Combined hormonal versus nonhormonal versus progestin-only contraception in lactation

Lopez, Laureen M; Grey, Tom; Stuebe, Alison M.; Chen, Mario; Truitt, Sarah T.; Gallo, Maria F

doi:10.1002/14651858.cd003988.pub2

Cited by 53 publications

(31 citation statements)

References 56 publications

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“…It advises that CHC should not be used before 6 months postpartum by breastfeeding women, unless no other method is available or acceptable (WHO MEC, Category 3) . However, most trials published after 2005 do not report any significant impact of CHC on breastfeeding duration, breast milk composition, or infant growth, and the UK and US guidance recommend that the benefits outweigh the theoretical risks of CHC use after 6 weeks postpartum (Category 2) among breastfeeding women.…”

Section: Methodsmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

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Section: Methodsmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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“…A recent Cochrane review noted that the quality of evidence regarding hormonal contraception and lactation was moderate overall and low for three of four placebo-controlled trials. 4 The contraceptive implant available in the United States contains ENG, a synthetic progesterone analogue. Serum levels peak at 1,200 pg/mL within the first 2 weeks after insertion and then gradually decline to 202 pg/mL at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Association of Etonogestrel-Releasing Contraceptive Implant with Reduced Weight Gain in an Exclusively Breastfed Infant: Report and Literature Review

Stuebe

Bryant

Lewis³

et al. 2016

Breastfeeding Medicine

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Background: Studies have not found that hormonal contraceptive implants adversely affect breastfeeding, but theoretical concerns exist. Methods: We reported a case of reduced weight gain in an exclusively breastfed infant in association with placement of (ENG)-releasing contraceptive implant (Nexplanon) to the FDA Adverse Events Reporting System (FAERS). We further queried reports to FAERS and reviewed published studies of the ENG implant during breastfeeding. Results: A breastfeeding mother received an ENG implant at 4 weeks postpartum. Her infant was exclusively breastfeeding. One month after implant placement, the infant had lost 145 g, dropping from the 44th percentile to the 6th percentile for growth. During this period, the mother had not returned to work or decreased frequency of feeding. During a 2-year period of FAERS reports, we found one other report of reduced milk supply following ENG implant placement. Among 108 breastfeeding women studied while using the ENG implant, there was one case of lactation failure. If this were not due to chance, the estimated risk of lactation failure with the ENG implant would be 0.9% (95% confidence interval 0.2-5.1%). Conclusion: Given uncertainty regarding the true effect of ENG implants on lactation, it seems prudent for providers to counsel each woman about a possible effect on milk supply so that she can monitor her infant for signs of impaired milk transfer. Patient-centered counseling approaches are needed that allow each woman to assess her own individual tolerance of risk of unplanned pregnancy versus possible risk of lactation failure.

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“…However, the evidence was inadequate to make recommendations regarding hormonal contraceptive use in lactating women. 37 Another systematic review of 43 articles, including 5 randomized trials and 38 observational studies, demonstrated no adverse effects of various progestogen-only methods of contraception on multiple measures of breastfeeding performance when initiated after the immediate postpartum period. Many of these studies also examined infant growth,health,anddevelopmentandfound 932…”

Section: Initiation Of Postpartum Contraceptionmentioning

confidence: 99%

Contraception and Breastfeeding

Pieh-Holder

2015

Clinical Obstetrics &Amp; Gynecology

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Postpartum contraception is important to lengthening birth intervals and improving the health of women and children. For breastfeeding women the choice and timing of contraception may influence breastfeeding and infant growth patterns. Nonhormonal methods of contraception are the preferred choice for breastfeeding women. Progestin-only methods comprise a viable next option. Combined hormonal methods of contraception containing estrogen and progestin may be considered as a third option for birth control in breastfeeding women. The objective of this chapter is to review the current literature and recommendations for the use of hormonal and nonhormonal methods of contraception while breastfeeding.

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Combined hormonal versus nonhormonal versus progestin-only contraception in lactation

Cited by 53 publications

References 56 publications

Contraception after pregnancy

Contraception after pregnancy

Association of Etonogestrel-Releasing Contraceptive Implant with Reduced Weight Gain in an Exclusively Breastfed Infant: Report and Literature Review

Contraception and Breastfeeding

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