Sonya

Your question about progestin-only contraceptives affecting 
migraine  and whether they can affect milk supply if started before 6 
weeks is very interesting.  I can't answer the first part of the 
question, but my experience with whether they can affect milk supply 
is that - yes, they can, whether started before 6 weeks, or after 6 
weeks.  I had a slew of clients who consulted me for various unhappy 
symptoms in the baby, from "colic" (persistent crying for no apparent 
reason) and low weight gain, and a full history often revealed that 
they had recently started the protesterone-only contraceptive.  I 
would explore whether they were willing to stop taking the mini-pill 
(as we called it) and use another form of contraception to see if 
this made a difference.  In all cases, it seemed to.  The symptoms 
would have commenced within a few days of starting the mini-pill and 
would resolve within about 4 days of stopping it.  I always 
recommended extremely frequent nursing as well, to kick-start the 
milk supply again, and it worked.

I did a little digging around, looking at the actual generic drugs 
contained in the various brand-name mini-pills.  There are many 
different drugs.  And there are many different doses too - some of 
these pills contain three times as much of the active ingredient as 
some others. .  And I found that the research apparently "showing" 
that there is no effect on lactation if the medication is started 
after lactation is well established, ie after 6 weeks, is quite 
misleading.  The original research was apparently done comparing 
weight gain between babies who were never breastfed and babies who 
were partly breastfed, ie none were exclusively breastfed.  This 
could mean that any reduction in the mother's milk supply would have 
been compensated for by formula.  Also some of the synthetic 
protestins behave like estrogen in vivo, which would account for the 
negative effect on the mother's milk synthesis. A site I just looked 
up says that Micronor contains norethisterone, which is the same drug 
contained in another mini-pill called Ovrette, which, in my 
experience, was the one that my clients most often reported as having 
negative effects on milk supply.

Finally, I discussed the problems I'd seen with an obstetrician I 
trusted.  He told me that different mini-pills "suit" different 
women, ie that different pills have different effects on different 
women.  So - where some mothers may take one particular mini-pill 
with no apparent ill effects on her breastfed baby, this happy state 
of affairs would not be consistent for all mothers.

I hope this helps.  I see that many of the replies you've received 
seem to suggest that after 6 weeks, the mini-pill has little 
effect.  As you can see, this was not my experience. It would also 
seem that the nearer to birth that a mother starts taking a 
protesterone-only contraceptive, the greater the likelihood that it 
could reduce her milk production, but for some mother-baby pairs, it 
can cause a problem any time.  Your client would have to decide 
whether the positive effect on her migraines is of greater benefit to 
her than the possible negative effect on her milk supply and/or the 
negative effects of formula supplementation.

Best wishes to mom and baby

Pamela Morrison IBCLC
Rustington, England
--------------------------
Date: Wed, 26 Dec 2012 21:12:18 -0500
From: Sonya Shaver <[log in to unmask]>
Subject: Progesterone, headaches, and milk supply

Hello all,
I have PTP. I have a few questions about progesterone and starting birth
control before 6 weeks. Can the progestin-only contraceptives affect milk
supply if started before 6 weeks? Everything that I can find only talks
about after 6 weeks. Is this because they can impact milk supply before 6
weeks? Or just because they don't measure it before 6 weeks?

I have a client who was receiving progesterone shots during her pregnancy
to prevent premature labor. Her first baby was premature, so she received
the shots during her second pregnancy, and that baby was full-term. This
was her third pregnancy, and she received the shots again, and this baby
was born 4 weeks early. The baby is now 2.5 weeks old, and she started
Micronor 4 days ago. She gets migraines, but while receiving the
progesterone shots during the pregnancy, she didn't have any headaches.
During the first two weeks after the birth, she started getting headaches
again, and they were getting to be severe. But then since starting the
Micronor, her headaches have gotten better. I have read that there can be
a connection between progesterone levels and headaches, and so I was
wondering about this.

However, also since starting the Micronor, she feels like her milk supply
might be lagging. Would it impact milk supply that quickly (within just a
couple of days?), and can it affect milk supply if started before 6 weeks?

Many thanks for any insights you have to share!
Best,
Sonya Shaver, BS, CHES, IBCLC

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