Birth Control while Breastfeeding

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IUD or other birth control while breastfeeding?

March 2009

Any day now, I will be a new mom, so my doctor has asked me to start thinking about birth control again. For years, I've used the pill but won't be able to while nursing. My doctor has recommended both the IUD (made of plastic and partially covered by copper) and the IUS (made of plastic and containing a form of progestin). I'd appreciate some feedback (pros/cons/advice) from moms who have used either the IUD or the IUS. I'd also like to welcome recommendations for other forms of birth control that would be safe for a nursing mother. Thank you. mom-to-be

I used the mini pill while breastfeeding my daughter. It's a birth control pill, but only has one of the two hormones most pills have. It worked fine for me, although I got spotting. You might want to ask your doctor about that option too. Sarah
Congrats on your new baby! I used an IUD which emitted a small amount of Progesterone and it worked fine and gave me no trouble whatsoever. However, this was about 30 years ago so I know my experience is out-of-date. Good luck. Sandy
i had the copper iud after the birth of my second child. it was really great for a year and then my periods became **very** heavy, a reported side effect. it was intolerable to me as i am very active and had to have double protection against the bleeding. so i had it removed. i am going to get the mirena (progestin secreting IUD) in a few weeks since i heard it doesn't have this side effect. the bleeding aside, i liked the iud- it was easy to insert and remove, had no effect on future fertility and we never noticed it. incidentally, i nursed my kids for a couple years each and did get pregnant, while nursing with the mini pill. momto4
I had an IUD, and was pretty happy overall with the idea of it because it isn't a chemical form of birth control, and I could remove it at any time if my husband and I wanted to start working on the family again.

I had mine put in 8 months postpartum, before my period returned.

The first period I had was HUGE - so much blood I genuinely thought there was something very wrong. So huge that it dislodged the IUD and it ultimately needed to be removed.

While I wanted to share my experience with you, I need to stress: I am a very tiny statistic. Very seldom does something like this happen, and while it was a bit scary at the time, my OB was very comforting and explained everything to me, and reassured me that no damage has been done.

I am now pregnant with my second, and am planning on getting a new IUD afterwards, although based on my experience with my gigantic first period, I will wait until I've had it at least once before putting the IUD in. IUD experienced

I use the mirena IUD (the plastic one with progesterone, and have been very happy with it. It hurts alot when they put it in and then I had pretty bad cramps for the next 2 days, and finally no cramps at all after a week and a half. Before having my baby (now one year old) I suffered from horrible cramps and pretty heavy bleeding when I got my periods and this IUD tends to make those things better. I've had it in for 8 months now and no probs. One thing to know is that it can cause menstrual irregularities, anywhere from random spotting to no periods at all. Now, here's the catch. I recommended it to my sister and she had it put in, too. After 2 months of cramps and bleeding she got it removed. She's fine now but what a drag. Good luck in your decision making! No more babies for now
I chose the copper IUD, no hormones, since I'm still breastfeeding my 14 month old and seem to be very sensitive to hormones. I got it when he was 11 months old. Don't believe the drama you'll read about insertion on the web - i took 800 mg of advil before I went in and barely felt it. I love the fact that it is hormone-free birth control, but the the first couple periods were rough. Cramping and HEAVY bleeding, longer periods. Still, it's worth it, b/c the rest of the month everything is great. And now, 4 months or so into it, my periods are more normal. I think you will get those rough couple of first months even with Mirena, which eventually takes your period away. You just have to weigh the pros and cons of the hormone, a little of which will get into the milk. Fan of Paragard
Honey, just make your husband wrap it up for awhile. you've been through enough! anon
I got the IUS at 6 months after birth. I noticed a slight dip in milk supply, but nothing a little fenugreek wouldn't help. Other than that (at least in terms of breastfeeding), no issues. It did come with lots of other side effects, but they are so different from person to person that it would hardly be worth relating.

I will say that you might check with your health insurance before going with the IUS. I've known a number of women to get them; some insurances cover, some don't, and doctors don't seem to be too concerned about it before recommending, inserting, and charging for them!

