Breastfeeding, Babies, and Hormonal Birth Control

Commenter and guest poster Ariela asked me to write about breastfeeding and birth control.  Since other methods generally don’t impact breastfeeding, I’ll limit the discussion to hormonal methods.

Hormonal methods include the pill, some IUDs, and patches. They contain either progestin  alone or a combination of progestin and estrogen. Progestin is a synthetic form of progesterone.

Most breastfeeding mothers begin using birth control after their six-week checkup, when the milk supply has already been established. In the early weeks milk supply is more sensitive to disruption by hormones and other factors, sometimes with long-term effects.

Does the “mini-pill” affect milk supply?

The mini-pill, or progestin-only pill (POP), is usually recommended for breastfeeding mothers. Here in Israel it has been sold under the brand names Femulen and (the expensive) Cerazette. According to studies progestin-only methods do not affect milk supply, but some women have reported a drop in supply when beginning the mini-pill.

A mother who senses lower supply while on the mini-pill can nurse and/or pump more frequently for a few days to see if that helps, before switching to another method of birth control. She should keep in mind that softer breasts, frequent nursing, fussiness, or a drop in pumping output may have other causes.

The mini-pill is not considered as effective as the standard combination pill in preventing pregnancy. You need to take it at the same time every day for best results. Cerazette appears to be more reliable than Femulen.

Bleeding and Spotting

The mini-pill can cause spotting because of thinning of the endometrial lining. Doctors often tell mothers not to expect bleeding while on the mini-pill. This confusion could stem from the fact that at six weeks, most breastfeeding mothers are still experiencing lactation amenorrhea. It seems that such a mother can expect bleeding to return at around the same time she would have without the mini-pill. But I could not find concrete information on this issue.

Wikipedia on Progestin-Only Pills: “With no break in the dosage, flow does not initially occur at a predictable time. Most women tend to establish, over a few months, light spotting at approximately regular intervals.”

According to another article, “Cerazette may initially cause irregular bleeding. Some women may also have amenorrhea. However, after a few months most women will have less frequent bleeding episodes.”

The Combination Pill: Weaning Not Required

The combination pill, containing estrogen and progestin, has been shown to reduce milk supply. Sometimes women believe they must wean to go on the combination pill. However, the risk is only to the milk supply and not to the baby’s health (except as it may be impacted by supplements). So a mother who wants added protection or other benefits of the combination pill has the option of continuing to breastfeed and supplementing with formula or extra solids, depending on the baby’s age.

Please share your experience in the comments. You can be anonymous if you like, but it’s easier if you give yourself some kind of nickname.

How Breastfeeding Affects Fertility: Breastfeeding: An Optimal Way to Space Babies

Check out the 2016 fashions at Hydrochic modest swimwear.

Comments

  1. Very informative post MIL – thank you!
    Several women have told me that the mini-pill dries up their milk, as you mentioned.
    I have a strong aversion to taking hormones, which is not entirely grounded in scientific evidence. Although, my gut feeling as a scientist and as a woman is that it is not a good idea. That is my “mishugas”.
    I have had good luck with IUDs – but some women find that they cause spotting.
    The bottom line seems to be that there is no perfect method.
    No method is 100%: I have a several friends who conceived on the pill or using an IUD or using a barrier method. I personally know a woman who conceived three different times, each time using a different form of birth control.

  2. mominisrael says:

    Thanks, Ariela.
    I saw an article recently about how little progress has been made in the area of birth control, because of a lack of funds.

  3. Thanks for the great post. I also didn’t use any birth control while breastfeeding and I have heard mixed feedback from moms who did – some say the mini-pill doesn’t affect their supply at all – others say it caused a big drop – I guess, like many things, it is going to vary from mom-to-mom.

  4. I got a copper IUD at 8 weeks postpartum, and I’ve been very satisfied with it. Of course I’m still breastfeeding (9 months post partum now) so my period hasn’t come back, and I understand when it does come back that could increase the chances of the IUD coming out. After ten years of being on the pill I was sick of carrying around an extra 5 kilos, and I am very pleased to not be taking any more hormones. I don’t notice the IUD at all, and don’t have any spotting.

    A little known tip I have read about is to do with lowered milk supply caused by the return of your period. Apparently from when you ovulate to when you have your period, you may have lower milk supply. A combination calcium magnesium supplement (with double the amount of calcium to magnesium) is apparently meant to help.

