What contraceptives can be used while breastfeeding?

Types of contraception during breastfeeding

After giving birth, you need to choose a reliable method of contraception in order to plan a new pregnancy no earlier than in 1.5-2 years. During this period, the body will have time to recover. After a cesarean section, it is necessary to take a pause of 2 years or more for a full-fledged scar to form on the uterus.

Contraception must be reliable during breastfeeding. During breastfeeding, ovulation may be suppressed for a long time, but in some women, ovarian function is restored after 3 months, which leads to accidental conception. Therefore, a month after giving birth, you need to visit your gynecologist and choose the most suitable method of contraception during lactation.

Prevention during breastfeeding is possible using the following methods:

• oral contraceptives with a gestagenic component;
• intrauterine device;
• barrier contraceptives;
• contraception with spermicidal agents;
• local hormonal preparations for contraception.

Hormonal contraceptives allowed during breastfeeding

Birth control pills for nursing mothers are pure progestin oral contraceptives with a minimal concentration of the hormone, which is why they are also called mini-pills. The dose of progestin, a synthetic analogue of progesterone, is lower in them than in COCs, so they act more gently, but have less contraceptive effect. Mini-pills are indispensable during breastfeeding, as well as in women with contraindications to COCs.

The Pearl index for contraception for the minipill is 1, which means that if used correctly during breastfeeding for a year, 1 woman out of 100 will become pregnant.

Progestins are not suitable for contraception in breastfeeding women who have suffered postpartum thrombosis of the veins of the limbs or lungs, have been treated for cancer within the previous 5 years, or have severe liver pathologies. When taking Rifampicin, Carbamazepine, and Phenytoin simultaneously, the effectiveness of contraception is reduced.

Microlute

The active ingredient is levonorgestrel in a dosage of 0.03 mg. Contraception during breastfeeding is provided by thickening the cervical mucus and blocking the release of the pituitary hormones FSH and LH. Ovulation is inhibited and pregnancy does not occur.

Available in a blister containing 28 tablets, intended for continuous use. You need to drink them at the same time during lactation so as not to reduce the contraceptive effect.

Lactinet

The active ingredient is desogestrel in a dosage of 0.075 mg.
These oral contraceptives are best used for breastfeeding; it has been proven that their use inhibits ovulation and prevents maturation of the dominant follicle. The Pearl index for the drug Lactinet is 0.4, which corresponds to the level of contraception of combined oral contraceptives. Lactinet reduces the production of estradiol. According to research, its concentration in the blood corresponds to the beginning of the first phase of the monthly cycle. But you need to remember that, like other progestin drugs, it affects the metabolism of lipids and carbohydrates, so it can lead to weight gain if you do not control your diet.

Exluton

The active ingredient is linestrol in a dosage of 0.5 mg. This is a synthetic gestagen, the main action of which is aimed at the transition of the endometrium from the proliferative to the secretory phase. Therefore, even if fertilization occurs, the embryo cannot implant into the uterine wall.

Other effects of Exluton are as follows:

• increased viscosity of cervical mucus;
• suppression of ovulation;
• decreased penetrating ability of sperm.

Charosetta

The active substance in tablets is desogestrel 0.075 mg. These contraceptives are safe during breastfeeding and rarely cause side effects. If you follow the recommendations for use, pregnancy protection is almost 100%. But you need to remember that you need to drink them strictly at the same time. If you miss taking the pill, you must additionally use barrier methods for 7 days.

Hormonal contraceptives for breastfeeding women do not protect against sexually transmitted infections. Therefore, in case of casual sexual intercourse, it is necessary to use post-coital means of prevention.

Progestin-based oral contraceptives

Progestin-based oral contraceptives do not contain estrogen, which makes them possible for women who are breastfeeding, as well as women for whom estrogens are contraindicated or undesirable. For example, such women include: smokers, women suffering from hypertension, migraines, overweight, etc.

A common misconception that after childbirth you cannot become pregnant during breastfeeding leads to the fact that 10% of women turn to medical institutions for termination of pregnancy in the first year after childbirth. If a woman does not plan to become pregnant soon after giving birth, she must use contraception. When breastfeeding, you can use only those birth control methods that are safe for the mother and, most importantly, for the baby. In addition to special birth control pills for nursing mothers, you can use condoms, spermicides, intrauterine devices, and implants. Talk to your doctor about postpartum contraception.

