Dear Lactnet Friends:

Here's what Lactmed says:

Summary of Use during Lactation:
Although nonhormonal methods are preferred during breastfeeding,
progestin-only contraceptives such as depot*medroxyprogesterone acetate* (DMPA)
are considered the hormonal contraceptives of choice during all stages of
lactation. Fair quality evidence indicates that DMPA does not adversely
affect the composition of milk, the growth and development of the infant,
or the milk supply.[1][2][3][4] Some evidence indicates that progestin-only
contraceptives may offer protection against bone mineral density loss
during lactation, or at least do not exacerbate it.[5][6][7]

The timing of initiation of DMPA is controversial.[8] The product labeling
states that it should be started no sooner than 6 weeks postpartum, based
on data submitted for product approval. Studies of fair quality seem to
indicate that concerns about immediate adverse effects on the infants is
unfounded; however, starting too soon theoretically could affect the
newborn infant adversely because of slower metabolism of the drug than
older infants. Of concern is that no data exist on the effects of
progesterone on brain and liver development at this age. Administration
sooner than 6 weeks postpartum could interfere with the exclusivity or
duration of lactation. A systematic review of studies using early
postpartum initiation of DMPA concluded that all of the studies were of low
quality and inadequate to disprove the concern about DMPA's effects on milk
production if given sooner than 6 weeks after delivery.[9] A subsequent
study raised the possibility of a slight reduction in breastfeeding
duration in women given DMPA before hospital discharge,[10] and another
study found that breastfeeding was less like to be initiated if mothers
received immediate postpartum DMPA.[11]

Expert opinion in the United States holds that the risks of progestin-only
contraceptive products usually are acceptable for nursing mothers at any
time postpartum.[12]The World Health Organization recommends that
injectable depot*medroxyprogesterone acetate* should not used before 6
weeks postpartum.[13]
-- 
​warmly,
​
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
Reviews Editor,* Clinical Lactation*
www.nikkileehealth.com
https://www.facebook.com/nikkileehealth
*Communications are confidential and meant only for whom they are
addressed.*

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