    I would be terrified not to use birth control while breastfeeding – aiee! 🙂

    • mominisrael says:

      Judy, thanks for visiting.
      K, most women don’t suffer from lower milk supply when their cycles return, and I’ve never heard of the concern you mention. The worst I’ve heard is babies who are fussy during menstruation. This might be from a change in taste as well as a slight drop in supply.

  5. I knew about the use of the mini pill while breastfeeding, but I never knew you could use the combo pill while breastfeeding. I thought it would affect the child or something else. Can you tell me where the combo pill is ‘ok’ to use while breastfeeding?
    Thanks!

  6. you’d probably be better off using nuvaring rather than a combo pill – it’s more expensive, but it’s as effective with a lower dose going into the blood.

    I certainly have heard of menstruation dropping the milk supply.

    On cerazette, I’ve never had a period, but I haven’t taken it more than 6 months either.

    I think that relying on lactation – even eco-feeding is really only for those moms who wouldn’t be devastated to find out they’re pregnant… At this point, if I had a positive pregnancy test, I’d cry, and not from joy. (my munchkin isn’t 3 months yet…)

  7. Missnursing says:

    I have 4 kids: #1 nursed until 11 months, #2 until 7 months, #3 until 12 months and #4 until 14 months. All quit on their own. Only with #2 was I on the mini pill. Does that say something? I think it does…

    • mominisrael says:

      MissNursing: Thanks for visiting and sharing your experience. As for the weaning ages of your children, it’s hard to draw conclusions from one person’s experience. Every baby is different.

  8. mominisrael says:

    Trilcat, thanks for the suggestion. Yes, I have heard of menstruation causing to cause the milk supply to drop enough that the mother and baby noticed it, but not to the extent that it was a real problem. According to the LLLI Breastfeeding Answer Book, the “slight” drop lasts no more for a couple of days. I don’t know if K’s suggestion would work.

  9. hey I thought this was anonymous posting – for where we all discuss contraception – am I busted? 🙂 oh well I don’t really care.

    yup it was just a suggestion that I read when I thought I was getting my period back, and was having serious milk supply/pumping issues, and that was the only thing I found for that particular problem. What it actually turned out to be was lowered milk supply caused by lack of sleep, PPD and just all round stress. Went on holiday for 2 weeks, got some sleep, and the problems disappeared – til I came back of course.

    trilcat I know what you mean – I would do more than cry!

  10. mominisrael says:

    K–Sorry! I edited out your name so only the people participating in the thread would be likely to see. The email was right there in front of me.

  11. 🙂 no problemo. just read your post about teachers and family friendly workplaces. I think you need to do a post about that. My husband’s workplace is definitely not family friendly – that or they think mother’s should stay home, because fathers never see their children!

  12. in school we were mostly concerned with lactation if a drug could be excreted in the milk. i don’t remember anything about the reduced supply as a side effect. interesting.

    • mominisrael says:

      The problem is that most doctors and pharmacists only look at the risk of the medication to the baby, and end up being overly cautious. They don’t look at the risk of formula or of sudden weaning (for example, infection). Most medications are safe for nursing mothers and babies, despite the manfacturer’s warnings and should be checked out in Dr. Hale’s book, Medications and Mother’s Milk (updated annually).

  13. Cerazette,
    I read a lot in the Hebrew forums for religous women, particulary the one called Kipa, “Pregnancy and childbirth”, where this is discussed very often.
    It is important to note that a lot of the women there mention that they experienced a lot of breakthrough bleeding when beginning this pill (for between a month to 6 weeks), to the extent that they had problems with familiy purity.
    The well known Machon Puah who not only give advice about getting pregnant, but on all aspects of Family purity law, and contraception have become very hesitant about recomending this (cerazette)as a form of birth control straight after childbirth. (their recomendation for the first 6 months is full time nursing etc)
    In addition, many women reported loss of libido when taking cerazette.

    Femulen is not easily available, it is privately imported by a small number of pharmacies, if there is any one reading this who wants to find out where this is available, Machon Puah has this info.
    However, I have heard that there is recently a new mini pill which I think is called microlet (or something similar)

    I am sorry if this sounds a bit pessimistic.

    • mominisrael says:

      Kanon–thanks for sharing the information. Why only after 6 months? Was there less bleeding if the women waited longer? Or was the issue milk supply?

