Is Ethinylestradiol + Drospirenone compatible with breastfeeding? Do we have alternatives for Ethinylestradiol + Drospirenone?

Ethinylestradiol + Drospirenone

January 31, 2016 (Low Risk)

Birth control pill that contains the combination of an estrogen (Ethinyl estradiol) and a progestin (Drospirenone) for oral use.

Ethinylestradiol is a synthetic estrogen with similar action than estradiol. Used in combination with progestogens for contraception.
Ethinylestradiol is excreted into the breast milk in no or small amount.
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.

Drospirenone is an analogue of spironolactone which has the effects of progesterone. It is excreted into breast milk in clinically non-significant amount.

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.
During 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.

Writings

  • Αιθυνυλοιστραδιόλη + Δροσπιρενόνη (Greek)
  • إيثينيلإيستراديول+& دروسبيرينون (Arabic)
  • Этинилэстрадиол + Дроспиренон (Cyrillic)
  • 炔雌醇 + 屈螺酮 (Chinese)
  • エチニルエストラジオール + ドロスピレノン (Japanese)
  • C20H24O2 + C24H30O3 (Molecular formula)

Drug trade names

References

  1. Berens P, Labbok M; Academy of Breastfeeding Medicine. Protocolo clínico de la ABM n.º 13: Anticoncepción durante la lactancia, revisado en 2015. Breastfeed Med. 2015 Full text (link to original source)
  2. 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)
  3. 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)
  4. AEMPS. Etinilestradiol+Drospirenona. Ficha técnica. 2015 Full text (in our servers)
  5. 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)
  6. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  7. Blode H, Foidart JM, Heithecker R. Transfer of drospirenone to breast milk after a single oral administration of 3 mg drospirenone + 30 microg ethinylestradiol to healthy lactating women. Eur J Contracept Reprod Health Care. 2001Abstract
  8. Dórea JG. Oral contraceptives do not affect magnesium in breast milk. Int J Gynaecol Obstet. 2000Abstract
  9. Dorea JG, Miazaki ES. The effects of oral contraceptive use on iron and copper concentrations in breast milk. Fertil Steril. 1999Abstract
  10. Dorea JG, Myazaki E. Calcium and phosphorus in milk of Brazilian mothers using oral contraceptives. J Am Coll Nutr. 1998Abstract
  11. Costa TH, Dorea JG. Concentration of fat, protein, lactose and energy in milk of mothers using hormonal contraceptives. Ann Trop Paediatr. 1992Abstract
  12. Briend A, Fauveau V, Chakraborty J. Contraceptive use and breast-feeding duration in rural Bangladesh. Eur J Clin Nutr. 1991Abstract
  13. Nilsson S, Mellbin T, Hofvander Y, Sundelin C, Valentin J, Nygren KG. Long-term follow-up of children breast-fed by mothers using oral contraceptives. Contraception. 1986Abstract
  14. Madhavapeddi R, Ramachandran P. Side effects of oral contraceptive use in lactating women--enlargement of breast in a breast-fed child. Contraception. 1985Abstract
  15. Tankeyoon M, Dusitsin N, Chalapati S, Koetsawang S, Saibiang S, Sas M, Gellen JJ, Ayeni O, Gray R, Pinol A, et al. Effects of hormonal contraceptives on milk volume and infant growth. WHO Special Programme of Research, Development and Research Training in Human Reproduction Task force on oral contraceptives. Contraception. 1984Abstract
  16. Peralta O, Díaz S, Juez G, Herreros C, Casado ME, Salvatierra AM, Miranda P, Croxatto H. [Effect of a combined oral contraceptive on lactation and growth of the infant]. Rev Chil Obstet Ginecol. 1983Abstract
  17. Peralta O, Díaz S, Juez G, Herreros C, Casado ME, Salvatierra AM, Miranda P, Durán E, Croxatto HB. Fertility regulation in nursing women: V. Long-term influence of a low-dose combined oral contraceptive initiated at day 90 postpartum upon lactation and infant growth. Contraception. 1983Abstract
  18. Croxatto HB, Díaz S, Peralta O, Juez G, Herreros C, Casado ME, Salvatierra AM, Miranda P, Durán E. Fertility regulation in nursing women: IV. Long-term influence of a low-dose combined oral contraceptive initiated at day 30 postpartum upon lactation and infant growth. Contraception. 1983Abstract
  19. Díaz S, Peralta O, Juez G, Herreros C, Casado ME, Salvatierra AM, Miranda P, Durán E, Croxatto HB. Fertility regulation in nursing women: III. Short-term influence of a low-dose combined oral contraceptive upon lactation and infant growth. Contraception. 1983Abstract
  20. Klinger G, Claussen C, Schröder S. [Excretion of ethinyloestradiol sulfonate in the human milk (author's transl)]. Zentralbl Gynakol. 1981Abstract
  21. [No authors listed] American Academy of Pediatrics. Committee on Drugs: Breast-feeding and contraception. Pediatrics. 1981Abstract
  22. Lönnerdal B, Forsum E, Hambraeus L. Effect of oral contraceptives on composition and volume of breast milk. Am J Clin Nutr. 1980Abstract Full text (link to original source) Full text (in our servers)
  23. Nilsson S, Nygren KG, Johansson ED. Ethinyl estradiol in human milk and plasma after oral administration. Contraception. 1978Abstract
  24. Guiloff E, Ibarra-Polo A, Zañartu J, Toscanini C, Mischler TW, Gómez-Rogers C. Effect of contraception on lactation. Am J Obstet Gynecol. 1974Abstract
  25. Marriq P, Oddo G. [Letter: Gynecomastia in the newborn induced by maternal milk? An unusual complication of oral contraceptives]. Nouv Presse Med. 1974Abstract
  26. Kaern T. Effect of an oral contraceptive immediately post partum on initiation of lactation. Br Med J. 1967Abstract Full text (link to original source) Full text (in our servers)