I highly recommend the non-hormonal (copper, or paraguard) IUD. It lasts for 10 years and provides the same effective birth control as a tubal ligation. I had one placed after each of my pregnancies (after the third, my husband had a vasectomy). I was able to remove the IUD and easily conceive because my hormones weren't altered. Because there are no hormones, it doesn't alter your milk supply at all. The potential downside to the non-hormonal IUD is that some women have increased bleeding and cramping with their periods--these symptoms usually ease up after a few months. If they don't you can just have it easily removed. I found that because I had my IUDs put in post-partum, my uterus was already accustomed to a ''foreign object'' and because I was breastfeeding I didn't have a period for almost a year--allowing my uterus plenty of time to adjust to having the IUD in place before I started having periods again (I had normal, light periods).

The hormonal (Mirena) IUD is also a good option, but it does release hormones into your system. You will stop having periods (a plus for many women). It only lasts for 5 years. It is safe to use while breastfeeding, but there is theoretical risk that the hormones can reduce your breastmilk--less likely if you are solo-breastfeeding for the first few months.

Finally, I am offering this advise up as a fellow mother, but I'm also a doctor and I feel comfortable recommending IUDs to my patients. In the past, there was some concern that sexually transmitted diseases could travel up the IUD strings and into the uterus, but this is not the case. The data is showing they are safe and IUDs are gaining a resurgence in popularity among doctors and women. There is a very minimal risk that the uterus could be perforated when the IUD is inserted, but it is a simple procedure and that risk is very small when done by an experienced practitioner. Without the hormones, there's no increased risk of breast cancer, blood clots, etc. It's all a balancing act. Good luck with your decision! anon

After I had my baby, my doctor recommended the ''mini pill'' while I was breastfeeding. It is a birth control pill but it only has progestin. I believe that it is slightly less effective and you have to much more diligent about taking it at the same time every day, but my doctor told me that it is safe for breastfeeding mothers. Happy on the mini-pill
I tried the IDU and didn't work for me (very long and very heavy periods!). I went back to the pill. While breastfeeding, I used a low dose pill that was OK, but you really have to be on top of it on terms of taking it at the same time everyday and not missing ANY pill. back on the pill
After I had my son, I requested an IUD, but was pushed to go on the shot. I did three rounds of the shot and experienced blinding headaches before going and finding a new doctor. I now have the Mirena, which I guess is considered an IUS. I've had it for four years, it comes out next year, and I will be requesting a new one. I feel great with it, it contains a small fraction of the hormones in other birth control methods, and you dont even notice it's there. The appointment to get it is mildly painful, you'll experience a cramping sensation in the pelvic region while they are inserting, but that aside, it's the greatest birth control method I have ever had. anon
I used the ParaGard IUD (copper) for a few months. Like it says, and as people told me, it gave me heavier periods. They lasted for 10 or 11 days, and for the first couple of days, I could go through 1 super plus tampon every hour. My PMS, usually not too bad in the past, was completely out of control. I felt, ok, I can handle this for a few months, because it is such a reliable type of birth control, and hopefully these side effects will subside. What I didn't consider is why these long periods happen. Is it because the copper IUD causes a huge surge in one's own hormones? What else can this sort of surge to this degree cause to happen? I did lose some hair, right at the widows peak (I found out on some message boards that I wasn't the only one). But, more disturbingly, I feel that the copper IUD caused my onset to Crohn's disease, which I was diagnosed with less than a year later. I didn't know that I was predisposed to Crohn's (I had a cousin who had it), but now here it is. I can't prove the connection; it just makes sense to me. I recently read that if you have an autoimmune disease, you should not use ParaGard. Wish I had explored that further at the time. I've been using a diaphragm. Kind of old-fashioned, but it works. anon
I had a Mirena IUD put in after my first two children were born (10 weeks after the births) and will have another one put in soon (I just gave birth to my third a few weeks ago). The Mirena worked really well for me and had no effect on breastfeeding whatsoever. I've heard that some people have a lot of spotting between periods with the Mirena, but that was not the case with me. I did have pretty light periods, which was an added benefit in my opinion. Kara
First of all, not all women who have IUD's have good reactions to it. Secondly, don't let anyone tell you that it's drama - IUD's CAN very much cause pain upon insertion. Not all women feel it, but some do, and it can be extremely uncomfortable. And then there are some of us whose bodies can't handle having a foreign object inside them, and develop severe pelvic inflammatory disease (PID), causing infection and subsequent scarring of the fallopian tubes, ovaries, uterus, and in my case, blowing out of the area into the diaphragm and liver quadrant. I could only have one child because of so much scarring, and I was a lucky one, and I'm alive. Most women have no trouble with the IUD, but some do and it's no joke, it's a statistic worth looking into. Feeling pain upon insertion might be the only thing that is troublesome for some, and worth it for the benefits this birth control offers. But think long and hard about possible risks of the IUD. I, if I'd had a daughter, would categorically dissuade her from ever using one, given the damage it did me. There are other, safer forms of birth control. Lisa
I breastfed both of my kids until they were 3 years-old, and both times I was very happy on the Depo Provera injection. You get it every three months and forget about taking pills or anything. I did not notice any changes in my milk supply, and the best part for me was that I did not get a period while I was on the Depo. I absolutely loved it and highly recommend it for people who do not want the IUD for any reason (my reason being that I got pregnant with in IUD, but that is very rare if properly placed). When I was ready for baby #2, i suspended the Depo, my period resumed in 6 months and I got pregnant right after. Loved the Depo
diaphragm (w/spermicide) works for us (over 20 years now, no accidents) anon

