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

Ethinylestradiol + Norethindrone

February 7, 2016 (Low Risk)

Birth control pill that contains the combination of an estrogen (Ethinyl estradiol) and a progestin (Noretindronel) for oral use. It is also used for treatment of acne.

Ethinylestradiol is a synthetic estrogen with similar action as 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.

Norethindrone or norethisterone is a progestin derivative of 19-nortestosterone. It is excreted into breast milk in clinically non-significant amount and no problems have been observed in infants whose mothers were treated with it. Its plasma levels in these infants were undetectable or very low.

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.


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.


  • Αιθυνυλοιστραδιόλη + νοραιθιστερόνη (Greek)
  • نورإيثيستيرون + إيثينيلإيستراديول (Arabic)
  • 炔雌醇 + 炔诺酮 (Chinese)
  • エチニルエストラジオール + ノルエチステロン (Japanese)
  • C20H24O2 + C20H26O2 (Molecular formula)


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