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Using emergency contraception during breastfeeding

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Topics: CopperLevonorgestrelReproductive health · Safety in BreastfeedingUlipristal ·

A copper IUD or a single oral dose of levonorgestrel are preferred. Ulipristal may also be considered. Recommendations apply to full term and healthy infants.

Contents
  1. General considerations
  2. Recommendations
  3. Specific recommendations
    1. Copper intra-uterine device (IUD)
    2. Levonorgestrel
    3. Ulipristal acetate
  4. Contact us
  5. About our recommendations
  6. Bibliography

General considerations

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.

Recommendations

It is possible to get pregnant again very soon after the birth of a baby, even if breastfeeding, and even if periods have not returned.

If emergency contraception is required during breastfeeding, a copper intra-uterine device (IUD) is the preferred option from day 28 after birth and has the additional benefit of providing long term, reversible contraception if desired. The Faculty of Sexual and Reproductive Healthcare recommend that the copper IUD be offered first line in the majority of cases, including during breastfeeding.

Progestogen-only options (levonorgestrel or ulipristal acetate) can be used from day 21 after birth.  There is more information on the use of levonorgestrel in breastfeeding and this would be the preferred option.

Specific recommendations

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the medicine in question is not included here
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data are now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.

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