Premature introduction of progestin-only contraceptive methods during lactation.

ABSTRACT

PIP: All major international family planning organizations have endorsed the use of progestin-only contraceptive methods once lactation has been established. Prospective, multicenter studies of infants of acceptors of progestin-only pills, injections, and implants have found no deleterious effects of the drug on infant growth and development; however, women enrolled in these trials did not initiate method use until at least the sixth postpartum week. Of concern is a recent trend toward administration of progestin subdermal implants and injectables to women prior to their discharge from the hospital (i.e., 0-72 hours after delivery). Since progesterone withdrawal is the likely stimulus that initiates lactogenesis, natural progesterone levels need a chance to decline to baseline before progestin contraceptive use is initiated. Moreover, the immature neonatal liver may have difficulties metabolizing exogenous steroids, the binding capacity of plasma is low, and the immature kidney may be inefficient in steroid excretion. Use of progestin-only contraceptive methods should be delayed for at least 3 days (optimally, until 6 weeks) after birth so lactation can become established. Nonhormonal methods remain the first choice for breast-feeding women, given the lack of potential to interfere with lactation, while progestin-only agents are a viable second choice.