Progesterone use while Breastfeeding

Drugs containing Progesterone: Prometrium, Crinone, Cyclogest, Endometrin, Menopause Formula Progesterone, First Progesterone MC10, Progestasert System, Progest, First Progesterone MC5, Prochieve, Show all 11 »Gestone

Progesterone Levels and Effects while Breastfeeding

Summary of Use during Lactation

Release from the progesterone-releasing intrauterine device available in the United States is 65 mcg/day or only 0.65% of the dose released from most of the devices reported in the literature. Because of the low levels of progesterone in breastmilk, even with the high-dose products, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. The progesterone vaginal ring available in some countries produces maternal blood levels that are lower than those of ovulating women.[1] Most studies indicate that progesterone is not detrimental to milk production or duration of nursing. No special precautions are required.

Drug Levels

Maternal Levels. Women who received 6 subdermal implants containing 100 mg each of progesterone between days 30 to 35 postpartum for contraception had milk progesterone levels measured. Milk progesterone levels were 5.7 mcg/L in 6 women at 3 to 4 months postpartum and 6.3 mcg/L in 7 women at 9 to 12 months postpartum. By comparison, 9 women who received a Copper T intrauterine device had negligible progesterone levels. The authors estimated that infants would receive about 5 mcg of progesterone daily through breastmilk.[2][3]

Infant Levels. Women received 6 subdermal implants containing 100 mg each of progesterone between days 30 to 35 postpartum for contraception. A metabolite of progesterone, pregnane-3-glucuronide, was measured in the urine of their infants. At 3 to 4 months (n = 9) and 9 to 12 months (n = 7) postpartum, urine metabolite levels were 6.3 mcg/L and 15.7 mcg/L, respectively. These values were not significantly different from those of infants whose mothers were using a Copper T intrauterine device.[2][3]

Effects in Breastfed Infants

Eighty-four women had 6 subdermal implants containing 100 mg each of progesterone inserted between days 30 to 35 postpartum as a contraceptive. Compared to women who received either a placebo or a Copper T intrauterine device, no difference was found in the breastfeeding rates during the first 9 months postpartum. At 1 year postpartum, more women in the Copper T group were breastfeeding than in the progesterone or placebo groups.[4]

Vaginal rings that released progesterone were inserted at about 60 days postpartum in 246 women. The 3 types of rings released progesterone either 5, 10 or 15 mg daily. Control women received a Copper T intrauterine device. At 6 and 12 months postpartum there was no significant difference in the percentage of infants who were breastfed between the progesterone and Copper T groups.[11]

One hundred twenty breastfeeding women used a vaginal ring that released about 10 mg daily of progesterone, starting during weeks 5 to 7 postpartum. The rate of weaning was greater in the progesterone ring group than in groups of women who received levonorgestrel or norethindrone implants for postpartum contraception.[7]

In a multicenter study, 802 women who received a vaginal ring that released about 10 mg daily of progesterone were compared to 734 women who received a Copper T intrauterine device beginning at day 29 to 63 postpartum. No differences were found in the rate of breastfeeding between the 2 groups over the first year postpartum.[12]

Two hundred eighty-five women who received a vaginal ring that released about 10 mg daily of progesterone were compared to 262 women who received a Copper T intrauterine device beginning between weeks 5 and 9 postpartum. No differences in the breastfeeding rates were seen between the 2 groups during the 14-month observation period.[10]

An observational study followed 192 women who used a vaginal ring that released 10 mg of progesterone daily beginning between days 54 and 64 postpartum. All subjects used the vaginal ring for at least 4 months; 90% were still using it at 6 months and 73% were using it at 9 months postpartum. The duration of breastfeeding and infant growth were similar to reference groups.[13]

Possible Effects on Lactation

Eighty-four women had 6 subdermal implants containing 100 mg each of progesterone inserted between days 30 to 35 postpartum as a contraceptive. Compared to women who received either a placebo or a Copper T intrauterine device, no difference was found in the breastfeeding rates during the first 9 months postpartum. At 1 year postpartum, more women in the Copper T group were breastfeeding than in the progesterone or placebo groups.[3]

Vaginal rings that released progesterone were inserted at about 60 days postpartum in 246 women. The 3 types of rings released progesterone either 5, 10 or 15 mg daily. Control women received a Copper T intrauterine device. At 6 and 12 months postpartum there was no significant difference in the percentage of infants who were breastfed between the progesterone and Copper T groups.[10]

