ICMR task force study on hormonal contraception

Betrabet, Shrikant S.; Shikary, Zehra K.; Toddywall, Vill S.; Patel, Dina; Vaidya, Pratibha R; Saxena, B.N.

doi:10.1016/0010-7824(86)90069-7

Cited by 6 publications

(2 citation statements)

References 21 publications

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“…Another study examined the passage of EE to the milk 2 h after administrating 0.1 mg of EE, compared to milk drawn immediately following birth, the colostrum. No significant trace of EE was found in breast milk [17]. In another study, 50-200 mcg of Estradiol (E2) was administered before breastfeeding, and E2 levels were then measured in the infants.…”

Section: Discussionmentioning

confidence: 99%

Combined Hormonal Contraception during Breastfeeding—A Survey of Physician’s Recommendations

Segev,

Weitzman,

Katz-Samson

et al. 2023

JCM

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Until breastfeeding is established, progesterone-only pill (POP) use is preferable over combined hormonal contraception (CHC), as the latter potentially reduces milk production. Yet, POPs are often associated with breakthrough bleeding (BTB), and irregular spotting is often a reason for their cessation. Conversely, CHC is less associated with BTB but is not usually prescribed, even if breastfeeding has been established, despite its verified safety profile. Here, we surveyed physicians’ perception of CHC safety during breastfeeding through an online questionnaire (N = 112). Physicians were asked if they would prescribe CHC to a woman three months postpartum, breastfeeding fully, and suffering from BTB while using POPs. Half of the physicians responded they would, 28% would not until six months postpartum, while 14% would not during breastfeeding. Of the physicians that would prescribe CHC, 58% would without any reservation, 24% would only after discussing milk reduction with the patient, 9% would use a pill with a lower hormonal dose, and 9% would only prescribe CHC 3 months postpartum. The main risk associated with CHC during breastfeeding, as perceived by physicians, is a potential decrease in breast milk production (88%). While some physicians consider CHC unsafe during breastfeeding, most health organizations consider CHC compatible with breastfeeding 5–6 weeks after birth. Thus, there is a gap in the attitude and knowledge of physicians about the safety profile of CHC, and only half acknowledge that the risk of BTB justifies the use of CHC instead of POPs while breastfeeding three months postpartum. We highlight the importance of physician’s education, advocate CHC breastfeeding compatibility if breastfeeding has been established (i.e., 30 days postpartum), and underline the importance of discussing the option of CHC with patients in case POPs have unwanted side effects.

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Section: Discussionmentioning

confidence: 99%

Combined Hormonal Contraception during Breastfeeding—A Survey of Physician’s Recommendations

Segev,

Weitzman,

Katz-Samson

et al. 2023

JCM

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“…Studies have generally found that very low levels of hormones transfer to the infant during breastfeeding [ 7 ]. While evidence is limited, studies have demonstrated that low levels of estrogen and progestins are present in breast milk [ 7 , 43 , 44 ]. However, there is theoretical concern that hormone levels may be higher in the infant because the immature liver may not metabolize effectively, the kidneys may be inefficient at excretion and plasma-binding capacity may be low [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Combined hormonal contraceptive use among breastfeeding women: an updated systematic review

et al. 2016

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Limited evidence of poor to fair quality demonstrates an inconsistent impact of COCs on breastfeeding duration and success. The evidence also demonstrated conflicting results on whether early initiation of COCs affects infant outcomes but generally found no negative impact on infant outcomes with later initiation of COCs. The body of evidence is limited by older studies using different formulations and doses of estrogen and poor methodologic quality. Given the significant limitations of this body of evidence, the importance of contraception for postpartum women and the theoretical concerns that have been raised about the use of combined hormonal contraception by women who are breastfeeding, rigorous studies examining these issues are needed. In addition, postpartum women should be counseled about the full range of safe alternative contraceptive methods, particularly during the first 6 weeks postpartum when the risk of venous thromboembolism is highest and use of estrogen may exacerbate this risk.

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Overlapping but distinct effects of genistein and ethinyl estradiol (EE2) in female Sprague–Dawley rats in multigenerational reproductive and chronic toxicity studies

Delclos

Weis

Bucci³

et al. 2009

Reproductive Toxicology

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Genistein and ethinyl estradiol (EE 2 ) were examined in multigenerational reproductive and chronic toxicity studies that had different treatment intervals among generations. Sprague-Dawley rats received genistein (0, 5, 100, or 500 ppm) or EE 2 (0, 2, 10, or 50 ppb) in a low phytoestrogen diet. Nonneoplastic effects in females are summarized here. Genistein at 500 ppm and EE 2 at 50 ppb produced similar effects in continuously exposed rats, including decreased body weights, accelerated vaginal opening, and altered estrous cycles in young animals. At the high dose, anogenital distance was subtly affected by both compounds, and a reduction in litter size was evident in genistein-treated animals. Genistein at 500 ppm induced an early onset of aberrant cycles relative to controls in the chronic studies. EE 2 significantly increased the incidence of uterine lesions (atypical focal hyperplasia and squamous metaplasia). These compound-specific effects appeared to be enhanced in the offspring of prior exposed generations.

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ICMR task force study on hormonal contraception

Cited by 6 publications

References 21 publications

Combined Hormonal Contraception during Breastfeeding—A Survey of Physician’s Recommendations

Combined Hormonal Contraception during Breastfeeding—A Survey of Physician’s Recommendations

Combined hormonal contraceptive use among breastfeeding women: an updated systematic review

Overlapping but distinct effects of genistein and ethinyl estradiol (EE2) in female Sprague–Dawley rats in multigenerational reproductive and chronic toxicity studies

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