Birth control pill while breastfeeding

When does a woman become fertile again after giving birth?

Women who do not breastfeed can ovulate again about three weeks after giving birth, and therefore they will see the first menstruation (the so-called foreman ) after about 5 weeks from the birth of the baby.

Therefore, if the couple has intercourse in those days when ovulation is about to occur, theoretically there is a possibility of conception, and in case of conception the foreman will jump.

Exclusively breastfeeding women are unlikely to ovulate the first few weeks after giving birth. Ovulation will usually occur no earlier than three months after the baby is born, but there are exceptions here too. That is, women who breastfeed exclusively and who ovulate again the month after giving birth.

For this reason it is important to address the subject already at the postpartum check-up, with the gynecologist or midwife, or even directly in the hospital, before going home with the baby . Contraceptive counseling can also be done towards the end of pregnancy but there are some factors to consider and which will need to be re-evaluated later.

The criteria for prescribing contraceptive methods

When evaluating which contraceptive method is suitable for the couple, there are some criteria to consider (those that are indicated as MEC = eligibility criteria for the prescription of available contraceptive methods).

The criteria are periodically updated by the World Health Organization .

Alongside the 4 basic conditions for accessibility to contraception which are:

1. condition in which there are no contraindications to the use of the contraceptive method
2. condition in which the advantages derived from the use of the contraceptive method are generally greater than the potential or demonstrated risks
3. condition in which the potential or proven risks deriving from the use of the contraceptive method are generally greater than the advantages
4. condition in which the use of the contraceptive method represents an unacceptable risk to health

for the choice of the contraceptive method in the postpartum it is necessary to keep in mind the following factors:

• the time elapsed since birth,
• exclusive breastfeeding or not
•  condition of amenorrhea or not
• frequency of sexual intercourse,
• lifestyle (smoking, diet, movement),
• personal, social, cultural or religious factors,
• any previous experience with contraceptive methods.

Non-hormonal contraception

There are two main non-hormonal methods of contraception (excluding abstinence and coitus interruptus), which are represented by the use of condoms, on which we will not dwell, and by the lactation amenorrhea method.

According to the LAM (Lactational Amenorrhea Method)  a postpartum woman has at least 98% protection from pregnancy for six months when she remains amenorrheic and breastfeeds exclusively with intervals between feedings never exceeding 6 hours at night and at 4 hours of the day.

Given that many women breastfeed, rightly so, on request , and given the difficulty of having precise and monitored rhythms in the first weeks and months of the baby’s life, this method could be unreliable.

Always remember that ovulation takes place before having the foreman (about two weeks before) and that ovulation is at risk of pregnancy if the couple has unprotected intercourse.

Hormonal contraceptives

Is it possible to take the contraceptive pill while breastfeeding?

According to the SIGO guide ” hormonal contraception raises perplexities and sometimes unjustified prohibitions, due to the possible effects on the newborn and on breastfeeding, since the hormones of combined hormonal contraceptives are excreted in milk, albeit in minimal quantities, no more than one per percent of the dose taken by the mother. Furthermore, in theory, the metabolic immaturity of the newborn could lead to an accumulation of progestogens and their metabolites, although no harm has been described in clinical practice. ”

Progestogen contraceptives

Progestin contraceptives, also known as mini-pills, are based on desogestrel. The subcutaneous implant releases a progestin, etonogestrel.

Both do not interfere with breastfeeding and infant development.

The World Health Organization advises against its use in the first 6 weeks after childbirth .

Intrauterine devices

Intrauterine devices (IUDs), commonly known as coils, release levonorgestrel. The WHO advises against its insertion in the first 4 weeks after birth

Estro-progestin hormonal contraception

According to the WHO, combined hormonal contraception, the one containing etroprogestogens, cannot be started before 3 weeks after delivery due to the high thromboembolic risk. In any case, it must be adopted with extreme caution and only if there are no contraceptive alternatives in the first 6 months after delivery

Six months after giving birth, the SIGO guide reads, ” there are no problems with use as long as the woman does not have other conditions that contraindicate its use “

The estrogen content of estrogen-progestogen pills decreases milk production , so these pills should not be prescribed to a nursing woman, especially in the first 6 months.

Breastfeeding emergency contraception

There are two main types of emergency contraceptives that differ in the active ingredient.

In the first 3 weeks after delivery there are no indications for using emergency contraception as the woman is not expected to be fertile.

Levonorgstrel (LNG)-based emergency contraceptives have no restrictions, as it does not appear that the passage of a small amount of LNG in the milk could be harmful to the newborn.

Instead, after taking emergency contraceptives based on Uripristal Acetate (UPA), it is necessary to avoid breastfeeding for a week, as there are not enough studies on the possible effects on the newborn. This is a precautionary principle because UPA has not been observed to cause problems, but it has been found in breast milk and its effects on the baby have not yet been studied.