Effective contraception helps to optimize birth-spacing, thus improving the health of parents and babies. All patients receiving prenatal care should be counseled about available forms of postpartum contraception, their risks, and timing of initiation. For otherwise healthy birthing parents, most hormonal contraception can be safely initiated in the postpartum period. Theoretical concerns exist surrounding the impact of exogenous progestins on lactation, however current clinical research often includes a small sample size and inconsistent outcome measures. The research that does exist does not demonstrate negative effects of postpartum hormonal contraception on lactogenesis, lactation outcomes, or infant health. However, more research is needed to fully understand the impact of hormonal contraception on chestfeeding.* Clinicians and patients should engage in shared decision-making about postpartum contraception, taking into consideration individual patient priorities around contraception and lactation goals.
Progestin-only pills, implants, and intrauterine devices can be initiated safely in the immediate postpartum period. There has been some controversy regarding timing of initiating progestin injections. Original product labeling and guidelines from the World Health Organization recommend against initiating injections before 6 weeks postpartum based on animal studies and possible developmental risks from exposure of infants to higher levels of hormone compared with other progestin-only methods. Injectable contraception in the immediate postpartum period is a category 2 in the US Medical Eligibility Criteria for Contraceptive Use from the Centers for Disease Control and Prevention, indicating that the benefits tend to outweigh the theoretical risks. Studies of poor to fair quality suggest little to no impact on lactation outcomes.
Combined Hormonal Contraceptives:
Estrogen-containing methods (pills, patch, ring) are not recommended during the first 3 weeks postpartum, when all patients are at increased risk for venous thromboembolism (VTE). At 30 days postpartum, lactating patients without other VTE risk factors may safely initiate combined hormonal contraception. Patients with other postpartum VTE risk factors may do so at 6 weeks. For patients at increased risk for breast/chestfeeding difficulties, shared decision-making should be utilized if initiating estrogen-containing methods before 6 weeks due to some evidence that doing so may affect breast/chestfeeding outcomes.
*Chestfeeding refers to feeding a child human milk from a person’s chest. RHAP uses these terms – chestfeeding and human milk – because we understand that people of all genders participate in this process.
Phillips SJ, Tepper NK, Kapp N, Nanda K, Temmerman M, Curtis KM. Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception. 2016;94(3):226-252. doi:10.1016/j.contraception.2015.09.010
Tepper NK, Phillips SJ, Kapp N, Gaffield ME, Curtis KM. Combined hormonal contraceptive use among breastfeeding women: an updated systematic review. Contraception. 2016;94(3):262-274. doi:10.1016/j.contraception.2015.05.006
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.