Contraception
Volume 82, Issue 1 , Pages 17-37, July 2010

Progestogen-only contraceptive use among breastfeeding women: a systematic review☆

  • Nathalie Kapp

      Affiliations

    • Department of Reproductive Health and Research, World Health Organization, CH-1211, Geneva 27, Switzerland
    • Corresponding Author InformationCorresponding author. Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
    • ,
  • Kathryn Curtis

      Affiliations

    • Centers for Disease Control and Prevention, Atlanta, GA, 3034127, USA
    • ,
  • Kavita Nanda

      Affiliations

    • Family Health International, Research Triangle Park, NC 27709, USA

Received 1 February 2010; accepted 2 February 2010. published online 19 March 2010.

Abstract 

Background

The use of progestogen-only contraceptives by breastfeeding women raises theoretical concerns regarding possible adverse effects on breastfeeding success, and infant health or growth. This review was conducted to determine from the literature whether use of progestogen-only contraceptives by breastfeeding women leads to adverse effects on lactation, or infant growth or health when compared to nonuse.

Study Design

We searched the Medline, Popline, Cochrane and LILACS databases for all articles published from database inception through May 2009. Studies were included if they investigated the use of progestogen-only methods in breastfeeding women and reported on clinical outcomes in either women or their infants. Standard data abstraction templates were used to systematically assess and summarize. Summary odds ratios were not calculated, given the heterogeneity of interventions, results and non-quantifiable outcomes reported.

Results

We identified 43 articles for this review. Overall, five randomized trials and 38 observational studies demonstrated no adverse effects of various progestogen-only methods of contraception on multiple measures of breastfeeding performance through 12 months in women using these methods in the postpartum period. Many of these studies also demonstrated no adverse effects of progestogen-only methods on infant growth, health or development from 6 months to 6 years of age. Additional studies demonstrated no effects on infant immunoglobulins or sex hormones of exposed male infants. A single study of a desogestrel pill reported two cases of gynecomastia in exposed infants.

Conclusions

Evidence suggests that progestogen-only methods of contraception do not adversely affect breastfeeding performance when used during lactation. Evidence that progestogen-only contraception does not adversely affect infant growth, health, or development when used by breastfeeding women is consistent but methodologically limited.

Keywords: Breastfeeding, Lactation, Postpartum contraception, Progestogen-only contraception

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

☆ The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the World Health Organization or Centers for Disease Control and Prevention.

PII: S0010-7824(10)00046-6

doi:10.1016/j.contraception.2010.02.002

Contraception
Volume 82, Issue 1 , Pages 17-37, July 2010

Article Tools