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.
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