I attended the fab-u-lous conference earlier this month in Amarillo, TX.
Pamela Berens, MD (who co-authored Clinical Therapy in BF Patients with Tom
Hale) gave a great presentation in which she described contraception that
can have an impact upon BF.

For her ob-gyn patients who want to use hormonal contraceptives, Dr. Berens
recommends they wait at least 6 months *unless* they re-start their menses
sooner.  Bear in mind: this assumes the mother has first been counseled
about the risks (to BF) of using hormone-based contraceptives, vs. barrier
or LAM methods.

She recommends *avoiding* combined estrogen/progestin contraceptives, which
include:

* combined pills.  Most of the studies have involved pills with 50
micrograms of estrogen. In the US, all pills use ethinyl estradiol as the
estrogen source .... the only thing that varies is the dosage.  Pills with
20 micrograms of this estrogen can be found, and if her patients insist on a
pill, she would recommend one with this lower estrogen amount.  Note that in
US-mfgd combo pills, there are several different progestins used for that
part of the pill.

* monthly injections of estrogen/progestin.  This is *not* the three-month
Depo-Provera shot, by the way.  This monthly shot would be her LAST choice
contraceptive.

* vaginal rings of estrogen/progestin.  Worn for three weeks, removed for
one; they don't require special insertion or positioning technique.

*  transdermal patches with estrogen/progestin.  NOTE that studies show
these are not efficacious in mothers weighing more than 190 lbs.

*  a combo morning-after pill(s).  Preven is only 55% efficacious, and has
greater side effects, than the progesterone only system, but Preven is much
more widely-advertised (hence prescribed) in the US.  See below too.

Progesterone-only contraceptives have *less* effect on milk supply --
although we all know that for some moms, there can be a drastic downturn of
supply.  Remember the basic recommendation is (1) to avoid ALL hormonal
methods of contraception, or (2) if such a method is still requested by mom,
to advise she wait six months.  Progesterone-only include:

* "mini pill," which must be taken at about the same time every 24 hours to
be efficacious.  (Dr. Berens recounts that she used to tell Mom to put the
pill on her toothbrush, assuming Mom brushed her teeth at about the same
time every day.  Dr. B was surpirsed to learn for how many Moms this would
not be a daily ritual!  Okay, everyone -- give in to that impulse to run and
brush your own teeth, then return and read on ....)

*  Depo-Provera shots, given every three months.

*  Norplant rods, lasting about 5 years but requiring surgical insertion and
removal.

* a progesterone-only morning-after pill (called Plan B -- you gotta love
the name) is 85% efficacious, with less side effects and less *theoretical*
impact on BF -- but less well-known; hence less prescribed.

IUDs come in copper (preferred) and progesterone-only models, but all types
suffer from poor P.R. ... perhaps not deserved in 2003.

Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

_________________________________________________________________
STOP MORE SPAM with the new MSN 8 and get 2 months FREE*
http://join.msn.com/?page=features/junkmail

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html