These are modern, estrogen-free pills that are as reliable as regular combination oral pills (99% effective). With modern progestin oral contraceptives, the main mechanism of action is the suppression of ovulation, which means the onset of an unplanned pregnancy is impossible.

Estrogen-free tablets are taken daily, without interruption, for 28 days; after completing one pack, you must immediately begin taking tablets from the next pack. If taking the next pill is delayed by less than 12 hours, the reliability of contraception does not decrease. However, a delay of more than 12 hours reduces their effectiveness, so it is necessary to use additional methods of contraception (for example, a condom).

The main mechanism of action of the modern estrogen-free pill is to reliably suppress ovulation. The previous generation of estrogen-free pills (mini-pills) thickened cervical mucus, preventing sperm from entering the uterus, and had little effect on ovulation, making them much less reliable and dependent on strict timing of dosing. Modern drugs, despite the absence of estrogens, suppress ovulation in 99% of cases, which makes them as effective as conventional combined oral contraceptives (COCs).

What birth control pills are currently available for breastfeeding women and how do they differ?

In Russia, 3 different drugs without estrogen are registered. Two of them are older and are also known as mini-pills. Their main mechanism of action is to thicken the mucus of the cervical canal, so the contraceptive effect is lower than that of combined contraceptive pills. One is more modern, which includes a highly selective progestogen - desogestrel. The main mechanism of action of this drug is the suppression of ovulation, so the effectiveness is more than 99%. You can learn more about existing medications and understand which one is right for you from a gynecologist.

If I'm breastfeeding, isn't it better to use an IUD?

From the point of view of the effect on the baby and milk, there is no fundamental difference. Numerous studies comparing spirals with nursing tablets have shown that there is no effect on breast milk or on the growth and development of the baby in either case. The spiral can increase the risk of infections. However, if the IUD is more convenient for you than the pill as a method of contraception, and you have no contraindications to its use, you can use it while breastfeeding.

How quickly can you get pregnant after stopping birth control pills?

Usually, birth control pills are cleared from the body within 36 hours, so you can get pregnant in the first month after stopping the pills.

I regularly take a contraceptive without estrogen and have not had a period for 2 months. Do I need to take a pregnancy test?

There is no need to take a pregnancy test if you have not missed taking any pills, since such modern drugs are very reliable. The absence of menstruation does not mean pregnancy and is a completely normal situation. Among women taking such drugs, 20% do not have menstrual-like bleeding, and among breastfeeding women this percentage is even higher - 55%. So you can continue taking the drug as normal.

If I am not breastfeeding, which drug should I use and when should I start using it?

Before starting to take any drug, you should consult your doctor. If you are not breastfeeding, you can use a combined oral contraceptive pill or a vaginal ring. You can start using the pill or ring any day in the fourth week after giving birth. Additional contraception is not required. If you start using the pill or ring from the first day of the 5th week or later, then during the first 7 days you must additionally use a barrier method (condom). If you have already had sexual intercourse after giving birth, then before starting to use the ring or pills, you must rule out pregnancy or wait until your first menstruation.

Birth control pill comparison chart

Prohibited contraceptive pills during breastfeeding

After childbirth, taking birth control pills from the group of combined oral contraceptives is prohibited. They contain high doses of gestagens and an estrogenic component, which is prohibited during breastfeeding.

The mechanism of milk production is associated with increased secretion of prolactin. During pregnancy, this hormone is inhibited by high concentrations of estrogen. Therefore, when taking COCs, a similar effect is possible; lactation will be inhibited.

Another reason why hormonal contraceptives are prohibited during breastfeeding is due to the penetration of estrogens into milk. In modern drugs, the dosage of the hormone is minimal, but this amount is enough to have a negative effect on the child. He will receive estrogen daily, which will change his own hormonal levels.

Rules for taking contraceptive pills during breastfeeding

What contraceptive pills can be taken while breastfeeding should be decided by the doctor after a gynecological examination and examination of the woman’s medical history. You need to come for an appointment one month after giving birth. You can start taking progestin contraceptives from 6 weeks after birth with full or partial breastfeeding. Sexual rest, which is recommended for this period, reliably protects against pregnancy.

Contraceptive pills are taken 1 daily at the same time. You should not miss the appointment time or reschedule it, this reduces the effectiveness of contraception. After finishing the package of tablets, you need to start a new one the next day; a break, as when using COCs, is not required.

