Medroxyprogesterone Acetate

Excerpt

Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as depot medroxyprogesterone acetate (DMPA) are considered the hormonal contraceptives of choice during all stages of lactation. Fair to moderate quality evidence indicates that DMPA does not adversely affect the composition of milk, the growth and development of the infant, or the milk supply.[1-3] Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.[4-6]

The timing of initiation of DMPA is controversial.[7] The product labeling states that it should be started no sooner than 6 weeks postpartum, based on data submitted for product approval; and, starting too soon theoretically could affect the newborn infant adversely because of slower metabolism of the drug than older infants. Studies of fair quality seem to indicate that concerns about immediate adverse effects on the infants is unfounded. Of concern is that no data exist on the effects of progesterone on brain and liver development at this age. A systematic review of studies using early postpartum initiation of DMPA concluded that all of the studies were of low quality and inadequate to disprove the concern about DMPA's effects on milk production if given sooner than 6 weeks after delivery.[8] A subsequent study raised the possibility of a slight reduction in breastfeeding duration in women given DMPA before hospital discharge,[9] and another study found that breastfeeding was less like to be initiated if mothers received immediate postpartum DMPA.[10] Other recent studies of variable quality have found no effect on lactogenesis-II or duration of breastfeeding.

Expert opinion in the United States holds that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[3] The World Health Organization recommends that injectable depot medroxyprogesterone acetate should not be used before 6 weeks postpartum.[11]