One hundred twenty breastfeeding women used a vaginal ring that released about 10 mg daily of progesterone, starting during weeks 5 to 7 postpartum. The rate of weaning was greater in the progesterone ring group than in groups of women who received levonorgestrel or norethindrone implants for postpartum contraception.[6]

In a multicenter study, 802 women who received a vaginal ring that released about 10 mg daily of progesterone were compared to 734 women who received a Copper T intrauterine device beginning at day 29 to 63 postpartum. No differences were found in the rate of breastfeeding between the 2 groups over the first year postpartum.[11]

Two hundred eighty-five women who received a vaginal ring that released about 10 mg daily of progesterone were compared to 262 women who received a Copper T intrauterine device beginning between weeks 5 and 9 postpartum. No differences in the breastfeeding rates were seen between the 2 groups during the 14-month observation period.[9]

An observational study followed 192 women who used a vaginal ring that released 10 mg of progesterone daily beginning between days 54 and 64 postpartum. All subjects used the vaginal ring for at least 4 months; 90% were still using it at 6 months and 73% were using it at 9 months postpartum. The duration of breastfeeding and infant growth were similar to reference groups.[12]

Alternate Drugs to Consider

(Contraception) Etonogestrel, Levonorgestrel, Medroxyprogesterone Acetate, Norethindrone

References

1. RamaRao S, Clark H, Merkatz R, Sussman H, Sitruk-Ware R. Progesterone vaginal ring: introducing a contraceptive to meet the needs of breastfeeding women. Contraception. 2013;88:591-8. PMID: 23769015

2. Croxatto HB, Diaz S et al. Subdermal progesterone implants for fertility regulation in nursing women. In, Zatuchni GI, Goldsmith A, Shelton JD, Sciara JJ, eds. Long-acting contraceptive delivery systems. Philadelphia. Harper & Row. 1984.

3. Croxatto HB, Diaz S. The place of progesterone in human contraception. J Steroid Biochem. 1987;27: 991-4 . PMID: 3320572

4. Croxatto HB, Diaz S et al. Fertility regulation in nursing women. II. Comparative performance of progesterone implants versus placebo and copper T. Am J Obstet Gynecol. 1982;144:201-8. PMID: 7114130

5. Diaz S, Peralta O et al. Fertility regulation in nursing women. VI. Contraceptive effectiveness of a subdermal progesterone implant. Contraception. 1984;30:311-25. PMID: 6509984

6. Diaz S, Jackanicz TM et al. Fertility regulation in nursing women: VIII. Progesterone plasma levels and contraceptive efficacy of a progesterone-releasing vaginal ring. Contraception. 1985;32:603-22. PMID: 3912105

7. Shaaban MM. Contraception with progestogens and progesterone during lactation. J Steroid Biochem Mol Biol. 1991;40:705-10. PMID: 1835650

8. Diaz S, Zepeda A et al. Fertility regulation in nursing women IX. Contraceptive performance, duration of lactation, infant gowth, and bleeding patterns during use of progesterone vaginal rings, progestin-only pills, Norplant implants, and Copper T 380-A intrauterine devices. Contraception. 1997;56:223-32. PMID: 9408703

9. Chen JH, Wu SC et al. The comparative trial of TCu 380A IUD and progesterone-releasing vaginal ring used by lactating women. Contraception. 1998;57:371-9. PMID: 9693396

10. Massai R, Miranda P et al. Preregistration study on the safety and contraceptive efficacy of a progesterone-releasing vaginal ring in Chilean nursing women. Contraception. 1999;60:9-14. PMID: 10549447

11. Croxatto HB, Diaz S. Progesterone vaginal rings for contraception during breastfeeding. In, Runnebaum R, Rabe T, Kiesel L, eds. Advances in gynecological and obstetric research series. Vol. 2. Female contraception and male fertility regulation. New Jersey. Parthenon. 1987;2:135-42.

12. Sivin I, Diaz S et al. Contraceptives for lactating women: a comparative trial of a progesterone-releasing vaginal ring and the copper T 380A IUD. Contraception. 1997;55:225-32. PMID: 9179454

13. Massai R, Quinteros E, Reyes MV et al. Extended use of a progesterone-releasing vaginal ring in nursing women: a phase II clinical trial. Contraception. 2005;72:352-7. PMID: 16246661

Progesterone Identification

Substance Name

Progesterone

CAS Registry Number

57-83-0

Drug Class

Administrative Information

LactMed Record Number

470

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2013-12-06

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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