Breastfeeding and combined pill (baby over 1)

[PenguinsandtheTantrumofDoom]

I have tried various methods of contraception and don't get on with them. The combined pill, however, I find fine.

When DD2 reached 12 months I was told that, despite still bfing a couple of times a day, it was fine to go back on the combined pill. I was told to watch out for supply issues, but had no problems (and have also continued to breastfeed through the first months of two pregnancies, which I suppose is the same hormones).

This time, I've been told that I must stop all bfing before going back on the combined pill as there is a risk oestrogen will damage DS. Is there any evidence for this? The only thing I can find online is a Dr Sears thing which says that there has been no evidence, but some GPs still like to avoid it 'just in case'. I was given the impression it was rather stronger than that.

Does anyone know?

I'd take the 'just in case' position on this: there is lots of research into the possibility that environmental oestrogens may be implicated in the increase in testicular cancer and reduced male fertility. Until they have proved or disproved any link I wouldn't want to knowingly give a son of mine oestrogen.....

Ok. But how is that different to if I bf in pregnancy? Is it different?

I am on the "take it every day" pill, bf DS who is now 16m, having started said Pill at 6w check.

Before DC I took the "take it daily for at least three weeks, then have exactly a week off" Pill. I got the impression from the GP that that's old-fashioned now.

Second opinion?

Yes. It is different. You aren't pregnant. You have received advice for the wellbeing of your son from a medical professional and you are here for a second opinion because you don't want to do what they suggest.
The advice is different because your first child was a daughter and now you have a son.
Differences taking a combined hormone contraceptive compared to pregnancy:
synthetic hormones at higher systemic exposure than in the first few months of pregnancy. Thus higher concentrations in milk.
In the early stages of pregnancy oestrogen levels are low overall and work within the uterus and ovaries. The levels in milk would be very small; they increase later in pregnancy.

Why would you take the risk? As Mrs H suggests, have you considered the progesterone only pill?

For good unbiased information on this I'd look on the BfN drugs in brestmilk website. You can also contact the helpline if you'd like to ask for any clarification on anything.

www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

from that BfN site:

The combined oral contraceptive pill

The combined pill is not suitable for a breastfeeding mother in the first 6 months after delivery. In theory after this time the supply is established and will not be lowered by the oestrogen content of the combined pill. However, some mothers do notice an effect so the decision to use it should
not be undertaken lightly if you want to carry on breastfeeding. If you take it and do notice your supply diminishes you can stop taking it (remember to take additional precautions!) and restimulate your supply with frequent breastfeeds

(It says nothing about different advice for boys/girls and mentions only the problem with supply)

kellymom.com/bf/can-i-breastfeed/meds/birthcontrol/ - also notes effects on milk supply and that there have not been adverse effects on the baby

Momb - I don't know if you mean to, but you come across incredibly pious and condescending. Hopefully that is just the difficulties in written tone.

Yes, I have tried the mini pill.

No, I was not told anything about the difference being because this child is a son. And I am here because two doctors have given me conflicting advice and I want to inform myself about why that might be. It is not unknown for GPs to be fairly clueless about drugs whilst bfing and there is no harm in doing some research yourself.

Nowhere in anything I have posted have I suggested I will go against medical advice.

MigGril and dementedpixie, thank you. I might see if the Bfn can help at all.

Not trying to be pious. The GP is taking the 'just in case' approach which hasn't filtered to the BFN site as it is still in review. There are at least 7 different labs working on this at the moment, including the one here which published this in 2013:

press.endocrine.org/doi/full/10.1210/en.2007-1318

I don't in all honesty fully understand that link and its link to possible oestrogen exposure in an older baby. But thank you for providing it.

But I can say with 99% confidence that new research of that sort is not what my GP was referring to. She didn't ask the sex of the baby and just said "Of course, you can't go on the combined pill until you've stopped breastfeeding because oestrogen could harm the baby". It was said as settled science with no reference to the sex of the baby or research. That was partly why it surprised me given previous advice.

momb that link is to a paper discussing in vitro experiments with a view to exploring the impact on a fetus.

MrsH you are right to explore other sources of info, which you can then share with your doctor.

It's fine to take responsibility for one's health and choices in that way, IMO :)

Thanks Tiktok (I was the op rather than mrsH). I am increasingly confused as none of the sources I trust as researched and referenced- like BfN- seem to see any issue. Especially one which is sex specific as has been suggested here.

I suppose I should book with another GP and discuss but I feel weirdly awkward .

Sorry, Penguins, yes, of course you are the OP!

Just do your own digging, go back to original GP, say 'thanks for seeing me again about this - I'm a bit confused as the info I have managed to get from a well-respected source, the Bf Network, indicates there's no problem....what do you think?'

It is so silly, but I think I feel embarrassed questioning them. Very inbuilt fear of 'wasting people's time' . It's a massive practice so I may struggle to get another appointment with the same GP too (they tend to reserve them for those with complex conditions, and my various childcare responsibilities mean I only have specific time windows to attend). Who of course may take the same view as my old GP (different area) and be perfectly happy...

Arrggh. Much as I have loved bfing my three kids, I have been either bfing or pregnant or both since 2008 now, so I'm kind of near ready to stop too. Totally off topic, but I slightly feel I'd be 'short changing' DS if I stopped just for this.

Oh Penguins I certainly empathise with that dilemma - I'm under medical pressure to wean DC3 nearly a year earlier than DC1 or DC2 (and have been nagged at for over a year already). I beat you on timescale to 2007 though

Penguins, don;t be nervous. You are asking the doc for clarification, not challenging or questioning him/her.

Thank you Tiktok. I know you are right. I should just woman up. I get embarrassingly deferential in these situations

MrsH - Yes, most definitely complete. I don't know. DH I think would consider vasectomy. But I think he's less absolute than me. If I went under a bus or ran off with the milkman I think he might consider more children with another partner (though we as a couple are most definitely done). I, on the other hand, could never contemplate the sheer physicality of doing it a fourth time. But obviously female sterilisation is something they are pretty resistant to. I'm starting to think that maybe I should get over myself and think about the implant. But I've never got on with mini pills. And my friend finds hers itches like mad. It's a bloody minefield!

2007. Wow!! I hope you reach a resolution on the stopping/not thing.

Thanks, and ditto

In fairness said DC3 is combining bf with cage fighting as I type, so the prospect of giving up and putting on a Very High Neck chainmail top is highly tempting

Google the UK medical eligibility criteria, this is a huge document which gives guidance about contraceptive safety in various circumstances eg breastfeeding less than 6 weeks, 6 w to 6mo and over 6 mo. It grades recommendations as 1-4 with 1 being no restriction on use and 4 essentially never use. Combined pill & bf past 6 mo is a 1, so recommended safe on best available evidence. It's on page 17 of the document if you want to print it out for your gp, who is spouting nonsense.

Thank you!