While taking progestin pills while breastfeeding, the following side effects are possible:

• menstrual irregularities, periodic spotting, bleeding, but in most cases the cycle normalizes within 1-2 months of use;
• the appearance of functional ovarian cysts, do not require special treatment, go away on their own after 1-2 months;
• activation of the fungus with predisposition to candidiasis;
• increased skin greasiness, acne;
• the appearance of sensitivity of the mammary glands;
• swelling of the legs;
• pigment spots on the skin under the influence of ultraviolet radiation.

Most side effects of birth control pills do not require discontinuation of the drug and go away over time. Increased breast sensitivity can occur in women with existing fibrocystic mastopathy. After the end of lactation, the doctor may recommend a course of Mammanorm tablets or their combination with a similar gel.

Approved tablets

Mini-pill: birth control pills
A breastfeeding mother thinks she won't get pregnant while breastfeeding, but that's only half true. Only in the first six months is the risk of pregnancy reduced to a minimum.

Lactation amenorrhea is a period of natural contraception. Breastfeeding your baby inhibits ovulation and is 98-99.5% effective in preventing pregnancy. [1]

However, even at this time, there is still a small risk of becoming pregnant. Each woman is individual; the menstrual cycle can begin in the second month of breastfeeding.

Oral medications are 99% effective. Previously, nursing mothers were not allowed to use this method of contraception, but with the development of medicine, medications appeared that were approved for use by women with breastfeeding. Birth control pills during lactation are prescribed by a specialist, taking into account the physiological characteristics of the body. After all, many women don’t even have an idea about what kind of birth control pills they can use while breastfeeding.

The effect of birth control pills on infants

Contraception during lactation with progestin preparations does not affect the child. The dosage of the hormone is minimal; it does not pass into breast milk. Estrogen-progestogen tablets pose a danger during breastfeeding.

Female sex hormones pass into breast milk and cause changes in the child's endocrine system. In boys, in response to the intake of estrogen, breast engorgement and enlargement may occur - gynecomastia.

For girls, an increase in estrogen is also undesirable. A natural reaction to hormones manifests itself in the form of gynecomastia; in some cases, colostrum appears when pressing on the nipple. They react to estrogens and the genitals, sometimes spotting appears from the genital opening.

Alternative methods of contraception during breastfeeding

Women who have contraindications to the use of birth control pills can use other methods of contraception while breastfeeding. In order for them to be highly effective, you must follow the rules of use.

If unprotected sexual intercourse occurs, young mothers can use emergency contraception during breastfeeding. The tablet also contains progestin, but in a high dosage. Therefore, after emergency contraception, you should not breastfeed for 24 days; milk should be expressed.

Spermicide suppositories for breastfeeding

Contraceptive spermicidal suppositories for hepatitis B act locally. The main active ingredient is benzalkonium chloride. It is not absorbed from the vaginal mucosa, so it is safe during breastfeeding. The disadvantage of this method is that the suppositories must be inserted into the vagina 10 minutes before sexual intercourse. The advantages of spermicidal agents are as follows:

• do not affect hormonal levels and lactation;
• do not require consultation with a doctor;
• can be used 4 weeks after birth;
• moisturize the mucous membrane and act as lubricants;
• partially protect against sexually transmitted infections.

Spermicidal suppositories can be used together with hormonal contraceptives during breastfeeding if errors were made in the time of taking the pill.

Intrauterine device for breastfeeding

During breastfeeding, an intrauterine device can be used for contraception.
Its principle of operation is based on a mechanical obstacle to implantation of the fertilized egg, disruption of tubal peristalsis and changes in the composition of cervical mucus. A focus of aseptic inflammation is created in the uterine cavity, as the body’s reaction to a foreign body, and immune cells migrate intensively. This disrupts the progress of sperm and prevents the attachment of the embryo if fertilization takes place. The IUD can be installed after childbirth after 3 months. During this period, the uterus is completely restored and the risk of the IUD falling out is reduced. But installing a coil during breastfeeding is not recommended for women who have had purulent-septic complications in the postpartum period: endometritis, myometritis, parametritis. This increases the risk of recurrence of the infectious disease.

Also, during breastfeeding, the IUD is not placed when there is an inflammatory type of vaginal smear. It is necessary to first sanitize the vagina, otherwise there is a risk of ascending infection.