Birth control postpartum - which method?

April 2004

I was encouraged by my midwife at my 6 week postpartum check up last week to decide on a birth control method as soon as possible if we didn't want to risk getting pregnant again. This is not to imply that we are having sex but was wondering what other folks have chosen to do while breastfeeding. new mom

I used the minipill and was very happy with it. It was an obvious choice for someone who'd used and liked the regular pill for many years! It's more important to take the minipill at about the same time every day than with the regular pill, and you don't get a withdrawal bleed every month because there's no placebo week, but otherwise it's similar.

I have friends who've used diaphragms and liked that, but you'll need to pay close attention to the fit; you can't use the same one after giving birth that you did before!

And if you are breastfeeding around the clock, including at least one or two nighttime feeds, with NO supplements or solid foods, and you have not yet had a period, you're actually quite safe until your baby is 6 months old. (If I recall correctly, the ''lactational amenhorrea method'' or LAM is about as reliable as the best barrier methods, under those conditions. But as soon as you have a period, your baby reaches 6 months, or your baby begins sleeping through the night, (or if you begin using formula or introduce solid foods) another method is advised.) anon

If you don't want to unexpectedly have another child soon, by all means use birth control (but it sounds like you know this already!). I have more than a few friends who thought that, since it took more than a year in some cases to get pregnant the first time, then it would take that long the second time, particularly since they were breastfeeding exclusively. Boy were they all surprised when they learned they were pregnant without even having had one period yet! As for me, I chose to use a diaphragm for intercourse while breastfeeding, particularly since we weren't very sexually active the first year or so and it therefore isn't that hard to pull a diaphragm out of a drawer once in awhile. [On the other hand, I did wish occasionally that there were something that did not involve doing *one more thing* in my stupefied and tired state of being a new parent in order to have intercourse. But I just don't like any of the alternatives, particularly taking hormones, that I've tried throughout my life for me.] anon
I had an IUD inserted about 12 weeks postpartum. That was going on five years ago (they last up to ten years), and all is still well. I breastfed until my daughter was 2. It means ABSOLUTELY NO HASSLE for sex, unlike the daily pill or any barrier method. You're supposed to check the position of the ''strings'' every month, but that is way too difficult for me and with my GYN's blessing I just have her check when I have my annual exam.

