Nofia - I am so glad you have brought this up.  I posted some time ago with
concerns about the possibility of the mini-pill interfering with
breastfeeding.  During the last year I have had several anecdotal reports
from mothers with babies aged 3 - 9 weeks reporting the onset of unusual
fussy symptoms, reduced urine output, markedly decreased breastfeeding
intervals.  They wonder if they have enough milk, or if it is "rich enough".
Suddenly the baby wants to feed "all day long" and wakes up to feed 5 or 6
times at night, one baby had prolonged jaundice.  The common thread with all
of them is that in the last 5 - 10 days they have started taking a mini-pill
called Ovrette containing 0.075 mg norgestrel, manufactured by Wyeth
Laboratories Inc. Philadelphia.  One mother started taking this on Day 1
postpartum, as soon as she received the prescription.  Others have started
taking it any time from 2 - 8 weeks.    I am informed that this particular
mini-pill is being brought into the country as part of a USAID family
planning project. It retails at approximately one-sixth the cost of other
mini-pills.

Since the third or fourth report I have told clients that I am receiving
anecdotal reports from other mothers with similar experiences and that it is
possible that this particular mini-pill may have an effect on lactation.  At
this point most mothers elect to stop using it so I recommend using an
alternative form of birth-control and breastfeeding very often for the next
few days.  Symptoms usually resolve within 5 days or so.  Baby becomes calm,
urine output increases, baby goes longer intervals between feeding, jaundice
resolves.

I'm documenting these cases carefully - what the mother notices, what she
says, her distress etc., how long since she commenced the Ovrette, what the
baby's feeding pattern and urine output was before, what it is now, how many
days for symptoms to resolve.  So many mothers *almost* start formula
supplements before contacting me, they are so relieved to find out it's not
*them*!

There are so many questions about this issue.  It seems that the younger the
baby the greater the effect of this mini-pill (I am aware that it shouldn't
be commenced before 6 - 8 weeks post partum, but it is being prescribed, as
I say sometimes from Day l).  It stands to reason that a synthetic
progesterone could be expected to exert an effect on breastmilk volume or
protein/fat content - what effect exactly?  And how, specifically?  Are
prolactin levels affected?  Why do we have all these different progestins in
the various mini-pills? - do they all exert slightly different effects on
lactation?  If so, what are they? Are only *some* women affected?  I am
finding the information in our reference books to the "Progestin-only pill"
frustrating - I want specific progestins to be listed, with dosages and
effects.  *We need more information*.

Pamela, Zimbabwe