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Progestogen-only contraception use during breastfeeding: an updated systematic review
Angeline Ti1, Sylvia Ayieko2, Mercedes Bonet3
1Wellstar Douglas Family Medicine Residency Program, Douglasville, Georgia, USA angeline.ti@wellstar.org.
BMJ Sexual & Reproductive Health
|November 3, 2025
Summary
Progestogen-only contraception (POC) is safe for breastfeeding women and their infants. This review found no increased risk of adverse breastfeeding or infant outcomes with POC use or early initiation.
Area of Science:
- Reproductive Health
- Maternal and Child Health
- Pharmacology
Background:
- Progestogen-only contraception (POC) is a common choice for postpartum women.
- Concerns exist regarding potential adverse effects on breastfeeding and infant outcomes.
- Previous reviews have assessed safety, necessitating an update.
Purpose of the Study:
- To systematically review evidence on the safety of POC use during breastfeeding.
- To evaluate risks associated with POC use compared to non-use.
- To assess risks related to early (pre-6 weeks) versus later initiation of POC.
Main Methods:
- Comprehensive database searches (MEDLINE, EMBASE, Cochrane, etc.) up to September 2023.
- Inclusion of 61 articles, with 11 new since the prior review.
- Data extraction and risk of bias assessment for all included studies.
Main Results:
- No significant adverse effects on breastfeeding continuation, supplementation, or duration were found.
- No significant adverse effects on infant growth or illness were identified.
- Evidence for preterm infants also suggests no adverse effects.
Conclusions:
- Updated systematic review confirms the safety of progestogen-only contraception for breastfeeding women.
- Newly identified studies reinforce previous findings of no adverse effects.
- Evidence now includes safety data for preterm infants.
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