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pediatrician - Dr. Victоr Аbdоw
Rоckville, МD, USА.


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Is it allowed to take Ethinylestradiol + Etonogestrel during lactation?
Is it safe for a nursing mother and a child?

Birth control pill that contains the combination of an estrogen (Ethinyl estradiol) and a progestin (Etonogestrel) for use as a vaginal ring (for 3 weeks) or as a subcutaneous implant (for 3 months). Ethinylestradiol is a synthetic estrogen with similar action than estradiol. Used in combination with progestogens for contraception.Ethinylestradiol is excreted into the breast milk in no or small amount.There is evidence (albeit inconsistent) that estrogen-containing pills may decrease milk production, especially during the first few weeks postpartum with a daily dose above 30 micrograms of ethinyl estradiol.It may reduce the protein content of the milk.No problems have been observed in infants whose mothers were treated, except some cases of transient gynecomastia in infants whose mothers were receiving a higher dose than usual. Etonogestrel is the active metabolite of Desogestrel. It is used as a contraceptive, alone or in combination with Ethinyl estradiol. It is excreted into milk in small quantities. No problems have been observed in infants whose mothers were using it. No differences were observed in the frequency of breastfeeding or the amount of milk produced or weight gain of infants nursed by mothers using mixed implants containing Ethinyl estradiol and Etonogestrel over other contraceptive methods (intrauterine devices, isolated progestogens). However, it would be advisable to avoid them until breastfeeding is well established (4-6 weeks). During lactation, progestin-only contraceptive pills are preferred to Estrogen containing ones, otherwise, the lowest estrogen dose should be used.During the first 6 postpartum weeks, non-hormonal methods are in the first line of choice. Hormone containing contraceptives do not affect the composition of milk, minerals (Mg, Fe, Cu, Ca, P) fat, lactose and calories but only a few the proteins.

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Types of risk

VERY LOW RISK
It is allowed while breastfeeding. It is not dangerous for a baby. It is moderately safe. more...

LOW RISK PROBABLE
Possible presence in breast milk is allowed. Follow the doctor's recommendation. more...

HIGH RISK PROBABLE
An unsafe drug, it is necessary to assess the risks while taking. Use safer analogs. more...

VERY HIGH RISK
It is not recommended. You need to stop breastfeeding or choose a safe analog. more...

Trade Names

The main trade names in different countries containing in its composition Ethinylestradiol + Etonogestrel:

Scientific literature

The level of risk for breastfeeding is confirmed in these scientific publications:
  1. http://www.ncbi.nlm.nih.gov/pubmed/25793657
  2. http://www.ncbi.nlm.nih.gov/pubmed/26002804
  3. http://www.ncbi.nlm.nih.gov/pubmed/26390248
  4. http://www.ncbi.nlm.nih.gov/pubmed/25551519
  5. https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/13-contraception-and-breastfeeding-protocol-english.pdf
  6. https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/13-contraception-and-breastfeeding-protocol-spanish.pdf
  7. http://www.ncbi.nlm.nih.gov/pubmed/26447268
  8. http://www.ncbi.nlm.nih.gov/books/NBK321151/pdf/Bookshelf_NBK321151.pdf
  9. http://www.ncbi.nlm.nih.gov/pubmed/23623474
  10. http://www.fertstert.org/article/S0015-0282(13)00455-X/pdf
  11. http://www.ncbi.nlm.nih.gov/pubmed/23635040
  12. http://www.ncbi.nlm.nih.gov/pubmed/23784109
  13. http://www.cdc.gov/mmwr/pdf/rr/rr6205.pdf
  14. http://www.ncbi.nlm.nih.gov/pubmed/20559203
  15. http://www.cdc.gov/mmwr/pdf/rr/rr5904.pdf
  16. http://www.ncbi.nlm.nih.gov/pubmed/19637436
  17. http://www.ncbi.nlm.nih.gov/pubmed/16531169
  18. http://whqlibdoc.who.int/hq/2002/55732.pdf
  19. http://www.ncbi.nlm.nih.gov/pubmed/11861054
  20. http://www.ncbi.nlm.nih.gov/pubmed/11727180
  21. http://www.ncbi.nlm.nih.gov/pubmed/11763981
  22. http://www.ncbi.nlm.nih.gov/pubmed/11044538
  23. http://www.ncbi.nlm.nih.gov/pubmed/11172794
  24. http://www.ncbi.nlm.nih.gov/pubmed/10438999
  25. http://www.ncbi.nlm.nih.gov/pubmed/9853546
  26. http://www.ncbi.nlm.nih.gov/pubmed/1381897
  27. http://www.ncbi.nlm.nih.gov/pubmed/1935859
  28. http://www.ncbi.nlm.nih.gov/pubmed/3816229
  29. http://www.ncbi.nlm.nih.gov/pubmed/3780231
  30. http://www.ncbi.nlm.nih.gov/pubmed/4085247
  31. http://www.ncbi.nlm.nih.gov/pubmed/6241559
  32. http://www.ncbi.nlm.nih.gov/pubmed/6681210
  33. http://www.ncbi.nlm.nih.gov/pubmed/6404597
  34. http://www.ncbi.nlm.nih.gov/pubmed/6404596
  35. http://www.ncbi.nlm.nih.gov/pubmed/6404595
  36. http://www.ncbi.nlm.nih.gov/pubmed/7234211
  37. http://www.ncbi.nlm.nih.gov/pubmed/7195545
  38. http://www.ncbi.nlm.nih.gov/pubmed/7361700
  39. http://ajcn.nutrition.org/content/33/4/816.full.pdf
  40. http://www.ncbi.nlm.nih.gov/pubmed/630883
  41. http://www.ncbi.nlm.nih.gov/pubmed/4128673
  42. http://www.ncbi.nlm.nih.gov/pubmed/4467130
  43. http://www.ncbi.nlm.nih.gov/pubmed/6038336
  44. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1842938/pdf/brmedj02152-0036.pdf

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