Combined hormonal versus nonhormonal versus progestin-only contraception in lactation

Cochrane Review by Truitt ST, Fraser A, Gallo MF, Lopez LM, Grimes DA, Schulz KF

This record should be cited as: Truitt ST, Fraser AB, Gallo MF, Lopez LM, Grimes DA, Schulz KF. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003988. DOI: 10.1002/14651858.CD003988.

ABSTRACT

Title

Combined hormonal versus nonhormonal versus progestinonly contraception in lactation

Background

Each year, more than 100 million women make decisions about beginning or resuming contraception after childbirth. Choices of contraception may be limited for lactating women due to concerns about hormonal effects on quality and quantity of milk and passage of hormones to the infant. Ideally, the contraceptive method chosen should not interfere with lactation. The timing of contraception initiation is also important, since the return of menstruation and ovulation can be unpredictable in breastfeeding women.

Objectives

To determine the effect of combined oral contraceptives and progestin-only contraceptives on lactation.

Search strategy

We searchedMEDLINE, POPLINE, EMBASE, LILACS, and CENTRAL along with review articles, and we contacted investigators.

Selection criteria

We sought randomized controlled trials in any language that compared hormonal contraception with another form of hormonal contraception, nonhormonal contraception, or a placebo during lactation. Hormonal contraception could include combined oral or injectable contraceptives, progestin-only oral or injectable contraceptives, implants, or intrauterine devices. Study participants included breastfeeding women of any age or parity who desired contraception.

Data collection and analysis

Principal outcomes included quantity of milk; biochemical analysis of milk composition; initiation, maintenance and duration of lactation; infant growth; efficacy of contraceptive method while breastfeeding; and timing of contraception initiation and its effects on lactation. Because the trials had different interventions, often lacked quantifiable outcomes, and had poor methods, we could not aggregate the data in a meta-analysis.

Main results

Five trials met our inclusion criteria.Most did not specify themethods for generating a random sequence or for allocation concealment, blinding of treatments, or use of an intention-to-treat analysis. Two reports comparing oral contraceptives to placebo had conflicting results. Another trial found no inhibitory effects on lactation from progestin-only contraceptives. The WHO trial found a decline in breast milk volume from combination contraceptives. High loss to follow up, however, undermined the credibility of the WHO trial. None of the trials showed a significant difference in infant growth or weight due to hormonal contraception during lactation.

Authors' conclusions

The existing trials are insufficient to establish any effect of hormonal contraception on milk quality and quantity. At least one properly conducted randomized controlled trial of adequate size is needed to address hormonal contraceptive use for lactating women.

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