Contraceptives for lactating women: A comparative trial of a progesterone-releasing vaginal ring and the Copper T 380A IUD

      This paper is only available as a PDF. To read, Please Download here.


      From approximately one week before normal ovulation resumes, lactating women require protection against pregnancy by a contraceptive that is safe for both infant and mother. In a multicenter one-year study, the natural hormone, progesterone, delivered vaginally by a sequence of four contraceptive rings designed for continuous use, was evaluated as a contraceptive for nursing mothers in comparison with the Copper T 380A IUD. Individual rings release an effective average dose of 10 mg/day for a 3-month period. Evaluation included measures of lactational performance as well as of contraceptive efficacy and safety to mother and child. Nine participating clinics enrolled 802 ring users and 734 IUD acceptors between postpartum days 29 and 63. Life table analyses were performed with parallel decrements for ring and IUD subjects. Continuation in the study and analysis required that subjects not stop breastfeeding. The ring, with a one-year pregnancy rate of 1.5 per 100, did not differ significantly from the IUD with respect to contraceptive effectiveness (p > 0.05). More than half of the ring subjects were continuing at 6 months post admission and a quarter (23.5 per hundred) were still using the ring and breastfeeding one year after admission. Women with the IUD, however, had higher continuation rates (p < 0.001) at both time points. The largest single decrement for each method was that for weaning. Ring users had more complaints of vaginal problems but had fewer vaginal disorders on examination. At 12 months postpartum, 46 per 100 continuing ring users remained in amenorrhea. Lactation performance and the health and weight gain of the infants were similar among users of either regimen.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kennedy K
        • Rivera R
        • McNeilly A
        Consensus statement on the use of breastfeeding as a family planning method.
        Contraception. 1989; 39: 477-496
        • Lewis PR
        • Brown JB
        • Renfree MB
        • Short RV
        The resumption of ovulation and menstruation in a well-nourished population of women breastfeeding for an extended period of time.
        Fertil Steril. 1991; 55: 529-536
        • Díaz S
        • Aravena R
        • Cárdenas H
        • et al.
        Contraceptive efficacy of lactational amenorrhea in urban Chilean women.
        Contraception. 1991; 43: 335-352
        • Pérez A
        • Labbok M
        • Queenan J
        Clinical study of the lactational amenorrhoea method for family planning.
        Lancet. 1992; 339: 968-970
        • Kennedy KI
        • Visness CM
        Contraceptive efficacy of lactational amenorrhoea.
        Lancet. 1992; 339: 227-230
        • International Planned Parenthood Federation
        Statement on breastfeeding, fertility and post-partum contraception.
        Statement by the International Medical Advisory Panel. 1989; : 1-5
        • Institute for International Studies in Natural Family Planning
        Guidelines for breastfeeding in family planning and child survival programs.
        Georgetown University, Washington, DC1990
        • Townsend S
        Postpartum options: matching the method to individual needs.
        Network. 1990; 11: 12-15
        • Chi I-Ch
        • Farr G
        Postpartum IUD contraception—a review of an international experience.
        Adv Contracept. 1989; 5: 127-146
        • Chi I-Ch
        • Wilkens LR
        • Champion CB
        • Machemer RE
        • Rivera R
        Insertional pain and other IUD insertion-related rare events for breastfeeding and non-breastfeeding women—a decade's experience in developing countries.
        Adv Contracept. 1989; 5: 101-119
        • Chi I-Ch
        • Potts M
        • Wilkens LR
        • Champion ChB
        Performance of the Copper T 380A intrauterine device in breastfeeding women.
        Contraception. 1989; 39: 603-618
        • Rivera R
        • Farr G
        Interactions between intrauterine contraceptive device and breast-feeding status at the time of intrauterine contraceptive device insertion: analysis of TCu 380A acceptors in developing countries.
        Am J Obstet Gynecol. 1992; 167: 144-151
        • World Health Organization
        Effects of hormonal contraceptives on breast milk composition and infant growth.
        Stud Fam Plann. 1988; 6: 361-369
        • Hull VJ
        The effects of hormonal contraceptives on lactation: current findings, methodological considerations, and future priorities.
        Stud Fam Plann. 1981; 12: 134-155
        • Croxatto HB
        • Díaz S
        • Peralta O
        • et al.
        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. 1983; 27: 13-25
        • World Health Organization
        Task Force for Epidemiological Research on Reproductive Health. Progestogenonly contraceptives during lactation: I. Infant growth.
        Contraception. 1994; 50: 35-53
        • World Health Organization
        Task Force for Epidemiological Research on Reproductive Health (HRP). Progestogen-only contraceptives during lactation: II. Infant development.
        Contraception. 1994; 50: 55-68
        • Harlap S
        Exposure to contraceptive hormones through breast milk—are there long-term health and behavioral consequences?.
        Int J Gynaecol Obstet. 1987; 25 (suppl): 47-55
        • Díaz S
        • Croxatto HB
        Contraception in lactating women.
        Curr Opin in Obstet Gynecol. 1993; 5: 815-822
        • Croxatto HB
        • Díaz S
        The place of progesterone in human contraception.
        J Steroid Biochem. 1987; 27: 991-994
        • Díaz S
        • Jackanicz TM
        • Herreros C
        • Croxatto HB
        Fertility regulation in nursing women: VII. Progesterone plasma levels and contraceptive efficacy of a progesterone-releasing vaginal ring.
        Contraception. 1985; 32: 603-622
        • Croxatto HB
        • Díaz S
        Progesterone vaginal rings for contraception during breastfeeding.
        in: 1st Edition. Advances in gynecological and obstetric research series. The Parthenon Publishing Group, New Jersey1991: 245-252 (Vol. 2: Female contraception and male fertility regulation)
        • Díaz S
        • Miranda P
        • Brandeis A
        • Cárdenas H
        • Croxatto HB
        Mechanism of action of progesterone as contraceptive for lactating women.
        in: Seppala M Hamberger L Frontiers in human reproduction. 1st Edition. The New York Academy of Sciences, New York1991: 11-21