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  • Title: A review of the use of progestogen-only minipills for contraception during lactation.
    Author: Fraser IS.
    Journal: Reprod Fertil Dev; 1991; 3(3):245-54. PubMed ID: 1947224.
    Abstract:
    Progestogen-only minipills and other systems for releasing low doses of progestogens alone are widely used for contraception in breast-feeding women around the world. There is good evidence to confirm their acceptability and their lack of effect on milk production, neonatal growth and early development. In contrast, combined oral contraceptives frequently decrease milk production, and may produce minor changes in milk composition. However, even combined oral contraceptives do not appear to produce adverse effects on neonatal well-being and development, although minor reductions in initial growth rate may sometimes occur. Progestogen-only methods may also produce subtle changes in milk composition, although less than combined oral contraceptives. Steroids are transferred from plasma into milk in small quantities, but the amounts are usually very low or insufficient to allow detection in the infants using present-day assays. There has been theoretical concern that these tiny amounts of steroids might affect neonatal reproductive development, but this appears to be unwarranted. Progestogen-only methods are being widely used for post-partum contraception, and they appear to have particular advantages in this situation. They also have few disadvantages; a theoretical concern about a possible effect on later reproductive or sexual development has no evidence to support it. The present licensing situation in Australia, which lists lactation as a relative contraindication to progestogen-only contraceptive use, causes real concern to potential users and appears to lead to frequent errors in compliance. A review of the literature revealed no justification for the identification in Australia of lactation as a relative contraindication for use of progestogen-only contraceptives. The patient information leaflet expresses concern about the effect on the growing infant of the small amounts of hormone that are found in human milk and possible reductions in milk supply. However, several studies have documented that progestogen-only contraceptive systems do not decrease--and in many cases actually increase--milk volume. In addition, the marginal changes in breast milk composition found in users of combined oral contraceptives have not been recorded in progestogen-only minipills. A study conducted in India found no significant differences between women treated with levonorgestrel and controls in terms of milk volume, total nitrogen, non-protein nitrogen, and important proteins and lactose. Concentrations of levonorgestrel in human milk are lower than those of norethindrone because of the lower oral dosage of the former. Moreover, even if a total 40 ng of norethindrone is ingested during breastfeeding, the amount of the hormone in an infant's bloodstream would be undetectable. Finally, there has been no published evidence of any adverse effect through adolescence of progestogens on physical and mental growth; in fact, some studies have recorded increased neonatal weight gain in infants of mothers who use oral or injectable progestogen contraceptives.
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