Breastfeeding while on Birth Control

The human body is an amazing living machine. While nobody is perfect or built precisely the same, our bodies are designed in such a way that the various organs synergize with each other to function seamlessly like gears in an expertly engineered clock. 

An excellent example of this natural synergy is lactational amenorrhea, which is the temporary absence of menstruation while a mother is lactating or breastfeeding. This pause from ovulation and fertility is for the sake of conservation. Imagine becoming pregnant a few days after giving birth? That would be physically and mentally exhausting for a mother and would, in turn, affect the development of a fetus.

Thankfully, this is not the case— at least for the most part. According to the World Health Organization, the lactational amenorrhea method (LAM) is only reliable if you are exclusively breastfeeding, and it is up to 98% effective. The downside of LAM is that it cannot be used as a regular or long-term method of contraception, as it loses its effectiveness after six months or once liquids other than breastmilk or solid foods have been introduced to your baby. 

If you would like to prevent pregnancy while breastfeeding and beyond, you have several safe and affordable options available to you. Consult with your doctor to determine which method is right for you.

How soon can I go on birth control after having a baby?

 If you are looking to prevent pregnancy right after giving birth, LAM is a natural, free, and effective form of birth control. As encouraged by most health professionals, breastfeeding should be done exclusively for the first six months of life and continue in combination with food until the age of two or more. As an added benefit, LAM is an entirely natural form of birth control, so there is no conflict with any moral or religious doctrines.

Immediately after birth

 Should you desire to prevent conception after doing LAM or would like to use other forms of contraception after giving birth, then you have several options to choose from. Immediately after delivery, you can receive a shot, implant, or an intrauterine device (IUD). These will protect against unwanted pregnancy with a very high effectivity rate (up to 99% effective). Unlike oral birth control pills, you won’t have to worry about forgetting to take a pill or mark your calendar because these types of birth control are low maintenance and can last several months to years when appropriately administered. Oral contraceptive pills (OCPs) that do not contain estrogen can also be used after delivery and are effective as long as you do not miss a dose.

Non-hormonal birth control methods, such as condoms, sterilization, and abstinence, can also be used. Only sterilization and abstinence are 100% effective at preventing pregnancy but tend to be unsuitable for couples for various reasons. Condoms and abstinence can be used immediately after birth but require discipline and cooperation with your partner. Sterilization, either through tubal ligation (“tube tying”) or vasectomy (done in a male partner), are more or less permanent methods of birth control and should be thought over seriously before deciding to have the procedure done.

Later after birth

If you have previously taken an OCP and would like to continue with your trusted brand, you can take them three weeks after delivery. In addition to pills, other forms of hormonal contraception can be used. These include dermal patches, IUDs, and vaginal rings. Proper placement and regular timing are essential for the effectiveness of these forms of birth control.

Non-hormonal birth control, like diaphragms and fertility awareness methods, can be used but have varied rates of effectiveness. Diaphragms should not be used until after you have had a postpartum checkup, as it is likely that your previous diaphragm will not fit the same way as it did before your pregnancy. 

Natural family planning methods like the calendar, cervical mucus, and temperature methods are safe but not always effective, especially if you get sick or have irregular periods. You will need to wait until your first ovulation—about 2 weeks after giving birth— or the first period after giving birth to use these methods. Keeping a log or using a fertility app can help you keep track of your period and symptoms and determine your fertility window. Avoid having sex a few days before and after this window period to prevent an unintended pregnancy.

Can birth control affect milk supply?

 Yes, certain birth control pills can affect your milk supply and ability to lactate. Birth control that contains the hormone estrogen should be avoided until about four to six weeks after giving birth to allow for normal breastmilk production. The reason why estrogen should be avoided while breastfeeding is that it can inhibit prolactin, the hormone responsible for milk production. The first few days to weeks after delivery are an important time for the shift of hormones from maintaining a pregnancy to nursing your baby.

What birth control is safe while breastfeeding?

 While some birth control pills should not be taken because they can affect your milk supply, other pills should not be taken at all while breastfeeding as they may affect your baby. Birth control that contains estrogen should not be taken while breastfeeding, as it can reduce the quality and quantity of your breast milk supply.

Contraception MethodEffectivenessAdvantagesDisadvantages
Breastfeeding (LAM)98%Costless, 2-in-1 solution, natural and safeOnly reliable if you are exclusively breastfeeding your child, you must allow your child to breastfeed every 4 hours or more, is not effective after 6 months
IUDs (copper-containing, ParaGard; progestin-containing, Mirena)99%Long-lasting protection (3-12 years), discreet, one-time placement, can be removed if you would like to conceive, can be used while breastfeedingCarries a slightly higher risk for ectopic pregnancy, can be costly for some
Progestin-only OCPs (“Mini pill”)91%Affordable, can be used while breastfeeding, self-administeredLoses effectiveness if you miss a dose, may cause unwanted side effects
Implants (Nexplanon)99%Affordable (with health insurance), one-time placement, long-lasting (up to 5 years), can be removed if you would like to conceive, discreetRequires a professional to administer, may be painful during the insertion, cannot be removed yourself if you would like to become pregnant, some women experience unwanted side effects such as weight gain or mood swing
Birth control shots (Depo-Provera)94%Affordable (with health insurance), does not require daily tracking, discreetRequires a professional to administer, may be painful during administration, requires administration every 3 months, cannot be removed, some women experience unwanted side effects such as weight gain or mood swing
Condoms85%Affordable, offers additional protection against many STDsA new condom must be used each time you have intercourse, your partner must be willing and know how to wear it properly, latex condoms may cause allergic reactions
Fertility Awareness76-88%Costless or almost costless, natural, safe, useful for determining your fertile days in case you plan to become pregnantRequires regular tracking, may not be reliable if you have irregular periods or are sick
Calendar
Cervical mucus
Standard days
Temperature
Tubal ligation100%Permanent form of birth control, one-time procedureRequires surgery, may be costly, cannot normally be undone
Abstinence100%Costless, does not require any tracking, natural and safeDifficult for couples, requires discipline and mutual effort between partners

