Hi Miriam and all-

Since in med school, we are trained to "find the evidence" if it is
available, and because there are some differences in the side effect profiles
of the different progesterones (a lot more women on depo-provera seem to end
up getting depressed than on straight OCP's and on Micronor; also many women
report significantly better tolerance of "natural progesterones" with respect
to mood, althought these aren't taken for contraception), the OB's claim that
depo and Micronor potentially aren't the same with respect to milk supply,
doesn't seem too unreasonable an opinion.  However, your approach (Micronor
first to make sure milk supply doesn't decrease, since Micronor is more
reversible) makes sense anyway.  It's always a principle to use the shortest
acting drug, if you are potentially concerned about a side effect that you
need to reverse.

All that said, the references I could find support Dr. Newman's "Progesterone
is progesterone" statement anyway, at least with respect to breastfeeding.
(I'm new here, but I gather I shouldn't have questioned this anyway :)  ).
Two abstracts of studies that looked at progesterone-only contraception
(including a "mini-pill" and depo) and lactation found no difference in
infant growth or development among different forms of hormonal contraception,
or in comparison to the control group who used non-hormonal contraception.
Unfortunately, I don't have the actual studies (our hospital library is too
small).

In the end, who you are recommending makes sense to me for women that desire
hormonal contraception, and here are some references in case the OB asks!

Shauna Farmer, MD (An FP in Rome, GA)

Progesterone-only contraception during lactation: I.  Infant Growth.
Contraception 1994 Jul:50(1):35-53.

Progesterone-only contraception during lactation: II.  Infant development.
Contraception 1994 Jul:50(1):55-68.

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