Luteinizing hormone releasing hormone agonist for contraception in breast feeding women.
During the period of lactation there is a need for a reliable method of contraception since the suppressive effects of lactation on ovulation decline as the duration of breastfeeding is decreased. The aim of this study was to establish that chronic treatment with a LHRH agonist would prevent ovulation throughout the period of lactation and to evaluate the effects of the treatment on estrogen production, bleeding patterns, and nursing practice. Starting 6 weeks postpartum, nine mothers took 300 micrograms LHRH agonist (buserelin), intranasally once daily for the remainder of the duration of breastfeeding [216 +/- 18 days (mean +/- SEM)]. Urinary excretion of LH, estrone, and pregnanediol was compared to that of nine control breastfeeding mothers. In the control subjects follicular development, as assessed by rises in estrone, was minimal during the first 90 days of the study. Thereafter, phases of estrogen secretion were observed. Ovulation occurred in seven of the nine mothers on one to six occasions; time to first ovulation varied from 90-296 days. In the women taking buserelin, LH and estrone were initially stimulated for 1 and 2 weeks, respectively, then declined to basal levels. No ovulations occurred in the treated group. In six treated mothers only minor fluctuations in estrone were observed during the remainder of agonist treatment. In three subjects more frequent and sustained episodes of estrogen secretion were observed, but in contrast to the controls the rises in estrone were not followed by a typical LH surge or a rise in pregnanediol. Bleeding occurred in eight of the nine of the control mothers on one to seven occasions during the study period. The first bleed in five of the mothers was anovular, while other menstrual bleeds occurred in response to falling levels of pregnanediol. Of the mothers taking buserelin, one was amenorrhoeic, and five had only one light bleeding associated with the initial stimulation of estrone. Of the three women with continued fluctuations of estrone, one had three light bleeds, one experienced frequent spotting, while one had regular bleeding. No other side-effects, such as hot flashes or changes in nursing practices, were reported. Our results indicate that LHRH agonist treatment has the potential to be developed as an acceptable method of contraception during the postpartum period. The duration of treatment may be long enough to have a significant effect on maternal-infant well-being without encountering significant problems associated with low estrogen output.
Fraser
H M
HM
Medical Research Council Reproductive Biology Unit, Centre for Reproductive Biology, Edinburgh, United Kingdom.
Dewart
P J
PJ
Smith
S K
SK
Cowen
G M
GM
Sandow
J
J
McNeilly
A S
AS
D000281:Administration, Intranasal; D000328:Adult; D001942:Breast Feeding; D002064:Buserelin / Q000008:administration & dosage* / Q000494:pharmacology; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004970:Estrone / Q000652:urine; D005260:Female; D005965:Glucuronates / Q000652:urine; D006801:Humans; D007774:Lactation / Q000187:drug effects*; D007986:Luteinizing Hormone / Q000652:urine; D008598:Menstruation / Q000187:drug effects; D010060:Ovulation / Q000187:drug effects; D011247:Pregnancy; D011276:Pregnanediol / Q000652:urine
D003271:Contraceptive Agents, Female; D005965:Glucuronates; D004970:Estrone; D007986:Luteinizing Hormone; D011276:Pregnanediol; D002064:Buserelin