This is where the subject of birth control and breastfeeding gets slightly more complicated. There's no definitive answer as to whether hormonal methods of contraception pose any risk to breastfeeding women. Contradictory lines of thought have resulted in conflicting recommendations from generally authoritative sources. Therefore, a woman should seriously consider all her options before deciding on hormonal contraception if she's lactating. Here's what the American College of Obstetricians and Gynecologists (ACOG) advises breastfeeding women who wish to go with hormonal methods of birth control:
- Progestin-only contraceptives: This is the method of hormonal birth control recommended by ACOG for breastfeeding women. This includes "minipills" and Depo-Provera. Progestin-only contraceptives are not thought to affect the quality of breast milk -- in fact, they may slightly increase the volume of milk while breastfeeding compared with nonhormonal methods. Because it may have some effect on breast milk, lactating women should not begin taking these contraceptives prior to two or three weeks postpartum.
- Combination estrogen-progestin contraceptives: Any contraceptives containing estrogen have been shown to reduce the quantity and quality of breast milk. The World Health Organization recommends that the breastfeeding woman wait at least six months after childbirth to start using these pills. And their labels, written by the Food and Drug Administration, currently read, "If possible, the nursing mother should be advised not to use oral contraceptives but to use other forms of contraception until she has completely weaned her child." But it can be argued that these warnings are a result of earlier studies, when combination pills used higher doses of estrogen. The lower-dose tablets used today probably have less effect on the quality and quantity of breast milk. As a result, there is no definitive answer regarding if and how much a combination pill taken today may affect breast milk.
If there are strong reasons that you would prefer to start using combined estrogen-progestin contraception, it's important to understand and weigh the potential disadvantages. Since most women experience reduced milk as a result of taking combination pills (and this may be dealt with more easily after breastfeeding skills and patterns are established) a woman who chooses to breastfeed should not begin taking these pills prior to six weeks postpartum. If you begin to take them following that six-week period, it's recommended that you meet regularly with your ob-gyn or a lactation specialist for a breastfeeding evaluation.