Breastfeeding and Birth Control

Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team

Is it Safe to Use Birth Control While Breastfeeding?

TLDR: Yes, it is safe to use birth control while breastfeeding. But, if it contains estrogen , it may reduce your milk supply.

Getting pregnant soon after giving birth can be emotionally and physically draining for women. According to the World Health Organization, it is best to wait at least 18 months before becoming pregnant again. Typically, it’s recommended to abstain from any sexual activity until 6 weeks after giving birth as the person who gave birth may still be recovering from vaginal tears that occurred during birth. That being said, it is possible for a person with a uterus to become pregnant as soon as 6 weeks after having a baby and during the time she is breastfeeding. For couples who are heterosexually sexually active, it’s smart to consider hormonal birth control options or copper IUD or condoms with spermicide to prevent pregnancy in the postpartum period. A few key points to know:

• It is safe to use hormonal birth control while breastfeeding.
• Estrogen containing birth control may decrease breast milk volume.
• Hormonal birth control will NOT harm the baby.

Is breastfeeding a form of birth control?

Although breastfeeding has been used as a form of birth control in the old days and in third world countries, it is NOT the most effective method at preventing pregnancy, and it must be done carefully.

For new mothers, breastfeeding is one of the most fatiguing and stressful experiences in life. When you are breastfeeding every 2-3 hrs non stop, it can be difficult to keep track of birth control methods that require significant human intervention. In order for breastfeeding to work as a form of birth control, a woman must breastfeed her infant exclusively (meaning NO other food/drinks for the baby); even then, it will only work for up to six months maximum, but for each baby/mother dyad it could be less if the baby is breastfeeding less. It’s also impossible to know precisely when the method will stop working, which puts a mother at risk of becoming pregnant again.

When women exclusively breastfeed their infant, the hormones that are used to produce milk can suppress ovulation, and thus, prevent pregnancy. Exclusive breastfeeding means a woman is nursing her infant at least every 4 hours during the day, and at least every 6 hours at night, and the baby is ONLY drinking breast milk and no formula. Breastfeeding as a method of birth control is also called the lactational amenorrhea method (LAM).

How effective is breastfeeding (LAM) as a form of birth control?

With absolute, perfect use, LAM is 98% effective. However, with perfect use, LAM only works for up to six months. By 6 months old, babies are starting to eat solid foods and need less breast milk to thrive. Plus, LAM only works if women exclusively breastfeed; introducing formula lowers the effectiveness rate.

Here are some questions that can be used to detect 3 signs that shows you may not be protected against pregnancy and that your fertility is coming back

• Have you had a menstrual bleed? (For LAM, this means any bleeding, on any 2 consecutive days, that occurs 2 months after the birth)
• Are you giving supplementary foods or fluids to your baby in addition to breastfeeding?
• Is your infant 6 months of age or older?

If you answer no to all 3, then you can do LAM. If you answer yes to any of the 3 questions, then you should use ANOTHER method for birth control.

For some women, exclusive breastfeeding can be challenging and/or impractical for their lives, for both their own needs and the baby’s. It is also impossible to determine precisely when you will begin to ovulate again after giving birth and breastfeeding. It’s risky to engage in unprotected sex during this period because you can get pregnant if you are not exclusively breastfeeding.

Is it unsafe to have sexual intercourse during the first 3 weeks postpartum? Why?

Yes because of the risk of infection from rips in the vagina that need time to heal. The arteries and veins in the uterus that helped to feed, nurture, and grow the developing fetus begin to shrink and close up during the first few weeks of the postpartum period. Inserting anything into the vagina can cause a severe, life-threatening infection; so having penetrative sex or using tampons isn’t safe until postpartum bleeding completely stops, which for most people with uteri that doesn’t happen until about 4 to 6 weeks postpartum (after the baby is born).

Will birth control pills or other contraceptives interfere with breastfeeding?

The birth control patch, ring, and pills with estrogen have been linked to low milk supply and shorter duration of breastfeeding. Because breastfeeding is very beneficial for both mothers and their infants, doctors advise not using an estrogen-containing combined hormonal birth control method while breastfeeding. However, there are other effective birth control options that do not interfere with the production or integrity of breast milk such as the birth control with no hormones in it (copper IUD, condoms, spermicide) or the ones that only contain progestin (synthetic progesterone hormone) such as hormonal IUD, Implant, shot, progestin only pills.

Are Hormonal Contraceptive Options Safe for Nursing Mothers?

As the body readjusts to its pre-pregnancy state, it is not safe to use any birth control methods with estrogen for the first 6 weeks after giving birth due to the risk of blood clots. As mentioned before, Progestin-only birth control methods are fine to start immediately after giving birth if needed. Though doctors recommend waiting until 6 weeks before having intercourse after giving birth to prevent the birther from getting an infection of the vagina. Estrogen decreases milk production so doctors recommend using progesterone only methods (IUD, implant, shot, progestin only pills) or non-hormonal methods (condoms, spermicide, copper IUD) until you are done with breastfeeding.

What’s the best birth control while breastfeeding?

The best birth control methods for women that are breastfeeding are the Copper IUD, progestin-only contraception or barrier methods with spermicide(condoms, diaphragm, etc). Fortunately, there are a few birth control options available for breastfeeding moms and one of them may work better for you than others. This depends on your needs. Let’s take a look at each of them.

Barrier methods like male and female condoms are safe to use while breastfeeding because they do not introduce hormones into the body which can interfere with milk supply; they are also one of the few ways to prevent the spread of STIs (Sexually Transmitted Infections)! Cervical caps and diaphragms are also safe to use while breastfeeding, although a woman will need to be re-fitted for these devices after she gives birth because her cervix has gotten larger.

Progestin-only contraceptives are the preferred option for breastfeeding mothers, because they don’t affect milk supply for most breastfeeding mothers and they are more effective than barrier methods. These methods include implant, IUD with hormone, the shot (depo-provera®), and Progestin Only Pills (POPs). However, the standard POPs in the U.S. are very finicky — if you take your pill 3 hours later than normal, you must abstain from sex or use condoms and/or use emergency contraception. There is a new POP with drosperinone (Slynd) that is more forgiving but it is expensive and your insurance may not cover it. FYI, mothers who stop breastfeeding or choose not to breastfeed can use any type of hormonal birth control.

Copper IUDs are also safe for nursing mothers — they have a 99% success rate for preventing pregnancy and do not introduce hormones into the body. The copper in the IUD makes the uterus inhospitable to sperm and does not interfere with ovulation. But some women on the copper IUD experience cramping, breakthrough bleeding, and heavier than normal periods (5%).

For busy mothers, low maintenance birth control methods are often the best choice for preventing pregnancy such as the copper IUD or IUD with hormone, the shot, or implant. It can be difficult to remember to take a birth control pill each day or it can be very difficult to get to a doctor’s office as the mother of a nursing infant for a birth control shot. As always, it’s important to explore birth control options relative to a particular woman’s lifestyle, her body, and her nursing infant’s needs.

Pandia Health has helped hundreds of women get low-cost, free (with insurance or via Pandia Health Birth Control Fund), and affordable hormonal birth control delivered to their homes. Birth control delivery services are incredibly convenient, especially for nursing mothers.

Consider using Pandia Health today to explore your options for birth control mini-pills (Progestin Only Pills/POPs) that are best for breastfeeding.

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Disclaimer: This article, even if and to the extent that features the advice of physicians and medical practitioners, it is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment, and should never be relied upon for specific medical advice. Always seek the advice of your doctor/primary care provider for specific health needs.