For women with heavy menstruation before pregnancy or fibroids, the Mirena hormonal IUD is recommended. It acts locally and does not affect breastfeeding.

An alternative to the IUD and birth control pills is the Nuvaring hormonal ring. It is placed in the vagina once a month and lasts for 21 days, after which it is removed. After a 7-day break, the cycle repeats. Hormones do not pass into breast milk and act locally.

Barrier methods for breastfeeding

Contraception for nursing women using barrier methods is safe and does not affect lactation. Married couples can use male and female condoms and cervical caps without fear of harming the child. The condom has the highest contraceptive effect; other means are inferior in quality of protection against pregnancy. The positive side of using barrier methods is protection against sexually transmitted infections.

Calendar method of contraception while breastfeeding

During lactation, menstruation can begin after 4-6 months, but in many women, due to physiologically increased secretion of prolactin, disruptions may occur.
Menstruation is interrupted and comes at different intervals. This condition may continue after breastfeeding ends. The calendar method is based on the rhythm of the menstrual cycle. To use it, the first day of menstruation, the length of the cycle and the approximate date of ovulation must be known exactly. They cannot be determined during breastfeeding, so the calendar method cannot be recommended.

Attempting to use other physiological methods of contraception while breastfeeding can also lead to unplanned pregnancy. It is difficult for a nursing woman to accurately determine her basal temperature. To achieve this, continuous night sleep must last at least 4 hours. If a young mother has to get up at night to see her baby, the basal temperature reading will be inaccurate.

Prevention after childbirth did not work: emergency contraception

If the chosen method of birth control did not work after childbirth or you forgot to take the pill, emergency contraception will help out. An emergency method of birth control does not provide 100% protection against pregnancy, but it reduces the risk.

Emergency contraception often involves the use of birth control pills, but an intrauterine device may be an alternative. Before taking these emergency contraceptives, make sure they are approved for breastfeeding.

Gynecologists advise to always keep emergency contraceptive pills on hand so that you can use them if there is an urgent need. The sooner you use emergency contraception after unprotected sex, the more effective it is.

Conclusion

Childbirth and breastfeeding are not an obstacle to the use of contraceptives and methods. But keep in mind that most birth control pills can only be taken 4-6 weeks after birth, so as not to harm either yourself or the baby. However, during this period your body will still be recovering from the stress experienced during childbirth, and therefore you yourself are unlikely to want to return to sexual activity. But when you decide to start using birth control after childbirth and during breastfeeding, be sure to consult with your doctor. The method of birth control after childbirth must be individual.

Doctors' recommendations

Gynecologists recommend abstaining from sexual activity for 4-6 weeks after childbirth. This will allow the uterus and vaginal tissue to recover. After this, you must come to an appointment for an examination and the first smear. The doctor gives recommendations on choosing a method of contraception when breastfeeding individually.

The doctor will help determine which birth control pills are suitable for breastfeeding, and whether there are any contraindications to this method.

Women with gestational diabetes mellitus should be careful. Sometimes it turns into type 2 diabetes, in the absence of proper treatment, the addition of nephropathy, it is a contraindication for taking hormonal contraceptives.

Doctors do not recommend resorting to the lactational amenorrhea method when breastfeeding. Even with a sufficient level of prolactin, spontaneous ovulation can occur, which the woman does not know about, because. I didn't have my period the day before. You may also not be aware of the onset of pregnancy for a long time, because... lactation will be maintained. But high prolactin is dangerous for the embryo, creating a high risk of early pregnancy termination.

Therefore, all women during breastfeeding need to select the most effective method of contraception. This will allow you not to put additional stress on the body in the form of a second pregnancy and avoid termination.

Can I use an intrauterine device immediately after childbirth?

American doctors not only allow women to use intrauterine devices after childbirth, but also often insert this contraceptive immediately after the birth of the baby.

What is an intrauterine device?

This is a T-shaped device that is placed in the uterine cavity and thereby blocks the fertilization of the egg. Some types of intrauterine devices release progestin. The spiral can remain in the uterus from 3 to 12 years.

Intrauterine devices are the most effective contraceptive method after childbirth and are safe during breastfeeding. But gynecologists do not recommend using IUDs for women who are at high risk of contracting sexually transmitted infections. Due to the presence of the coil, infections can enter the uterus.