When a breastfeeding woman comes to primary care for information on contraception, questions may arise about the best method for her situation. This article reviews the most appropriate birth control methods for breastfeeding women and their compatibility with breastfeeding.

Contraception methods are those actions, devices, or medications that are used to prevent pregnancy and are also known as birth control. For breastfeeding women, there are many effective and safe contraceptive methods to choose from.

As in the general non-breastfeeding population, when recommending a contraceptive method, a complete anamnesis should be carried out to choose the most suitable one according to each patient’s personal situation.

Natural birth control methods

The LAM (lactational amenorrhoea method) inhibits ovulation as a result of high prolactin levels after childbirth and during the first months of breastfeeding. For maximum efficacy of this method (which has been described to be around 98%) (4), these essential conditions must be met:

• The nursing baby must be less than 6 months old
• Breastfeeding must be exclusive, without replacing human milk with any other foods or formula.
• The mother’s period must not have started yet

IUD

Intrauterine devices (IUD or coil) are inserted into the uterus to prevent pregnancy. There are two types, copper and hormonal (progestogens). Both are safe for the woman and compatible with breastfeeding, and can be inserted immediately after childbirth or from 4 weeks postpartum, provided there is no suspicion of puerperal infection.

Other hormonal contraceptive methods

• Gestagen-only methods

There is a wide variety of gestagens as they have been changing over time in order to reduce unwanted side effects. They prevent ovulation by inhibiting the luteinizing hormone (LH) peak. They are available as oral pills, injectables, or implants. They can be started as early as 21 days postpartum and are safe for the woman. The hormonal IUD also contains only progestin.

Gestagen-only contraceptives are usually the contraceptive of choice for lactating women. The women should be informed about the characteristics of each option:

• • As for the oral pill, it must be taken on a daily basis, without breaks or missing a pill.
  • In general, gestagens can influence a woman’s bleeding, and she can have long time spans without periods or have small bleedings of varying regularity. It is important to note that any bleeding can be normal.

• Combined methods with estrogen and progestin:

The estrogen currently used is ethinylestradiol, a synthetic molecule derived from estradiol. One of the side effects to be taken into account is the high risk of thromboembolism. A good anamnesis of the patient will be necessary to look for possible contraindications.

Estrogens can cause a decrease in milk supply, and although they may be safe for the mother after 6 weeks postpartum, they would not be the first choice for breastfeeding women.

In situations where a breastfeeding woman requests emergency contraception, both the ulipristal acetate pill and the levonorgestrel pill are compatible with breastfeeding, and no interruption of breastfeeding is necessary.

 

References:

1. https://espanol.nichd.nih.gov/salud/temas/contraception/informacion/tipos
2. https://www.who.int/es/news-room/fact-sheets/detail/emergency-contraception
3. https://www.healthychildren.org/Spanish/ages-stages/baby/breastfeeding/Paginas/Birth-Control-and-Breastfeeding.aspx
4. https://decisionscompartides.gencat.cat/ca/decidir-sobre/anticoncepcio/opcions_tractaments/anticoncepcio_metodes_naturals/metode_lactancia/index.html
5. https://apps.who.int/iris/bitstream/handle/10665/205016/WHO_RHR_15.07_spa.pdf?sequence=1
6. Capella S Daniela, Schilling R Andrea, Villaroel Q Claudio. Criterios Médicos de elegibilidad para el uso de anticonceptivos de la OMS. Rev. chil. obstet. ginecol.  [Internet]. 2017  Abr;  82( 2 ): 212-218. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-75262017000200012&lng=es.  http://dx.doi.org/10.4067/S0717-75262017000200012.
7. García-Figueroa RB, Malanco-Hernández LM, Lara-Ricalde R, García-Hernández A. Anticoncepción y lactancia. Espaciamiento de los embarazos. Conceptos actuales [Contraception and breastfeeding. Spacing of pregnancies. Present concepts]. Ginecol Obstet Mex. 2014 Aug;82(8):547-51. Spanish. PMID: 25282947.