Is Levonorgestrel Implant Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Levonorgestrel Implant? Is Levonorgestrel Implant safe for nursing mother and child? Does Levonorgestrel Implant extracts into breast milk? Does Levonorgestrel Implant has any long term or short term side effects on infants? Can Levonorgestrel Implant influence milk supply or can Levonorgestrel Implant 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 implant, which is not available in the United States. 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]

Numerous studies have found no systematic differences in growth, development or illness rates between the infants of mothers who received Norplant as a contraceptive and those of other mothers receiving either no contraception or nonhormonal contraception.[8][11][12][13][14][15] One study found serum thyroid stimulating hormone levels to be lower in the infants exposed to levonorgestrel than in control infants.[16] Ten women received Norplant-2 beginning at 4 weeks postpartum. Mothers collected 4-hour urine samples daily from weeks 4 to 11 postpartum from their infants. Urine samples were analyzed for follicle-stimulating hormone, luteinizing hormone and testosterone. No difference was found in these levels when compared to those of infants whose mothers were taking either no contraception or an oral progestin-only contraceptive containing 30 mcg of levonorgestrel.[17] Multicenter, nonrandomized studies followed infants whose mothers received levonorgestrel contraception during breastfeeding, either as oral tablets of 37.5 mcg daily (n = 246) or as Norplant (n = 453). No adverse effects on infant growth through the first year were found in comparison to standard measurements.[18][19] In a continuation study, infants from these studies who were exposed to levonorgestrel via Norplant (total n = 220) were followed up to 6 years of age. Infants were fully breastfed for an average of 7.8 months and were breastfed at least once daily for an average of 16.5 months. No differences in growth, diseases, surgery or hospitalizations were found from years 2 though 6 between infants whose mothers used levonorgestrel implants or Copper T IUD. An increase in skin conditions occurred in the levonorgestrel group and an increase in urogenital conditions occurred in the Copper T group.[15]

Numerous studies of varying size and quality have found that the use of levonorgestrel implants (Norplant or Norplant-2) as a contraceptive beginning at 7 days postpartum or later either has no clinically important negative effect on the quality of breastmilk and results in either no effect or an increase in the milk supply and duration of lactation.[12][14][20][21][22][23][24] In a nonrandomized study, 100 women who received Norplant implants at an average of day 55 postpartum were compared to 100 women receiving a postpartum IUD. No differences were found between the control and Norplant groups in the number of women nursing at days 10 and 20 and months 1 to 12 postinsertion except a slight decrease in the number of mothers using Norplant who were exclusively breastfeeding at 12 months. No difference since the time of weaning was noted between the groups.[8] A secondary analysis of a study in Uganda examined 96 postpartum women randomized to receive a 2-rod levonorgestrel implant (Jadelle, Bayer AG, Berlin) either within 5 days of birth (n = 55) or at 6 to 8 weeks postpartum (n = 42). No differences were found between the groups in infant growth from birth to 6 months, time to lactogenesis II, or proportion of mothers breastfeeding at 3 and 6 months.[25]