The Basics
What is Levonorgestrel Implant?
A type of long-acting reversible birth control.
Brand names for Levonorgestrel Implant
Jadelle
How Levonorgestrel Implant is classified
Contraceptives
Levonorgestrel Implant During Pregnancy
Levonorgestrel Implant pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Levonorgestrel Implant while pregnant
N/A
Taking Levonorgestrel Implant While Breastfeeding
What are recommendations for lactation if you're taking Levonorgestrel Implant?
This record contains information specific to the levonorgestrel implant, which is not available in the United States. Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as levonorgestrel are considered the hormonal contraceptives of choice during lactation. Fair quality evidence indicates that levonorgestrel does not adversely affect the composition of milk, the growth and development of the infant or the milk supply. Expert opinion holds that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[1][2][3][4] Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.[5][6][7]
Maternal / infant drug levels
This record contains information specific to the levonorgestrel implant, which is not available in the United States. Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as levonorgestrel are considered the hormonal contraceptives of choice during lactation. Fair quality evidence indicates that levonorgestrel does not adversely affect the composition of milk, the growth and development of the infant or the milk supply. Expert opinion holds that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[1][2][3][4] Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.[5][6][7]
Possible effects of Levonorgestrel Implant on milk supply
Numerous studies of varying size and quality have found that the use of levonorgestrel implants (Norplant or Norplant-2) as a contraceptive beginning at 7 days postpartum or later either has no clinically important negative effect on the quality of breastmilk and results in either no effect or an increase in the milk supply and duration of lactation.[12][14][20][21][22][23][24]
In a nonrandomized study, 100 women who received Norplant implants at an average of day 55 postpartum were compared to 100 women receiving a postpartum IUD. No differences were found between the control and Norplant groups in the number of women nursing at days 10 and 20 and months 1 to 12 postinsertion except a slight decrease in the number of mothers using Norplant who were exclusively breastfeeding at 12 months. No difference since the time of weaning was noted between the groups.[8]
A secondary analysis of a study in Uganda examined 96 postpartum women randomized to receive a 2-rod levonorgestrel implant (Jadelle, Bayer AG, Berlin) either within 5 days of birth (n = 55) or at 6 to 8 weeks postpartum (n = 42). No differences were found between the groups in infant growth from birth to 6 months, time to lactogenesis II, or proportion of mothers breastfeeding at 3 and 6 months.[25]
A study in Malawi compared the breastfeeding rates between women who received an etonogestrel (n = 28) or levonorgestrel (n= 112) implant immediately postpartum. Mothers chose the method and were followed for 2 years postpartum. Most women breastfed for 2 years. No difference was seen in the exclusive breastfeeding rate at 6 months between the groups nor in the continuation of breastfeeding to 2 years.[26]
Possible alternatives to Levonorgestrel Implant
Etonogestrel, Intrauterine Copper Contraceptive, Medroxyprogesterone Acetate, Norethindrone.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. World Health Organization Department of Reproductive Health and Research. Medical eligibility criteria for contraceptive use: Executive summary. Fifth ed. Geneva. 2015. PMID: 26447268
2. Curtis KM, Tepper NK, Jatlaoui TC et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65:1-103. PMID: 27467196
3. ACOG: American College of Obstetrics and Gynecology. Committee Opinion No. 670: Immediate Postpartum Long-Acting Reversible Contraception. Obstet Gynecol. 2016;128:e32-7. PMID: 27454734
4. Vricella LK, Gawron LM, Louis JM. Society for Maternal-Fetal Medicine (SMFM) Consult Series #48: Immediate postpartum long-acting reversible contraception for women at high-risk for medical complications. Am J Obstet Gynecol. 2019;220:B2-B12. PMID: 30738885
5. Caird LE, Reid-Thomas V, Hannan WJ et al. Oral progestogen-only contraception may protect against loss of bone mass in breast-feeding women. Clin Endocrinol (Oxf). 1994;41:739-45. PMID: 7889609
6. Diaz S, Reyes MV, Zepeda A et al. Norplant(R) implants and progesterone vaginal rings do not affect maternal bone turnover and density during lactation and after weaning. Hum Reprod. 1999;14:2499-505. PMID: 10527977
