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Contraception and milk supply

14 May, 2009

Question:

I have two children aged 3 and 4 years old, and a baby who is 6 months old. I have just completed a full pack of Microgynon which greatly reduced my milk supply, I’m in my second day off the pill now.

What reliable method of contraception is available to me?

I had an ectopic pregnancy between my first two children while I was breastfeeding. So I was advised to take Cerazette.  However this pill had caused such irregular bleeding that it prevented me from going to mikveh for about 3-4 months. Therefore I was advised to use Microgynone which was fine back then and didn’t cause any problems with milk.

My gynecologist told me that an IUD is not an option for me because the neck of my uterus is damaged and significantly shortened. And also because of my previous ectopic pregnancy.

I have heard of taking two pills of Cerazette a day. Can I do it for a couple of months till I manage to add more solid food to my baby’s diet? ( I was exclusively breastfeeding up to now)

Would Nuvaring help? Does it affect the milk supply?

Please help! I was niddah for almost 5 months after this birth, and I do not want to risk more irregular bleeding right now!

Thank you for all your effort!


Answer:

Mazal tov on the recent birth of your baby!

Microgynon and Nuvaring are both combined hormonal contraceptive methods (estrogen and progesterone), and as such may affect your milk supply. However, sometimes different formulations affect women differently so it may be worth trying Nuvaring for a month. In the meantime, you may be able to counteract the decrease in supply caused by the hormones by nursing more frequently, which can increase your milk supply. With a six-month-old, you should be able to start solids (especially cereals) to help fill in what he may missing from the amount you are currently producing.

As a progesterone only pill, Cerazette is less likely to affect your milk supply, but as you pointed out, it often causes irregular bleeding or spotting. Often the staining resolves within the first 2-3 months, although some women continue to experience staining even after this initial adjustment period as you did. Taking a double dose of Cerazette may or may not help as far as spotting and the increased dose may also affect your breastmilk supply. In light of your baby's age, it would seem that increasing breastfeeding frequency (and perhaps some pumping), as well as increasing solids would be a better option.

If you are looking to completely avoid staining issues, or any impact on your milk supply, it may be worthwhile to look into using a diaphragm with spermicide. You can discuss with your physician using this as a long term method, or using it as a temporary method until you wean and then switching to a combined hormonal contraceptive.

B'Hatzlacha!


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