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

Norethindrone

February 15, 2016 (Very Low Risk)

Progestin contraceptive used as a single product or linked to ethinyl estradiol (see Etinilestradiol + Norethindrone).

Norethindrone is a progestin derivative of 19-nortestosterone. It is excreted in breast milk in clinically significant amount and no problems have been observed in infants whose mothers took it. Plasma levels of these infants were undetectable or very low.

Progestin is generally considered contraceptive drugs of choice during lactation since it neither alter the quantity and composition of milk nor cause side effects on both growth of infants and the duration of breastfeeding.
Published study results have shown protection against breast bone mass loss with the use of progestin-only contraceptives.

For the first 6 weeks postpartum, non-hormonal methods are of choise. There is a debate on the role of progestin-related drugs in decreasing milk production when used before lactation has been fully established.

The American Academy of Pediatrics states that this medication is usually compatible with breastfeeding.
WHO List of Essential Medicines 2002: rates it as compatible with breastfeeding after the 6th postnatal week.

Alternatives

We do not have alternatives for Norethindrone since it is relatively safe.

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.

Synonyms

  • Ethinylnortestosterone
  • Norethisterone
  • Norethisterone Acetate
  • Norethisterone Enantate
  • Norpregneninolone

Writings

  • νοραιθιστερόνη (Greek)
  • نورإيثيستيرون (Arabic)
  • Норэтистерон (Cyrillic)
  • 炔诺酮 (Chinese)
  • ノルエチステロン (Japanese)
  • C20H26O2 (Molecular formula)

Drug trade names

References

  1. Lopez LM, Grey TW, Stuebe AM, Chen M, Truitt ST, Gallo MF. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev. 2015Abstract
  2. Tepper NK, Phillips SJ, Kapp N, Gaffield ME, Curtis KM. Combined hormonal contraceptive use among breastfeeding women: an updated systematic review. Contraception. 2015Abstract
  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)
  6. Mwalwanda CS, Black KI. Immediate post-partum initiation of intrauterine contraception and implants: a review of the safety and guidelines for use. Aust N Z J Obstet Gynaecol. 2013Abstract
  7. Bahamondes L, Bahamondes MV, Modesto W, Tilley IB, Magalhães A, Pinto e Silva JL, Amaral E, Mishell DR Jr. Effect of hormonal contraceptives during breastfeeding on infant's milk ingestion and growth. Fertil Steril. 2013Abstract Full text (link to original source) Full text (in our servers)
  8. 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)
  9. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  10. Hall KS, Trussell J, Schwarz EB. Progestin-only contraceptive pill use among women in the United States. Contraception. 2012Abstract
  11. Centers for Disease Control and Prevention (CDC). U S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep. 2010Abstract Full text (link to original source) Full text (in our servers)
  12. [No authors listed] Intrauterine devices: an effective alternative to oral hormonal contraception. Prescrire Int. 2009Abstract
  13. Taneepanichskul S, Reinprayoon D, Thaithumyanon P, Praisuwanna P, Tosukhowong P, Dieben T. Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants. Contraception. 2006Abstract
  14. Díaz S. Contraceptive implants and lactation. Contraception. 2002Abstract
  15. 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)
  16. Reinprayoon D, Taneepanichskul S, Bunyavejchevin S, Thaithumyanon P, Punnahitananda S, Tosukhowong P, Machielsen C, van Beek A. Effects of the etonogestrel-releasing contraceptive implant (Implanon on parameters of breastfeeding compared to those of an intrauterine device. Contraception. 2000Abstract
  17. Lawrie TA, Hofmeyr GJ, De Jager M, Berk M, Paiker J, Viljoen E. A double-blind randomised placebo controlled trial of postnatal norethisterone enanthate: the effect on postnatal depression and serum hormones. Br J Obstet Gynaecol. 1998Abstract
  18. Shaaban MM. Contraception with progestogens and progesterone during lactation. J Steroid Biochem Mol Biol. 1991Abstract
  19. Betrabet SS, Shikary ZK, Toddywalla VS, Toddywalla SP, Patel D, Saxena BN. ICMR Task Force Study on hormonal contraception. Transfer of norethisterone (NET) and levonorgestrel (LNG) from a single tablet into the infant's circulation through the mother's milk. Contraception. 1987Abstract
  20. Cooke ID, Back DJ, Shroff NE. Norethisterone concentration in breast milk and infant and maternal plasma during ethynodiol diacetate administration. Contraception. 1985Abstract
  21. West CP. The acceptability of a progestagen-only contraceptive during breast-feeding. Contraception. 1983Abstract
  22. Fotherby K, Towobola O, Muggeridge J, Elder MG. Norethisterone levels in maternal serum and milk after intramuscular injection of norethisterone oenanthate as a contraceptive. Contraception. 1983Abstract
  23. Koetsawang S, Nukulkarn P, Fotherby K, Shrimanker K, Mangalam M, Towobola K. Transfer of contraceptive steroids in milk of women using long-acting gestagens. Contraception. 1982Abstract
  24. Melis GB, Strigini F, Fruzzetti F, Paoletti AM, Rainer E, Düsterberg B, Fioretti P. Norethisterone enanthate as an injectable contraceptive in puerperal and non-puerperal women. Contraception. 1981Abstract
  25. Toddywalla VS, Mehta S, Virkar KD, Saxena BN. Release of 19-nor-testosterone type of contraceptive steroids through different drug delivery systems into serum and breast milk of lactating women. Contraception. 1980Abstract
  26. Seth U, Yadava HS, Agarwal N, Laumas KR, Hingorani V. Effect of a subdermal silastic implant containing norethindrone acetate on human lactation. Contraception. 1977Abstract
  27. Saxena BN, Shrimanker K, Grudzinskas JG. Levels of contraceptive seroids in breast milk and plasma of lactating women. Contraception. 1977Abstract
  28. Giner Velázquez J, Cortés Gallegos V, Sotelo López A, Bondani G. [Effect of daily oral administration of 0.350 mg of norethindrone on lactation and on the composition of milk]. Ginecol Obstet Mex. 1976Abstract
  29. Karim M, Ammar R, el-Mahgoub S, el-Ganzoury B, Fikri F, Abdou I. Injected progestogen and lactation. Br Med J. 1971Abstract Full text (link to original source) Full text (in our servers)