Cochrane for Clinicians

Putting Evidence into Practice

The Impact of Contraception on Lactation


Am Fam Physician. 2016 Mar 1;93(5):356-357.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does use of hormonal contraception impact lactation and infant growth?

Evidence-Based Answer

Use of hormonal contraception does not appear to shorten breastfeeding duration or negatively impact infant growth, based on inconsistent evidence of moderate quality. It is unclear if hormonal contraception negatively impacts breast milk volume or composition. Overall, there was limited evidence regarding any particular hormonal contraceptive method. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Contraception is an important health topic for breastfeeding women, because unintended pregnancy is associated with late entry into prenatal care, lower birth weight, and decreased breastfeeding rates. Similarly, a shortened interpregnancy interval is associated with low birth weight and preterm births.1 This review sought to determine whether contraceptives adversely affect infant growth or breast milk supply and breastfeeding duration.

The authors identified 11 randomized trials with 1,482 women that examined the effects of combined oral contraceptives, the levonorgestrel-releasing intrauterine system (Mirena), progestin-only pills, or an etonogestrel-releasing implant vs. another method or placebo. Five studies were published before 1985, whereas six were published within the past 11 years. No studies examined the vaginal ring or transdermal patch. Inclusion and exclusion criteria varied across trials, although most included healthy women who delivered at 37 weeks' gestation or later

Author disclosure: No relevant financial affiliations.


Lopez LM, Grey TW, Stuebe AM, Chen M, Truitt ST, Gallo MF. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev. 2015;(3):CD003988.

The practice recommendations in this activity are available at

The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of Defense, the U.S. Army Medical Corps, or the U.S. Army at large.


1. Centers for Disease Control and Prevention. Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. MMWR Morb Mortal Wkly Rep. 2011;60(26):878–883.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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