Is Estradiol Valerate Safe in Breastfeeding

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

A natural Estrogen that is marketed for oral, injection and topical administration (skin and vaginal).On the chemical form of valerate, it is used in association with a progestin as a combined birth-control compound (e.g. Estradiol + Dienogest) Estradiol is excreted into breast milk in clinically non-significant amount (Nilson 1978) and no problems have been observed in infants whose mothers were treated (Pinheiro 2016). Plasma levels of these infants were undetectable or very low (Pinheiro 2016). After administration in the form of transdermal patches milk levels have been undetectable (Pinheiro 2016, Perheentupa 2004). Despite these data, an older publication associated the use of transdermal estradiol with a case of jaundice and poor weight gain (Ball 1999).There is greater passage to milk when the administration is vaginal. There is evidence (albeit inconsistent) that estrogen-containing pills may decrease milk production, especially during the first few weeks postpartumThey 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. Estrogen exposure in childhood or adolescence, does not influence the subsequent production of milk. The American Academy of Pediatrics states that this medication is usually compatible with breastfeeding.

Estradiol valerate has not been studied during breastfeeding. Injectable estradiol valerate has been used to suppress lactation, usually in combination with testosterone. Generally, it should be avoided in mothers wishing to breastfeed. Oral estradiol valerate is only available in the United States in a combination oral contraceptive product that also contains dienogest. Based on the available evidence, expert opinion holds that nonhormonal methods are preferred during breastfeeding and progestin-only contraceptives are preferred over combined oral contraceptives in breastfeeding women, especially during the first 4 weeks postpartum. For further information, consult the record entitled, "Contraceptives, Oral, Combined."

Estradiol valerate injection was previously used therapeutically to suppress lactation, usually in combination with testosterone.[3][4][5] A retrospective cohort study compared 371 women who received high-dose estrogen (either 3 mg of diethylstilbestrol or 150 mcg of ethinyl estradiol daily) during adolescence for adult height reduction to 409 women who did not receive estrogen. No difference in breastfeeding duration was found between the two groups, indicating that high-dose estrogen during adolescence has no effect on later breastfeeding.[6]