  14. so I have a question – why the focus on hormonal birth control? Apart from issues to do with heavy flow, I think a copper IUD is a great idea for those who can use them. And once you’ve had a baby the insertion process is a breeze – it did not hurt me at all. Nor did I have discomfort afterwards. I just like the idea that it is something mechanical and not something hormonal – I took the pill for ten years and experienced side-effects such as major crankiness (we all know this sounds like something small but its not), weight gain, and reduced, shall we say, enthusiasm.

    Are there any issues to do with family purity laws and IUDs?

  15. oh and of course to the topic at hand – it hasn’t reduced my supply at all, which is great.

  16. IUD is a good way, but if people are planning on small gaps between children, then they often do not want to use this on the short term, sometimes people just want to be sure that they have a year and half between their first sets of kids (1-2 and 2-3 etc etc as each person wants). Family purity issue is only with the Mirena hormonal type of IUD which apparently can cause bleeding for a L o n g time.

    MII asked why Machon PUAH suggested conraception by full time nursing for the first 6 months, they suggested this like you do in your post Breastfeeding: An Optimal Way to Space Babies, where they thought it was reliable for that amount of time only.

  17. mominisrael says:

    K Anon:
    Thanks. I hope they explain how it really works. Is this because of the spotting, or because of possibly lowered milk supply?

  18. Hi,
    Just to clear things up. The aforementioned Machon Puah suggestion is based on two things.
    1) Nursing only
    2) And using spermicides.
    The logic is, if you are only nursing you should not get your period, they clearly state that if you get your period you should switch to another form of contraception. The spermicides are a backup. That is because some women ovulate without having a period for one cycle.
    I’m pretty sure that the six months suggestion is because at that point most children start eating solids and therefore it is not considered full time nursing.

    Bottom line the Puah method is based on the fact that you are not getting your period and not able to fall pregnant, it is not really birth controll in the classical sense and is therefore limited to 6 months. I have much more to write about my own personal experience with Cerezette and the Puah method. When I have a minute.

    • mominisrael says:

      Y, if you like send your story to me for a guest post.
      Okay, I think I understand. The six months is based on the idea that after six months you are more likely to ovulate before the first period. The LAM method can only be relied on for six months.
      My question was why Puah preferred LAM to the mini-pill. In other words I wondered what was the specific concern, but I guess the answer is obvious.

  19. Michal Schonbrun says:

    To all you moms who are breastfeeding and don’t want to be pregnant- you should know that breastfeeding is not an effective method of contraception. Furthermore, the LAM method is not reliable either in the western world because of “cultural” patterns of breastfeeding. Women can rely on their own bodies- by checking their natural secretions on a daily basis in order to know when they are/are not fertile. I have been teaching this method, known as “Fertility Awareness” for over 20 years. You do not need hormones! For more info, see my website: http://www.poriutivit.com

  20. mominisrael says:

    Michal, thanks for your comment. I’d be interested in your source for LAM’s ineffectiveness in the West. From what I have read LAM has been tested in western countries and is equally effective, if the rules are followed. at any rate it only works for six months at most.
    Nevertheless I agree with you that fertility awareness is extremely valuable for women who want to use breastfeeding to avoid hormonal birth control.

  21. I had a question that related to this. I am currently breast feeding, and not having a menstral period. I recieved the “POP” pills at my 6 week check up. I don’t know when to start taking them. Because I haven’t had a period, I can’t take the pills on the Sunday of the start of my period. How do I know when to start? This is my 3rd child and I DO NOT want an oops! 🙂 TIA.

    • mominisrael says:

      Hi Angie,
      Progesterone only pills are taken continuously. It’s important to take it at the same time every day to be most effective. You may spot but keep taking the pill every day.

  22. ladies, i conceived my 2nd baby 5 months after i delivered by 1st child and 4.5 months after i delivered by 2nd child i discovered i was pregnant with my 3rd, breast feeding is NOT reliable form of contraception and while taking the progesterone only pill together with breastfeeding should also include a barrier method for at least 2 -3 weeks!!! comming from a yiddisha mom in SA who struggled to get pregnant to start – delivery REBOOTS your piturity gland to get your whole reproductive system going 🙂

Trackbacks

  1. […] Breastfeeding, Babies and Hormonal Birth Control […]

%d bloggers like this: