Can you take birth control pills while breastfeeding?

What does the evidence say about birth control pills while breastfeeding?

1. Combination birth control pills that contain estrogen can meaningfully reduce milk supply, with one study finding milk volume declined 42% in the combination-pill group compared with 17% in a non-hormonal comparison group from 6 to 24 weeks. 1
2. Progestin-only pills, including levonorgestrel-based versions, have not been shown to adversely affect milk composition, milk supply, or infant growth and development across the studies reviewed in the National Library of Medicine's lactation database. 2
3. Progesterone and progestin hormones pass into breastmilk in low amounts, and breastfeeding while using them is not expected to be harmful to a nursing infant. 3
4. Because estrogen can lower milk supply, healthcare providers commonly suggest waiting until supply is well established, generally around 4 weeks postpartum, before starting a combination pill, while progestin-only pills don't carry that same waiting period. 4
5. Progestin-only contraception can generally start soon after delivery for most breastfeeding parents under World Health Organization eligibility guidance, though people with risk factors for low milk supply may be advised to delay starting until 4 to 6 weeks postpartum. 5

How birth control pills changes by nursing stage

• Early weeks. In the first few weeks postpartum, progestin-only pills can typically start within days of delivery since research has not found an adverse effect on breastfeeding when they're started this early. Estrogen-containing combination pills are different: guidance says breastfeeding parents should generally avoid them for at least the first 3 to 4 weeks after delivery.
• Established nursing. Once breastfeeding is well established, usually by 4 to 6 weeks, a combination pill becomes a more reasonable option for those who want or need estrogen, though some people still notice a drop in supply after starting one. If you have risk factors for low milk supply, your provider may suggest staying on a progestin-only method a bit longer.
• Weaning. Later in breastfeeding, hormone choice matters less for supply since production is well established by this point, and the decision usually comes down to side effects, convenience, and any non-contraceptive benefits, worth revisiting with your provider at a follow-up visit.