| Premature introduction of progestin-only contraceptive methods during lactation. | |
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MedLine Citation:
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PMID: 9262929 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Experts on contraceptive technology concur that progestin-only methods can be used safely during lactation. However, very few studies exist of the effects on lactation of the introduction of progestin-only methods prior to the sixth postpartum week. Since progesterone withdrawal is the likely stimulus that initiates lactogenesis, it appears necessary for natural progesterone levels to decline to baseline before a progestin-only contraceptive is initiated. Therefore, the use of such contraceptive methods should be delayed for at least 3 days after the birth. Non-hormonal methods remain the first choice category of contraceptive methods for breastfeeding women, since there is no possibility that they will interfere with lactation. Progestin-only methods comprise a viable and often desirable next choice category, although the timing of their commencement must be determined with care in order to support lactation. All major international family planning organizations have endorsed the use of progestin-only contraceptive methods once lactation has been established. Prospective, multicenter studies of infants of acceptors of progestin-only pills, injections, and implants have found no deleterious effects of the drug on infant growth and development; however, women enrolled in these trials did not initiate method use until at least the sixth postpartum week. Of concern is a recent trend toward administration of progestin subdermal implants and injectables to women prior to their discharge from the hospital (i.e., 0-72 hours after delivery). Since progesterone withdrawal is the likely stimulus that initiates lactogenesis, natural progesterone levels need a chance to decline to baseline before progestin contraceptive use is initiated. Moreover, the immature neonatal liver may have difficulties metabolizing exogenous steroids, the binding capacity of plasma is low, and the immature kidney may be inefficient in steroid excretion. Use of progestin-only contraceptive methods should be delayed for at least 3 days (optimally, until 6 weeks) after birth so lactation can become established. Nonhormonal methods remain the first choice for breast-feeding women, given the lack of potential to interfere with lactation, while progestin-only agents are a viable second choice. |
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Authors:
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K I Kennedy; R V Short; M R Tully |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Review |
Journal Detail:
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Title: Contraception Volume: 55 ISSN: 0010-7824 ISO Abbreviation: Contraception Publication Date: 1997 Jun |
Date Detail:
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Created Date: 1998-01-02 Completed Date: 1998-01-02 Revised Date: 2009-11-19 |
Medline Journal Info:
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Nlm Unique ID: 0234361 Medline TA: Contraception Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 347-50 Citation Subset: IM; J |
Affiliation:
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Department of Perinatal Medicine, Royal Women's Hospital, Carlton, Victoria, Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Contraception / methods* Contraceptive Agents, Female / administration & dosage*, adverse effects Female Humans Lactation / drug effects*, physiology Medroxyprogesterone Acetate / administration & dosage*, adverse effects Progesterone Congeners / administration & dosage*, adverse effects Rats Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Contraceptive Agents, Female; 0/Progesterone Congeners; 71-58-9/Medroxyprogesterone Acetate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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