Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team
Is it Safe to Use Birth Control While Breastfeeding?
TLDR: Yes, it is safe to use birth control while breastfeeding. But, depending on which method (the estrogen containing ones), it may reduce your milk supply.
Getting pregnant soon after giving birth can be emotionally and physically draining for women. According to the World Health Organization, it is best to wait at least 2 years before becoming pregnant again — if possible. Typically, it’s recommended to abstain from any sexual activity until 6 weeks after giving birth as the woman may still be recovering from vaginal tears that occurred during birth. That being said, it is possible for a woman to become pregnant as soon as 6 weeks after having a baby and during the time she is breastfeeding. For couples who are heterosexually sexually active, it’s smart to consider hormonal birth control options or copper IUD to prevent pregnancy in the postpartum period. A few key points to know:
- It is safe to use hormonal birth control while breastfeeding.
- Depending on the type of birth control a woman is using (estrogen containing ones), her breastmilk volume may be affected.
- Hormonal birth control will NOT harm the baby.
Isn’t breastfeeding itself a form of birth control?
Although breastfeeding has been used as a form of birth control in the old days and in third world countries, it is NOT the most effective method at preventing pregnancy, and it must be done carefully.
For new mothers, breastfeeding is one of the most fatiguing and stressful experiences in life. When you are breastfeeding every 2-3 hrs non stop, it can be difficult to keep track of birth control methods that require significant human intervention. In order for breastfeeding to work as a form of birth control, a woman must breastfeed her infant exclusively (meaning NO other food/drinks); even then, it will only work for up to six months. It’s also impossible to know precisely when the method will stop working, which puts a mother at risk of becoming pregnant again.
When women exclusively breastfeed their infant, the hormones that are used to produce milk can suppress ovulation, and thus, prevent pregnancy. Exclusive breastfeeding means a woman is nursing her infant at least every 4 hours during the day, and at least every 6 hours at night, and the baby is ONLY drinking breast milk and not formula. Breastfeeding as a method of birth control is also referred to as the lactational amenorrhea method (LAM).
Is LAM an effective form of birth control?
With perfect use, LAM is 98% effective — but it only works for up to 6 months. By 6 months old, babies are starting to eat solid foods and need less breast milk to thrive. Plus, LAM only works if women exclusively breastfeed; introducing formula will lower the effectiveness rate as will using a breast pump.
- Have you had a menstrual bleed? (For LAM, this means any bleeding, on any 2 consecutive days, that occurs 2 months after the birth)
- Are you giving regular supplementary foods or fluids to your baby in addition to breastfeeding?
- Is your infant older than 6 months of age?
If you answer no to all 3, then you can do LAM. If you answer yes to any of the 3 questions, then you should use ANOTHER method for birth control.
For some women, exclusive breastfeeding can be challenging and/or impractical for their lives, for both their own needs and the baby’s. It is also impossible to determine precisely when they will begin to ovulate again after giving birth and breastfeeding. It’s risky to engage in unprotected sex during this period while the woman is still caring for an infant.
Will birth control pills or other contraceptives interfere with breastfeeding?
The birth control patch, ring, and pills with estrogen have been linked to low milk supply and shorter duration of breastfeeding. Because breastfeeding is very beneficial for both mothers and their infants, women may be hesitant to try a hormonal birth control method while breastfeeding. However, there are effective birth control options that do not interfere with the production or integrity of breast milk. (Note: Doctors usually do NOT recommend starting hormonal birth control until at least six weeks after birth).
Barrier methods like male and female condoms are safe to use while breastfeeding because they do not introduce hormones into the body which can interfere with milk supply; they’re are also one of the only ways to prevent the spread of STIs (Sexually Transmitted Infections)!
Progestin-only contraceptives are the preferred option for breastfeeding mothers, because they don’t affect milk supply for most breastfeeding mothers. These methods include: implant, IUD with hormone, the shot (depo-provera®), and Progestin Only Pills (POPs).
Copper IUDs are also safe for nursing mothers — they have a 99% success rate for preventing pregnancy and do not introduce hormones into the body. The copper in the IUD makes the uterus inhospitable to sperm and does not interfere with ovulation. But some women on the copper IUD experience cramping, breakthrough bleeding, and heavier than normal periods (5%).
Are Hormonal Contraceptive Options Safe for Nursing Mothers?
As the body readjusts to its pre-pregnancy state, it is not safe to use any birth control methods with estrogen for the first 6 weeks after giving birth due to the risk of blood clots. (Progestin-only methods are fine).
It is unsafe to have sexual intercourse during the first 3 weeks postpartum? Why?
The arteries and veins in the uterus that helped to feed, nurture, and grow the developing fetus begin to shrink and close up during the first few weeks of the postpartum period. Inserting anything into the vagina can cause a severe, life-threatening infection; so having penetrative sex or using tampons isn’t safe until postpartum bleeding completely stops, which for most people with uteri that doesn’t happen until about 4 to 6 weeks postpartum (after the baby is born).
Combination birth control pills (birth control pills with estrogen and progesterone) are NOT recommended for breastfeeding mothers as the estrogen in these pills might decrease the milk supply. That being said, birth control mini-pills (that only contain progestin a.k.a. Progesterone Only Pills, POPs) are safe to take while breastfeeding, and won’t interfere with milk supply. However, POPs are very finicky — if you take your pill 3 hours later than normal, you must abstain from sex or use condoms and/or use emergency contraception. FYI, Mothers who stop breastfeeding or choose not to breastfeed can use any type of hormonal birth control.
Cervical caps and diaphragms are also safe to use while breastfeeding, although a woman will need to be re-fitted for these devices after she gives birth because her cervix has gotten larger.
For busy mothers, low maintenance birth control methods are often the best choice for preventing pregnancy such as the copper IUD or IUD with hormone, or implant or birth control vaginal ring. It can be difficult to remember when to take a birth control pill or it can be nearly impossible to get to a doctor’s office as the mother of a nursing infant for a birth control shot. As always, it’s important to explore birth control options relative to a particular woman’s lifestyle, her body, and her nursing infant’s needs.
Pandia Health has helped hundreds of women get low-cost, free (with insurance or via Pandia Health Birth Control Fund), and affordable hormonal birth control delivered to their homes. Birth control delivery services are incredibly convenient, especially for nursing mothers.
Please contact Pandia Health today to explore your options for birth control mini-pills (Progestin Only Pills/POPs) that are best for breastfeeding.
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The above information is for general informational purposes only and is NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.