title: Progestogen-only contraceptive use among breastfeeding women: a systematic review.
abstract: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes.
  
  
  
  We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs.
  
  
  
  We searched the PubMed database for all articles published from database inception through December 2014.
  
  
  
  We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, injectables, implants or hormonal intrauterine devices (IUDs). The main outcomes were breastfeeding performance (as measured by initiation, continuation, frequency and exclusivity of breastfeeding) and infant health (as measured by growth, development or adverse health effects).
  
  
  
  Forty-nine articles reporting on 47 different studies were identified that investigated the use of POCs in breastfeeding women and reported clinically relevant outcomes of infant growth, health or breastfeeding performance. Studies ranged from poor to fair methodological quality and generally failed to show negative effects of the use of POCs on breastfeeding outcomes or on infant growth or development. One randomized controlled trial (RCT) raises concerns that immediate insertion of the levonorgestrel IUD postpartum may be associated with poorer breastfeeding performance when compared with delayed insertion, although two other RCTs evaluating early etonogestrel implants compared with delayed initiation of implants or depot medroxyprogesterone acetate failed to find such an association.
  
  
  
  The preponderance of evidence fails to demonstrate adverse breastfeeding outcomes or negative health outcomes in infants such as restricted growth, health problems or impaired development. Evidence newly added to this review was largely consistent with previous evidence.
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. Electronic address: sjp633@mail.harvard.edu.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Phillips
authors.affiliation: Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Naomi K
authors.initials: NK
authors.lastname: Tepper
authors.affiliation: Reproductive Health Consultant, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Kapp
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: Kavita
authors.initials: K
authors.lastname: Nanda
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Curtis
mesh_terms: D001942:Breast Feeding; D002657:Child Development; D003267:Contraception / Q000379:methods; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D004343:Drug Implants; D005260:Female; D006801:Humans; D007223:Infant; D007434:Intrauterine Devices / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic
chemical_list: D003278:Contraceptives, Oral, Hormonal; D004343:Drug Implants; D011372:Progestins; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate
keywords: Breastfeeding; Contraception; Lactation; Progestogens