Is Estradiol + Medroxyprogesterone compatible with breastfeeding? Do we have alternatives for Estradiol + Medroxyprogesterone?

Estradiol + Medroxyprogesterone

February 7, 2016 (Low Risk)

Birth control compound that contains the combination of an estrogen (Estradiol cypionate) and a progestin (Medroxyprogesterone) for IM injection once a month.

Estradiol is excreted into the breast milk in no or small amount. No problems have been observed in infants whose mothers were receiving this drug.
There is evidence (albeit inconsistent) that estrogen-containing pills may decrease milk production, especially during the first few weeks postpartum with a daily dose above 30 micrograms of ethinyl estradiol.
It may reduce the protein content of the milk.
No problems have been observed in infants whose mothers were treated, except some cases of transient gynecomastia in infants whose mothers were receiving a higher dose than usual.

Medroxyprogesterone is a synthetic progestin drug similar to progesterone. It is excreted into breast milk in clinically non-significant amount and no problems have been observed in infants whose mothers were treated. Plasma levels in these infants were usually very low.
There may be increased prolactin and milk production in women treated with Medroxyprogesterone.

With other similar combined contraceptives no differences have been observed in the frequency of breastfeeding or the amount of milk produced or weight gain of breastfed infants compared to other contraceptive methods (intrauterine devices, isolated progestogens). However, it would be advisable to avoid them until breastfeeding is well established (4-6 weeks).

During lactation, progestin-only contraceptive pills are preferred to Estrogen containing ones, otherwise, the lowest estrogen dose should be used.
Within the first 6 postpartum weeks, non-hormonal methods are in the first line of choice.

Hormone containing contraceptives do not affect the composition of milk, minerals (Mg, Fe, Cu, Ca, P) fat, lactose and calories but only a few the proteins.

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

References

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  3. Bhardwaj NR, Espey E. Lactation and contraception. Curr Opin Obstet Gynecol. 2015Abstract
  4. Berens P, Labbok M; Academy of Breastfeeding Medicine. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeed Med. 2015Abstract Full text (link to original source) Full text (in our servers)
  5. Department of Reproductive Health and Research World Health Organization. Medical Eligibility Criteria for Contraceptive Use. WHO/RHR/15.07. 2015Abstract Full text (link to original source) Full text (in our servers)
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  7. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep. 2013Abstract Full text (link to original source) Full text (in our servers)
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  20. [No authors listed] Progestogen-only contraceptives during lactation: I. Infant growth. World Health Organization Task force for Epidemiological Research on Reproductive Health; Special Programme of Research, Development and Research Training in Human Reproduction. Contraception. 1994Abstract
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