Which pill to choose if breastfeeding.

Abstract

For women who are breast-feeding, the combined oral contraceptive is contraindicated because estrogen may suppress lactation, reducing the quantity and quality of breast milk with a decreased percentage of proteins and fats. The progestogen-only pill (minipill) may be used instead as the clinical impression has been that minipills have no adverse effect on lactation performance. However, some women have commented to Family Planning Association doctors that they found their babies became "fussy" correlating to the start of therapy with the progestogen-only pill. Small amounts of steroids are secreted in breast milk. "At dose levels used in oral contraceptives, steroids present in breast milk probably have no adverse effects on nursing infants. At higher doses, however, steroids in milk have been suspected of contributing to neonatal jaundice and of causing vaginal epithelial changes indicative of estrogenic influence." A lactating woman should be changed from the progestogen-only pill to the combined oral contraceptive only when she weans the baby. It is not necessary to wait for a period to start the 1st cycle.