraceptives During Breastfeeding
Timing Restrictions
- Combined hormonal contraceptives like Xulane should not be used during the first 3 weeks postpartum (absolute contraindication) due to increased risk of venous thromboembolism 2, 3
- Generally should not be used during the fourth week postpartum because of concerns about potential negative effects on breastfeeding performance 2
- Combined hormonal contraceptives can be started 6-8 weeks after delivery if breastfeeding, though this remains suboptimal 4
Impact on Milk Supply
- Hormonal birth control methods containing estrogen, like Xulane, may decrease the amount of milk you make 1
- The patch delivers ethinyl estradiol systemically, which can suppress lactation 5, 2
- You will be exposed to about 60% more estrogen with Xulane compared to a typical 35-microgram birth control pill, potentially increasing the risk of reduced milk production 1
Hormone Transfer to Infant
- A small amount of hormones from the Xulane patch may pass into your breast milk 1
- While long-term follow-up studies of children breastfed by mothers using oral contraceptives containing 50 micrograms ethinyl estradiol showed no adverse effects on development up to 8 years of age, mothers using these contraceptives lactated for significantly shorter periods 6
Recommended Alternatives for Breastfeeding Women
Progestin-Only Methods (Preferred)
- Progestin-only contraceptive implants (Nexplanon) are highly effective and safe during breastfeeding, with studies showing no effects on breastfeeding performance or infant health and growth 5, 7
- Immediate postpartum LARC (long-acting reversible contraception) methods do not negatively influence lactation and should be encouraged 7
- Progestin-only methods are the only acceptable hormonal contraceptives during the first 6 weeks postpartum 8
Important Caveat for Progestin-Only Pills
- In Latino populations of breastfeeding women, progestin-only oral contraceptives were associated with a 2-3 fold increased risk of developing diabetes in women with a history of gestational diabetes 4
- This finding has not been confirmed in non-breastfeeding women or other populations 8
Non-Hormonal Options
- Copper IUD (highly effective, no hormonal effects on lactation) 5
- Barrier methods (condoms, diaphragm) 5
Clinical Bottom Line
The FDA label for Xulane explicitly states: "Consider another method of birth control until you are ready to stop breastfeeding." 1 This recommendation is based on the dual concerns of reduced milk production from estrogen exposure and hormone transfer to the infant. If you need contraception while breastfeeding, progestin-only methods (particularly LARC devices like the implant or levonorgestrel IUD) provide highly effective alternatives without compromising lactation 5, 7.