Contraception during breastfeeding
First line
Contraception during breastfeeding. MEC 2015 category 1 from day 1 postpartum. Compatible with lactation, does not reduce milk supply. RID about 1-2%. Alternative to desogestrel where available.
Older-generation progestogen-only pill
ATC code: G03AC01 (Norethisterone)
Norethisterone 350 µg daily. Acts mainly via cervical mucus and endometrium. Suppresses ovulation in only 60% of women (vs 97% for desogestrel), so the missed-dose window is strict – 3 hours. Has mild androgenic activity, may cause acne.
First line
Contraception during breastfeeding. MEC 2015 category 1 from day 1 postpartum. Compatible with lactation, does not reduce milk supply. RID about 1-2%. Alternative to desogestrel where available.
Second line
Contraception when estrogen is contraindicated and desogestrel is unavailable. Per SEGO 2023, inferior to desogestrel due to a strict 3-hour missed-dose window – higher unintended-pregnancy risk with typical use. Taken continuously at the same time.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
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Discontinue if pregnant.
WHO MEC 2015 category 1. Does not reduce milk supply. RID 1-2%, Hale L2.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Norethisterone is evaluated for the following indications with varying evidence strength: Contraception during breastfeeding (evidence tier A), Contraception (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Norethisterone (≥ 1 in 100): Irregular bleeding, Amenorrhea, Acne, Breast tenderness, Headache. See the Safety section for uncommon and serious reactions.
FDA category X. Discontinue if pregnant.
WHO MEC 2015 category 1. Does not reduce milk supply. RID 1-2%, Hale L2.
Norethisterone is contraindicated in: Hypersensitivity; Pregnancy; Active VTE; Severe liver disease; Breast cancer. Full list in the Safety section.