Why is OCP contraindicated while breastfeeding?

 Some OCPs are contraindicated while breastfeeding, but not all of them. Estrogen-containing OCPs are generally contraindicated for use while breastfeeding, especially within the first three months after giving birth. If you are not sure what OCP contains estrogen, look for any of the following active drugs in the label: ethinylestradiol, mestranol, or estradiol. These are often combined with progestin-type hormones.

 Estrogen-containing birth control can interfere with breastmilk production, affecting the quality of milk and the amount of milk produced. This is because estrogen blocks the function of prolactin, the hormone responsible for milk production.

During pregnancy, estrogen and progesterone hormone levels are generally high to maintain the pregnancy. The breast tissue develops in preparation to produce milk during this time. Still, lactation does not begin due to the high levels of progesterone and estrogen and low levels of prolactin.

Another hormone, oxytocin, triggers uterine contractions and marks the imminent delivery of the baby. Oxytocin also stimulates the release of breastmilk from the breasts. Prolactin, the hormone responsible for milk production, begins to rise and predominate as estrogen and progesterone are cleared and return to baseline levels.

If you plan to use OCPs during breastfeeding, you can take progestin-only pills, also known as the mini-pill, switch to a combination estrogen-progestin OCP once your milk production has been established long enough. Consult with your doctor to discuss what is best for you.

Can you get your period while breastfeeding and on birth control?

 The chances of getting your period or seeing spotting are low while you breastfeed after giving birth and when you are taking birth control pills. If combined, the chances are even slimmer but not 100% bulletproof (unless you get your tubes tied or practice strict abstinence). The risk of getting your period or getting pregnant while breastfeeding and using birth control is likely due to improper use of your birth control or insufficient breastfeeding.

 Spotting can occur while breastfeeding or while taking OCPs, but this does not mean you had your period. Spotting, which can be mistaken for a light period, can occur during implantation or as a consequence of suddenly stopping OCPs or missing doses, known as a withdrawal bleed. 

If you get your period while breastfeeding, you can no longer use LAM as a form of birth control. You can opt for hormonal or non-hormonal forms of contraception, as directed by your doctor.

Can a breastfeeding mother get pregnant without having her period?

 Yes, but the chance is very low. Usually, after giving birth, fertility returns after two weeks. For mothers who breastfeed immediately after giving birth, fertility does not return as long as they exclusively breastfeed. Contraception via breastfeeding typically lasts for six months. However, LAM is not foolproof. 

 Before you get your period, there is a window of fertility when you ovulate. While breastfeeding, ovulation is delayed, and in turn, menstruation is delayed. If, for some reason, your lactation decreases, your ovaries may release an egg, which can then become fertilized if you have intercourse with your partner. 

A period will indicate that there was no conception, and you will not become pregnant. However, it also indicates that you will become fertile again and may become pregnant unless you use birth control. Once your period returns, you can no longer use LAM as a form of birth control and should switch to either hormonal or non-hormonal forms of contraception if you wish to avoid pregnancy.

Is Microlut safe while breastfeeding?

Microlut is a progestin-only OCP that contains the active ingredient levonorgestrel. It is also known as the “Mini-pill.” As it only contains progestin and no estrogen, Microlut is safe to use while breastfeeding and can be started as soon as you give birth. Unlike with estrogen-containing OCPs, Microlut will not affect your milk production and quality, and in some women may actually improve milk supply.

References

Cleveland Clinic. (2018, January 1). Contraception During Breastfeeding. Retrieved May 19, 2020, from https://my.clevelandclinic.org/health/drugs/15280-contraception-during-breastfeeding

Department of Health & Human Services. (2016, November 2). Contraception After Giving Birth. Retrieved May 20, 2020, from https://www.betterhealth.vic.gov.au/health/HealthyLiving/Contraception-after-childbirth

King, J. (2007, November 20). Contraception and Lactation. Retrieved May 20, 2020, from https://www.medscape.com/viewarticle/565623_2

Planned Parenthood. (2020). Breastfeeding as Birth Control: Information About LAM. Retrieved May 19, 2020, from https://www.plannedparenthood.org/learn/birth-control/breastfeeding

Planned Parenthood. (2020). Birth Control Methods & Options: Types of Birth Control. Retrieved May 20, 2020, from https://www.plannedparenthood.org/learn/birth-control

U.S. Department of Health & Human Services. (2019, May 24). Lactational Amenorrhea Method (LAM). Retrieved May 19, 2020, from https://www.hhs.gov/opa/pregnancy-prevention/birth-control-methods/lam/index.html

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