My periods are much heavier, and somewhat crampier, than before my pregnancy, which is probably due to the IUD, but being over 35 and the daughter of a breast cancer (of the estrogen sensitivity variety) survivor, there was no way I was going to take the pill; and as for the diagphragm, well--been there done that, NO THANK YOU. IUDs are generally recommended for women who have given birth and are MUCH safer than old kind which caused significant problems and gave them a bad rap, and nearly 100% effective in preventing pregnancy. Happy IUD Mom Loves Sex

I started taking the mini-pill when my son was 8 weeks old. For the first 10 months of his life his diet consisted entirely of breast milk, he simply refused to eat any solids. He will be two years old next week and I am still nursing. The progesterone-only pill that I was, and still am, taking did not affect my milk supply in the least. My son\x92s weight has always been in the 50\x92s percentile. Originally I was taking Nor-QD, but now I have switched to a less expensive generic substitute NORA-BE. Prior to going on the pill, I tried to get information on whether the pill would have any effect on my child\x92s health, but unfortunately was unable to find anything.
Try the Mirena IUD. I have one and just LOVE it. I have gone from a postpartum period that was irregular and heavy (7 days long twice a month some months, 10 days long other months) to minimal spotting two days a month. It does have hormones in it which reduce the thickness of the uterine lining, but not a significant amount so it doesn't effect breast milk production. And I don't remember if this was supposed to be a side effect, but my libido has improved too. If only it would allow me to eat as much as I want without weight gain... then it would really be perfect!!! happy mom
I had an IUD inserted about 8 weeks after my son was born 3 1/2 years ago. I guess there are several kinds out there; I got the kind without hormones as I was concerned about the effect of hormones on breastfeeding. Here's my experience:

Pros: After insertion, you don't have to do anything. They last for a long time. (I think you can use the same IUD for something like 10 years.) It's very effective. There's no ''lag- time'' in returning to fertility after you get it removed. (In fact, I had mine removed in July, and never got another period because I got pregnant right away -- I'm due with baby #2 any day now!)

Cons: The insertion is a bit uncomfortable. (Though very manageable-- especially if you take ibuprofin beforehand.) I found the ''string'' to be a bit poke-y at first, so I would have to move it to a comfortable place. My husband also noticed it during intercourse at first. (But there were lots of things to get used to in the postpartum love-making department, so it wasn't that big of a deal.) After time, I think the string softened a bit and we both got used to it. Neither of us noticed it after a couple of months. My periods were perhaps a bit heavier-- but it was hard to tell how much of that was just from having a baby.

All in all, it worked very well for us and we'll probably use it again at some point. Good luck! Loved the IUD

Will the Pill decrease milk production?


I recently had my postpartum checkup and the nurse practicioner gave me a prescription for the pill, saying that it was okay to use while breastfeeding. However, the blurb that came with the pill said that you should not use it while breastfeeding because it can decrease the amount of milk. I'm confused. Has anyone taken the pill while breastfeeding? Has it caused any problems concerning milk supply? Your help would be greatly appreciated! Angela

I was wondering if anyone has experienced any problems with taking a low estrogen birth control pill while breastfeeding 6 months post-partum or beyond. My ob/gyn says I should not have any problems, but I still feel concerned. The particular pill she prescribed is called LOESTRIN FE 1/20. Thank You.
I have an 8-month old baby and have been taking the pill (Micronor) since the doctor first prescribed it post-partum. I have not noticed any problems with it at all.
I used a low estrogen pill while nursing my first child, over 5 years ago. I, too, had been told not to worry, but had continual problems with my child not getting enough milk. I ended up quitting the pill after 4 months, while at the same time supplementing with formula so my daughter would get enough nourishment (she was in the bottom 5th percentile). My milk never came in very well. The second child, born 3 years ago, nursed very well, had plenty of milk (he's always been in the 95th percentile, which may be genetic--he was 9lbs.13oz. at birth!), and although I did supplement later with formula (for convenience), I never felt he wasn't getting enough milk. He was able to nurse quickly and fully, usually getting his fill within 15-20 mins., whereas my daughter would nurse for an hour or more (sore nipples!). I never used the mini-pill while nursing my second child.

