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Am Fam Physician. 2023;107(5):461

What is the preferred oral contraceptive during breastfeeding?

Progestin-only contraceptives are preferred to combination oral contraceptives during breastfeeding. The estrogen in oral contraceptives does not affect the composition of breast milk or infant growth and development but may decrease milk production. Combination oral contraceptives should be avoided for at least three weeks postpartum because of the increased thrombotic risk.

What is the preferred treatment for hyperprolactinemia due to a prolactinoma?

Dopamine agonists are first-line therapy for hyperprolactinemia. Cabergoline is preferred because it has been shown to more effectively lower prolactin levels and decrease tumor size. Dopamine agonist therapy should be continued for at least two years, after which tapered discontinuation may be attempted if prolactin levels have normalized and tumor size is significantly reduced.

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