Updates in Contraception From The XVI World Congress of the International Federation of Gynecology and Obstetrics

David A. Grimes, MD


September 20, 2000

In This Article

Implanon for Breastfeeding Mothers?

When to start hormonal contraception after childbirth when the mother is breastfeeding is a contentious issue. Data from WHO studies several decades ago showed a small deleterious effect of combined high-dose oral contraceptives on the quantity and quality of breast milk when the pills were started 6 weeks after delivery.[18] Of note, however, the infants of these women grew and developed normally, suggesting some compensatory mechanism. By contrast, no such effect has been seen with progestin-only mini-pills in this setting.

The potential effect on breast milk of the single subdermal rod Implanon is unknown. Hence, Damrong Reinprayoon and his associates[19] at Chulalongkorn University, Bangkok, Thailand, conducted a prospective cohort study to address this question. Implanon contains the potent progestin 3-ketodesogestrel (etonogestrel) in a single rod. The comparison contraceptive was the Multiload 375, a copper IUD. A total of 42 women who chose the Implanon and 38 patients who chose the IUD were studied over several months.

Use of the Implanon device had no discernible effect on the quantity or quality of breast milk over several months of study. The fluid volume produced was similar in both study groups. Similarly, the milk lactose concentration, total protein, and fat concentrations all showed no clinically important differences between baseline and treatment phases. The authors concluded that Implanon has no adverse effect on breast milk. The mean transfer of etonogestrel to the infant was highest in month 1 and amounted to 20 ng/kg/day; the transfer rate decreased with time.

This is reassuring news for women and their clinicians. The practical importance of this study is that this contraception can start right after delivery without concern about impairing lactation. In many developing countries, access to healthcare is limited and difficult. Often, women encounter the healthcare system only in acute situations, such as childbirth or injury. If women are required to return some weeks postpartum to begin contraception, many will be lost to follow-up. The immediate postpartum period may be an ideal time to start subdermal contraception with this product.


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