Breast-feeding contraceptives

Women who particularly benefit from progestin-only methods, including minipills, are those who are breast-feeding, those who are intolerant to estrogens, and those with concomitant medical conditions in which estrogen is not recommended. Also injectable and implantable contraceptives are beneficial for women with compliance issues. 

Use after childbirth - Women who elect not to breast-feed should start contraceptive therapy with the norelgestromin/ethinyl estradiol transdermal patch no sooner than 4 weeks after childbirth. If a woman begins using the patch postpartum and has not yet had a period, consider the possibility of ovulation and conception occurring prior to use of the patch, and instruct her to use an additional method of contraception (eg, condoms, spermicide, diaphragm) for the first 7 days. 

Vaginal ring - Advise women who are breast-feeding not to use the contraceptive vaginal ring but to use other forms of contraception until the child is weaned. 

Insertion and removal To be sure that the woman is not pregnant at the time of capsule placement and to ensure contraceptive efficacy during the first cycle of use, insert capsules during the first 7 days of the cycle or immediately after an abortion. Insertion is not recommended before 6 weeks postpartum in breast-feeding women. Infection If infection occurs, institute suitable treatment. If infection persists, remove the capsules. 

The use of oral contraceptives may interfere with lactation. In addition, the hormones may be present in the mother s milk, hence be taken in by the nursing ctfild. If breast feeding is planned, the use of oral contraceptives should be discontinued until after weaning. 

Many practitioners recommend progestin-only contraceptives for breast-feeding women because progestins provide effective contraception without diminishing the amount of breast milk produced. 

Discontinuation of the Oral Contraceptive, Return of Fertility, and Breast-Feeding... 

A recent review by the Cochrane Library indicated that existing randomized, controlled trials are insufficient to establish an effect of hormonal contraception, if any, on milk quality and quantity. Furthermore, the review stated that current recommendations are for breast-feeding women to avoid combined OCs in the first 6 weeks postpartum and to use them with caution in the 6-month postpartum period. ... 

Isomers of hexachlorocyclohexane (HCH) are found in air, soil, water, food and even breast milk. Lindane is used in large quantities in agriculture and forestry as a wood preservative as well as in veterinary medicine. Provided that the required safety measures are adhered to, no liver damage occurs during the production of lindane. On the other hand, liver cell necrosis was observed in animal experiments after HCH isomers were added to the feed a carcinogenic effect was seen after long-term administration. An increased toxic potential is to be expected when there is simultaneous exposure to DDT, PCB, contraceptives, etc. 

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