7. Costa ML, Cecatti JG, Krupa FG et al. Progestin-only contraception prevents bone loss in postpartum breastfeeding women. Contraception. 2012;85:374-80. PMID: 22036473
8. Diaz S, Herreros C, Juez G et al. Fertility regulation in nursing women: VII. Influence of Norplant levonorgestrel implants upon lactation and infant growth. Contraception. 1985;32:53-74. PMID: 3931973
9. Shikary ZK, Betrabet SS, Patel ZM et al. ICMR task force study on hormonal contraception. Transfer of levonorgestrel (LNG) administered through different drug delivery systems from the maternal circulation into the newborn infant’s circulation via breast milk. Contraception. 1987;35:477-86. PMID: 3113823
10. Shaaban MM, Odlind V, Salem HT et al. Levonorgestrel concentrations in maternal and infant serum during use of subdermal levonorgestrel contraceptive implants, Norplant by nursing mothers. Contraception. 1986;33:357-63. PMID: 3089681
11. Abdulla KA, Elwan SI, Salem HS et al. Effect of early postpartum use of the contraceptive implants, Norplant, on the serum levels on immunoglobulins of the mothers and their breastfed infants. Contraception. 1985;32:261-6. PMID: 3936675
12. Shaaban MM, Salem HT, Abdullah KA. Influence of levonorgestrel contraceptive implants, Norplant, initiated early postpartum upon lactation and infant growth. Contraception. 1985;32:623-35. PMID: 3937665
13. Affandi B, Karmadibrata S, Prihartono J et al. Effect of Norplant on mothers and infants in the postpartum period. Adv Contracept. 1986;2:371-80. PMID: 3105266
14. Diaz S, Zepeda A, Maturana X et al. Fertility regulation in nursing women IX. Contraceptive performance, duration of lactation, infant gowth, and bleeding patterns during use of progesterone vaginal rings, progestin-only pills, Norplant(R) implants, and Copper T 380-A intrauterine devices. Contraception. 1997;56:223-32. PMID: 9408703
15. Schiappacasse V, Diaz S, Zepeda A et al. Health and growth of infants breastfed by Norplant contraceptive implants users: a six-year follow-up study. Contraception. 2002;66:57-65. PMID: 12169382
16. Bassol S, Nava-Hernandez MP, Hernandez-Morales C et al. Effects of levonorgestrel implant upon TSH and LH levels in male infants during lactation. Int J Gynaecol Obstet. 2002;76:273-7. PMID: 11880130
17. Shikary ZK, Betrabet SS, Toddywala VS et al. Pharmacodynamic effects of levonorgestrel (LNG) administered either orally or subdermally to early postpartum lactating mothers on the urinary levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) in their breast-fed male infants. Contraception. 1986;34:403-12. PMID: 3096635
18. Anon. Progestogen-only contraceptives during lactation: I. Infant growth. World Health Organization Task force for Epidemiological Research on Reproductive Health; Special Programme of Research, Development and Research Training in Human Reproduction. Contraception. 1994;50:35-53. PMID: 7924321
19. Anon. Progestogen-only contraceptives during lactation: II. Infant development. World Health Organization, Task Force for Epidemiological Research on Reproductive Health; Special Programme of Research, Development, and Research Training in Human Reproduction. Contraception. 1994;50:55-68. PMID: 7924322
20. Sas M, Gellen JJ, Dusitsin N et al. An investigation on the influence of steroidal contraceptives on milk lipid and fatty acids in Hungary and Thailand. WHO Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on oral contraceptives. Contraception. 1986;33:159-78 PMID: 2938886
21. Anon. Effects of hormonal contraceptives on breast milk composition and infant growth. World Health Organization (WHO) Task Force on Oral Contraceptives. Stud Fam Plann. 1988;19:361-9. PMID: 2906764
22. McCann MF, Moggia AV, Higgins JE et al. The effects of a progestin-only oral contraceptive (levonorgestrel 0.03 mg) on breast-feeding. Contraception. 1989;40:635-48. PMID: 2515939
23. Costa TH, Dorea JG. Concentration of fat, protein, lactose and energy in milk of mothers using hormonal contraceptives. Ann Trop Paediatr. 1992;12:203-9. PMID: 1381897
24. Chi IC, Robbins M, Balogh S. The progestin-only oral contraceptive–its place in postpartum contraception. Adv Contracept. 1992;8:93-103. PMID: 1519499
25. Averbach S , Kakaire O, McDiehl R et al. The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: A randomized controlled trial. Contraception. 2019;99:87-93. PMID: 30408456
26. Krashin JW, Lemani C, Nkambule J et al. A comparison of breastfeeding exclusivity and duration rates between immediate postpartum levonorgestrel versus etonogestrel implant users: A prospective cohort study. Breastfeed Med. 2019;14:69-76. PMID: 30508390
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
