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Using emergency contraception during breastfeeding

Published
Topics: CopperLevonorgestrelReproductive health · Safety in BreastfeedingUlipristal ·

A copper IUD or a single oral dose of levonorgestrel are preferred. Ulipristal may also be considered. Recommendations apply to full term and healthy infants.

Contents

  1. General considerations
  2. Recommendations
  3. Specific recommendations
    1. Copper intra-uterine device (IUD)
    2. Levonorgestrel
    3. Ulipristal acetate
  5. Contact us
  6. About our recommendations
  7. Bibliography

General considerations

It is important to complete an individual risk assessment (SPS page) for your patient and to apply the principles of prescribing in breastfeeding (SPS page) when looking at the available information and making treatment decisions.

Recommendations

It is possible to get pregnant again very soon after the birth of a baby, even if breastfeeding, and even if periods have not returned.

If emergency contraception is required during breastfeeding, a copper intra-uterine device (IUD) is the preferred option from day 28 after birth and has the additional benefit of providing long term, reversible contraception if desired. The Faculty of Sexual and Reproductive Healthcare recommend that the copper IUD be offered first line in the majority of cases, including during breastfeeding.

Progestogen-only options (levonorgestrel or ulipristal acetate) can be used from day 21 after birth.  There is more information on the use of levonorgestrel in breastfeeding and this would be the preferred option.

Specific recommendations

Preferred choice

A copper IUD can be used for emergency contraception during breastfeeding from day 28 after birth.

Infant monitoring

No infant monitoring is required.

Further information

Copper is an essential trace element and is present naturally in breast milk.  Limited evidence has shown that a copper IUD has no effect on copper levels in breast milk.

No short or long term side effects have been reported in breastfed infants.

Preferred choice

Levonorgestrel can be used for emergency contraception during breastfeeding from day 21 after birth.  A copper IUD is an alternative choice.

Infant monitoring

As a precaution, monitor the infant for drowsiness, vomiting, diarrhoea, irritability, poor feeding or adequate weight gain

Further information

There is limited published evidence of using single doses of levonorgestrel as an emergency contraceptive during breastfeeding.  Studies have shown negligible levels in breast milk.  No changes in milk supply have been reported.

Although levonorgestrel is almost completely orally bioavailable, there is no risk of accumulation in the infant after a one-off dose.

There is no information on infant serum levels.

No short or long term side effects have been reported in breastfed infants after the use of levonorgestrel for emergency contraception.

No interruption of breastfeeding is necessary after taking a single dose.

Use with caution

Ulipristal acetate can be used for emergency contraception during breastfeeding from day 21 after birth, but levonorgestrel or a copper IUD are preferred if clinically appropriate.

Infant monitoring

As a precaution, monitor the infant for drowsiness, irritability, vomiting, diarrhoea, poor feeding or adequate weight gain.

Further information

Very limited evidence shows it is excreted in negligible levels into breast milk.

It is highly bound to plasma proteins which limits its excretion into breast milk.  Despite its long half-life, the single dose for emergency contraception is unlikely to result in accumulation in infants.

Although, there is no information on infant serum levels, based on milk levels reported and the properties of ulipristal acetate, infant levels are predicted to be low and infant side effects would not be expected.

No interruption of breastfeeding is considered necessary after taking a single dose.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS) (SPS page), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the medicine in question is not included here
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data are now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.