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