I recommend against the mini-pill; I felt that the Kaiser GYN depts. don't really get the feedback about whether it's affecting nursing or not--this shows up later in the Pediatrics dept., and unless you have to go to your GYN regularly after birth, there's no way this info gets passed back down to them. I don't care what the studies show--I think it makes sense that your body would, if on the pill, believe itself to be pregnant and be less likely to produce milk as a result. We have successfully used foam with condoms (except for a several years when I had an IUD, which has since been removed--another story!). Best of luck.

I took a very light pill while nursing and also had concerns about it. Two different ob/gyns assured me it was safe. I also looked up the studies myself to make sure the doctors weren't just being glib (a pet peeve of mine). We were in something of a bind because other birth control methods weren't an option. I'm glad I did it because being on the pill gave us peace of mind about not getting pregnant again too soon.
I, too, was prescribed a low-estrogen pill in the months after my daughter was born, since I was breastfeeding. I was given Micronor (not what you have) but I suspect they are similar. Anyway, they seemed to be effective (no unwanted pregnancy!) and it didn't seem to have any negative effect on nursing, but they really affected my mood. I wasn't really aware of how depressed I was, and how wildly my moods would swing, until I stopped taking them after 10 months. I don't think I will ever take them again, it was that bad, and I'm quite sure that it was the pills that were causing the problems. Indeed, in the first few months I'm sure that other things like normal hormone imbalances, stress of a new baby, nursing issues, etc., contributed to my depression. But after 6 months or so I had really found a nice balance of dealing with the new stuff, finding other mothers to talk with and getting back to the work I love part-time. But my mood didn't improve until almost immediately after stopping the mini-pill. You didn't mention what it is you are concerned about with the pills you are taking, but if it's emotional I'd see your OB or nurse practitioner about other birth control options. Hope this helps, for what it's worth!
I am confused by this topic thread. So if my post doesn't address the original concern I am sorry, but here are my thoughts.

The mini pill is a progesterone only pill. There is no estrogen in it. It is commonly prescribed for nursing women because it is not supposed to have any effect on milk supply. However, I know at least one lactation consultant who says that she has occasionally seen women who have experienced a supply decrease while taking this pill. This decrease was easily remedied by ceasing to use the medication. (She has also seen some women who thought it helped their supply, so it is definitely one of those things that varies from woman to woman.)

This same LC doesn't recommend that women start birth control pills of any kind until they are 6-8 weeks post partum so that they will have enough time to start building a good milk supply. After this time, she says, that there is rarely any risk to milk supply, and if there is a decrease, it will resolve when you stop using the pill (I guess I already said that). By the way, Depo Provera and Norplant are not recommended by this LC because if there is a decrease in supply, there is no way to quit them to get your supply back.

Birth control pills that contain estrogen are more likely to have an effect on milk supply, but the later in your nursing career you use them, the less likely they will have an effect. (At least that is what I have been reading.) However, you are never going to find any dr. or pharmacist who will give you a guarantee that there will be no effect on your supply. It will just be one of those things you have to discover on your own. The good news is that just like the progesterone pills, if you see a supply dip, you can quit them, and it should go right back up. I hope that helps someone out there.

