Emergency contraceptive whilst breast feeding

Guidance states (1):

• It is possible for a woman 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, women can be advised that progestogen-only emergency contraception (levonorgestrel or ulipristal acetate) can be used from day 21 postpartum and the emergency copper intra-uterine device from day 28
  • if considering progestogen-only options then there is more information on the use of levonorgestrel in breastfeeding and this would be the preferred option (2)
  • is limited published evidence of using single doses of levonorgestrel as an emergency contraceptive during breastfeeding (2)
    • studies have shown negligible levels in breast milk. No changes in milk supply have been reported
    • although levonorgestrel is almost completely orally bioavailable, there is no risk of accumulation in the infant after a one-off dose
    • is no information on infant serum levels
    • no short or long term side effects have been reported in breastfed infants after the use of levonorgestrel for emergency contraception
    • no interruption of breastfeeding is necessary after taking a single dos
      
• a copper intra-uterine device can be inserted up to 120 hours (5 days) after unprotected intercourse or contraceptive failure. No restriction on breastfeeding is required. The copper IUD has the additional benefit of providing long term, reversible contraception to women who wish to prevent pregnancy. The Faculty of Sexual and Reproductive Healthcare recommend that the copper IUD be offered to women first line in the majority of cases where emergency contraception is indicated, including breastfeeding women
  • copper is an essential trace element and is present naturally in breast milk. Limited evidence has shown that a copper IUD has no effect on copper levels in breast milk (2)
  • no short or long term side effects have been reported in breastfed infants

• a single dose of 1.5mg levonorgestrel is licensed to be taken within 72 hours (3 days) of unprotected intercourse or contraceptive failure. No restriction on breastfeeding is required (1)
  
  
• a single dose of 30mg ulipristal acetate is licensed to be taken within 120 hours (5 days) after unprotected intercourse or contraceptive failure. Ulipristal is not the preferred emergency contraceptive during breastfeeding, however, based on pharmacokinetic data, UKDILAS do not consider it necessary to withhold breastfeeding if a single dose has been taken (1)

Reference:

• NHS Specialist Pharmacy Service (August 6th 2020).Which emergency contraceptives can be used while breastfeeding?
• NHS Specialist Pharmacy Service (October 10th 2023). Using emergency contraception during breastfeeding