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Published on: February 5, 2019
Combined hormonal versus nonhormonal versus progestin-only contraception in lactation
S T Truitt1, A B Fraser, D A Grimes
1Family Health International, P. O. Box 13950, Research Triangle Park, North Carolina 27709, USA. dgrimes@fhi.org
The Cochrane Database of Systematic Reviews
|June 14, 2003
Summary
Limited evidence exists on hormonal contraceptives for breastfeeding women. Combined oral contraceptives may reduce milk volume, while progestin-only options show no adverse effects on lactation, though more research is needed.
Area of Science:
- Reproductive Health
- Maternal and Child Health
- Pharmacology
Background:
- Contraception for breastfeeding women is a global public health priority, with over 100 million women annually making decisions about postpartum contraception.
- Method selection is complex due to concerns about hormonal effects on milk, infant passage, and infant growth, necessitating methods that do not interfere with lactation.
Purpose of the Study:
- To evaluate the impact of combined oral contraceptives (COCs) and progestin-only contraceptives (POCs) on lactation in breastfeeding women.
- To test the hypothesis that COCs impair lactation more than POCs or nonhormonal methods.
Main Methods:
- Systematic search of multiple databases (PubMed, POPLINE, EMBASE, LILACS, Cochrane) for randomized controlled trials (RCTs) comparing hormonal contraceptives with other methods or placebo during lactation.
- Inclusion criteria encompassed breastfeeding women of any age/parity desiring contraception, using various hormonal methods (oral, injectable, implants, IUDs).
Main Results:
- Seven reports from five RCTs were included, but most had significant methodological flaws (e.g., inadequate randomization, blinding, high loss to follow-up).
- Conflicting results emerged regarding COCs' effects on lactation; one trial suggested a decline in milk volume.
- Progestin-only contraceptives showed no inhibitory effects on lactation in one trial, but data quality was often compromised.
Conclusions:
- The current evidence base on hormonal contraceptives during lactation is limited and of poor quality, necessitating cautious interpretation.
- Insufficient data exists to definitively establish the effect of hormonal contraception on milk quantity/quality or to provide recommendations for lactating women.
- A well-designed, adequately powered RCT is urgently needed to clarify the safety and efficacy of hormonal contraceptives in breastfeeding populations.
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