There is a pill called Micronor which is supposedly safe to use while breastfeeding. In fact, it is only effective while you are breastfeeding. I used it while breastfeeding both my sons with no known side effects. Virginia
I took the pill while breastfeeding with no problems, but it was the mini pill - one hormone instead of two. The Dr. said that it was about as effective as the regular pill as long as I was nursing and was unlikely to affect the milk supply. Ask about it. Robin
I was given a mini-pill while still breastfeeding. It does not have estrogen (right?) and can be used, per my doctor, until the baby is weaned or as my doctor put it, just doing social nursing (i.e. for comfort and not really nutrition). Then he switched me back to the regular pill. I would double check with the practioner or talk to the pharmicist. Janette
Don't do it! If it is a regular pill (estrogen & progesterone) it is *guaranteed* to cause problems with your breastfeeding (& it's not safe for your baby). If it is the mini-pill (progesterone only), the doctors will tell you it's OK, but my experience, and the experience of MANY women I have talked to through La Leche League, is that it still causes a drop in your milk supply. I was absolutely FINE on my milk supply till I started to take the mini-pill. I took it for about 8 months, from the time my baby was about 4 mos till about her 1 year birthday. It's very hard to sort out what exactly was the cause of my problems, since at the same time I started the pill I also went back to work and started pumping, but I can tell you that it was nothing but misery trying to get enough milk for my baby after that. I ended up having to supplement her, which I was not happy about. I think that the doctors are more concerned about you not getting pregnant again than they are about your continued breastfeeding, so they like to err on the side of pregnancy prevention. And for some women, the mini-pill may not cause a problem (the type of woman who leaks a lot, and gets engorged easily). But for those of us with a precariously-balanced milk supply (never leak after the first couple weeks, rarely get engorged), it can spell disaster. My sister-in law concluded that she just didn't have enough milk, and quit nursing after only a few weeks because of this. Think VERY carefully before you take those pills. (And remember that you can't take the shots, implants, or some of the IUD's either, since they are all hormonal methods.) My 2 cents: You won't be nursing forever. Use a barrier method till you're done, and give your baby the best you have to offer while you're in this special phase. Feel free to contact me if you want to discuss this in more detail; I'm glad to share my experience. (We're still nursing, by the way, at 16 mos and counting). Dawn
I recently nursed my daughter who is now one for 10 1/2 months and I took a low estrogen pill for most of the time. My milk production was fine. I did not notice any change in production after I started taking the pill. Good Luck! Tamara
Regarding the pill and breastfeeding, my doctor prescribed a pill called Micronor. I took this pill for approximately 7 months (until I stopped breastfeeding) and did not notice any negative side effects. It is tough to know whether it reduced my milk supply, since I returned to work when my daughter was 2 months old and pumped during the day. It did not seem to have any effect on it, and I felt great, better than with traditional pills. Hope that this helps. Lori
I would like to reply to the person who stated that Micronor - the mini-pill aka the progesterone only pill - only works while breastfeeding. This is not true. I have used it very successfully for 2 years until I decided to stop using it so I could get pregnant. It is slightly less effective than the traditional pill which means that if you miss even one day's dose you have to rely on some other method of birth control for a while after. Because of my latex allergy (which basically rules out almost all barrier methods of birth control), I have used the mini-pill since my son, now 7-months, was 2 months, and have not had any problems with my milk supply. I would like to add that I switched to the mini-pill originally because of problems with too many side- effects while using the regular pill. I found the mini-pill much better than the regular pill, giving me almost no side-effects. Pia
I feel I have to respond to the comment, I think that doctors are more concerned about you not getting pregnant again than they are about your continued breastfeeding. My response: and well they should be! I got pregnant by accident when my second child was five months old. I still don't know how it could have happened. I hope all women considering their birth control options imagine themselves in that situation before they make a choice. I felt my new son needed all the attention and energy I could spare for him and could not imagine a way to share that with a third child that wouldn't have sacrificed the baby already in my arms. So I sacrificed the unborn child instead. Everytime I look at my son, I know I made the right decision. But I have a permanent hole in my heart and soul that pains me every single day. (I have tried for five years to conceive another baby and am now 46: it's not going to happen.) My advice? Consider the bigger picture, credit the doctors for having your well-being in mind, and don't take a risky approach to birth control unless you're willing to pay the price. Anonymous
I recently asked my OB/GYN about taking Birth Control while nursing. Her response was that there haven't been conclusive studies, but personally she wouldn't use the pill because of hormones the kid might be getting. I know some people don't have much choice, but I just thought I would mention this aspect of the pill and nursing. I've decided not to take the pill for awhile. My son is 2.6 years old and will probably be weaning him soon, although I'm not in a hurry.