Best Birth Control Method with Lactation at the Same Time by DrJim

Best Birth Control Method with Lactation at the Same Time
by DrJim

Many couples have said “I want to have lactation with an ANR but I don’t want to get pregnant. I have to use a birth control method. What is the best one to use that will not affect my ability to lactate?

Well, there is tubal ligation and vasectomy, but that is not good for young couples at least because it is permanent. There is rhythm, foam, condoms and cervical caps. Perhaps not reliable enough. IUDs- don’t recommend them. That leaves Birth Control Pills, Depo Provera shots, Norplant and the “Mini Pill”. If Birth control Pills in general is what you have decided then this discussion is for you. Depo Provera shots, Norplant (no longer available in the USA) and the “Mini Pill” are all Progesterone only. They have no Estrogen. They all behave similarly, it is just the method of administration that differs. Regular Birth control pills all behave similarly as well so this is a comparison between regular BCPs and Progesterone only types.

If you want to induce lactation you will find the Estrogen in BCPs will interfere because Estrogen feeds back to the Pituitary to inhibit Prolactin release with any nipple stimulation. The success rate of being able to maintain lactation while on BCPs varies, some women are successful, some are unable to produce much milk.

Here is something that goes against conventional wisdom; The conventional wisdom is that Progesterone inhibits lactation because women have high levels of Estrogen and Progesterone during pregnancy. They do not lactate until they deliver the placenta because the placenta produces the tremendous amounts of hormones present during pregnancy. When these levels drop, then lactation ensues. It has been assumed that Progesterone is just as responsible for not lactating as Estrogen. I disagree, it is only Estrogen that inhibits lactation. It is only Estrogen that feeds back to the Pituitary to inhibit the release of Prolactin.

Progesterone only birth control does not inhibit lactation, rather encourages it. This is because Progesterone lowers Estrogen levels in the body and induces the ovaries to go into a quiet resting phase much like the Post-partum hormonal balance. Nipple sensitivity to bring about Prolactin release consequently is greatly increased. Women who use this often feel their breasts stay tender because of the increased levels of Prolactin in their system. The alveoli are stimulated to be ready for lactation although they usually do not, at least initially. Because the nipples have increased sensitivity and the breasts are ready for lactation, if women have sex frequently with much fondling and attention to the breasts they will often start lactating spontaneously. This attention will also cause the breasts to enlarge somewhat as they would when inducing lactation. This is a recognized “side effect” of Progesterone only birth control. Most women have significant effects on their Menses. Although Menses are regular and light on regular BCPs, they are not on Progesterone only. Menses usually stops altogether within 3 months of starting. This is again because the Uterus goes into a resting phase, as the ovaries do, similar to the Post Partum state. In the first 3 months irregular bleeding usually occurs which is not liked by most women. Once they get past the first 3 months most women feel the lack of menses is a plus.

Now consider the methods of administration- Depo Provera is a shot every 3 months. This slow release form has a very long half life. After being on Depo for a year or more many women do not resume ovulation and regular menses for 6 months or more after stopping the shots. Some women have trouble regaining their fertility for even longer. Because it stays in your system so long I am not a big fan of this extremely long acting synthetic Progestin, however it is very effective at preventing pregnancy and women don’t have to remember to take a daily pill.

The “Mini Pill” is the other choice. The pills look similar to regular BCPs and come in a small dispensing pack of 28. They must be taken daily. There are no “blanks” to take like regular BCPs during a menses because menses is expected to stop. The pills are taken continuously. The one bad thing about them is that missing 2 pills in a row has an increased risk of pregnancy as compared to regular BCPs. This is because in that short time the ovaries may “escape” from the hormonal suppression of the pills and ovulate. Keeping this in perspective however, the reliability of regular BCPs is considered about 98% while the reliability of the mini pill is about 96%. Still, it is more important for a woman to take these pills absolutely faithfully, daily in the morning with breakfast for example. Overall I prefer these. They are a shorter acting Progestin and more similar to natural progesterone. The “Mini pill” I think, is no doubt the best birth control to take and have lactation at the same time. There are two versions of these available in the United States that I know of; Ortho Micronor and Nor-Q, a generic brand.

Here is a true experience from my practice; An attractive young woman about 22 years old moved in with her boyfriend and started on Depo shots. She had never been pregnant. Her period stopped fairly quickly and things went well for her. She did not know anything about inducing lactation purposefully or make any attempt to stimulate her breasts in any way. She loved to have sex however. Apparently her boyfriend was a “breast lover”. By 6 months she started to spontaneously lactate just from being sexually active. Her boyfriend loved this and paid even more attention to her breasts. By 9 months her breasts were filling to the point that she was able to “squirt across the room”. This continued until she stopped the Depo shots. Her breasts increased in size during this time as well and it took 6 to 9 months for her breasts to get back to their “normal” condition after stopping the Depo.

DrJim

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