Is Intrauterine Levonorgestrel Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Intrauterine Levonorgestrel? Is Intrauterine Levonorgestrel safe for nursing mother and child? Does Intrauterine Levonorgestrel extracts into breast milk? Does Intrauterine Levonorgestrel has any long term or short term side effects on infants? Can Intrauterine Levonorgestrel influence milk supply or can Intrauterine Levonorgestrel decrease milk supply in lactating mothers?

Progestin containing contraceptive drug that is used as a single dose for oral, subcutaneous implant, intrauterine device (IUD), or emergency contraception administration.Also marketed in association with ethinylestradiol Levonorgestrel is a progestin, and active metabolite isomer of norgestrel, both derived from nortestosterone. It is excreted in breast milk in clinically non-significant amount, and, no problems have been observed in infants whose mothers were treated. The plasma levels of these infants were very low. Levonorgestrel and progestogens are generally considered contraceptive drugs of choice during lactation since they neither alter the quantity and composition of milk nor cause side effects on both growth of infants and the duration of breastfeeding.Published study results have shown protection against breast bone mass loss with the use of progestin-only contraceptives. For the first 6 weeks postpartum, non-hormonal methods are of choise. There is a debate on the role of progestin-related drugs in decreasing milk production when used before lactation has been fully established. The American Academy of Pediatrics states that this medication is usually compatible with breastfeeding.WHO List of Essential Medicines 2002: rates it as compatible with breastfeeding after the 6th postnatal week.

This record contains information specific to the levonorgestrel intrauterine device (IUD). Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as levonorgestrel are considered the hormonal contraceptives of choice during lactation. Fair quality evidence indicates that levonorgestrel does not adversely affect the composition of milk, the growth and development of the infant or the milk supply. Expert opinion holds that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[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 levonorgestrel IUD (Myrena) is recommended to be inserted at least 6 weeks postpartum and in some cases up to 12 weeks postpartum when uterine involution is complete. However, the American College of Obstetrics and Gynecology considers earlier insertion to be appropriate based on expert opinion.[8] The World Health Association recommends that progestin-only intrauterine devices (IUDs) can be inserted before 48 hours postpartum and after 4 weeks postpartum, but should not have be inserted between 48 hours and 4 weeks postpartum.[1] Four small, randomized studies on this point differed in their outcomes. Three found that early insertion did not adversely affect breastfeeding,[9][10][11] and the other found that immediate IUD insertion markedly reduced the breastfeeding rate at 6 months postpartum.[12] A meta-analysis found that uterine perforation with an IUD was 6 to 10 times more likely in breastfeeding mothers than in non-breastfeeding women, but that the risk of expulsion was no greater in breastfeeding mothers.[13] More recent prospective studies found an increase in the risk of expulsion of intrauterine devises with breastfeeding,[10][14] and the American College of Obstetrics and Gynecology recommends that women be counseled that immediate postpartum insertion may have a higher expulsion rate than later insertion.[4]

One study found serum thyroid stimulating hormone levels to be lower in the infants exposed to levonorgestrel than in control infants.[17] IUDs that released levonorgestrel were inserted 6 weeks after delivery. IUDs released 10 mcg per day (n = 30) or 30 mcg per day (n = 40); copper-releasing IUDs (n = 40) were used as controls. No differences were seen in infant height, weight, development, respiratory infections or blood chemistries up to 12 months of age between the levonorgestrel and copper IUD groups.[18] Three hundred twenty lactating women were randomized to either an IUD containing levonorgestrel (Mirena; n =163) or the copper-containing IUD Cu T380A group (n =157). Follow-up of infants for 1 year found no differences in growth and development or in duration of breastfeeding.[19]

IUDs releasing levonorgestrel were inserted 6 weeks after delivery. IUDs released 10 mcg per day (n = 30) or 30 mcg per day (n = 40); copper-releasing IUDs (n = 40) were used as controls. The rate of breastfeeding discontinuation was higher with the levonorgestrel groups than in the copper IUD group at 75 days, but not at other times.[18] In a small prospective study, forty-six women were randomized to have an IUD containing levonorgestrel (Mirena) inserted either within 10 minutes after placental delivery (n = 15), between 10 minutes and 48 hours after placental delivery (n = 15), or after 6 weeks postpartum (n = 16). At 6 months postpartum, no statistical difference in the rates of continued breastfeeding (extent not stated) was found among the groups.[9] Women who gave birth were offered contraception with a levonorgestrel-containing IUD and randomized to have the IUD placed immediately following delivery (n = 46) or at 6 to 8 weeks postpartum (n = 50). Women randomized to later IUD insertion were more likely to be nursing at 6 months postpartum (24% vs 6%) and tended to have a longer median duration of exclusive breastfeeding.[12] A noninferiority trial compared breastfeeding in women who received a levonorgestrel IUD (product and dose not specified) immediately postpartum (n = 132) or at 8 weeks postpartum (n = 127). At 8 weeks, women who received the IUD immediately postpartum had a 5% lower rate of any breastfeeding (79% vs 84%), which fell withing the predetermined 15% noninferiority margin. Exclusive breastfeeding was slightly lower at 8 weeks in the immediate group (33% vs 40%), but the difference was not statistically significant. The time to lactogenesis in the immediate group was noninferior to that of the delayed group (65.3 vs 63.6 hours). Twenty-four device expulsions occurred in the immediate group compared to 2 in the delayed group (19% vs 2%), which was statistically significant.[10]