Last update: Feb. 7, 2016

Mestranol + Norethindrone

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Birth control pill that contains the combination of an estrogen (Mestranol) and a progestin (Noretindrone) for oral use.

Mestranol is a synthetic estrogen that is metabolized to Ethinylestradiol with similar actions as estradiol. A latest up
date no published data on excretion in breast milk, found were found. However, it is known that its metabolite Ethinylestradiol is excreted into milk in no or small amount.
There is evidence (albeit inconsistent) that estrogen-containing pills may decrease milk production, especially during the first few weeks postpartum with a daily dose above 30 micrograms of ethinyl estradiol.
It may reduce the protein content of the milk.
No problems have been observed in infants whose mothers were treated, except one isolated case of transient gynecomastia.

Norethindrone or Norethisterone is a progestin derivative of 19-nortestosterone. It is excreted in breast milk in clinically non-significant amount and no problems have been observed in infants whose mothers were treated with it. Its plasma levels in these infants were undetectable or very low.

With other similar combined contraceptives no differences have been observed in the frequency of breastfeeding or the amount of milk produced or weight gain of breastfed infants compared to other contraceptive methods (intrauterine devices, isolated progestogens). However, it would be advisable to avoid them until breastfeeding is well established (4-6 weeks).

During lactation, progestin-only contraceptive pills are preferred to Estrogen containing ones, otherwise, the lowest estrogen dose should be used.
Within the first 6 postpartum weeks, non-hormonal methods are in the first line of choice.

Hormone containing contraceptives do not affect the composition of milk, minerals (Mg, Fe, Cu, Ca, P) fat, lactose and calories but only a few the proteins.

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Mestranol + Norethindrone in other languages or writings:

Group

Mestranol + Norethindrone belongs to this group or family:

Tradenames

Main tradenames from several countries containing Mestranol + Norethindrone in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. - / 70 %
Molecular weight 310 / 298 daltons
Protein Binding - / 97 %
VD - / 4 l/Kg
Tmax - / 1,8 hours
T1/2 50 / 8,5 hours
M/P ratio - / 0,3 -
Theoretical Dose - / 0,0001 mg/Kg/d
Relative Dose - / 2,2 %

References

  1. Lopez LM, Grey TW, Stuebe AM, Chen M, Truitt ST, Gallo MF. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev. 2015 Abstract
  2. Tepper NK, Phillips SJ, Kapp N, Gaffield ME, Curtis KM. Combined hormonal contraceptive use among breastfeeding women: an updated systematic review. Contraception. 2015 Abstract
  3. Bhardwaj NR, Espey E. Lactation and contraception. Curr Opin Obstet Gynecol. 2015 Abstract
  4. Berens P, Labbok M; Academy of Breastfeeding Medicine. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  5. WHO. Department of Reproductive Health and Research World Health Organization. Medical Eligibility Criteria for Contraceptive Use. WHO/RHR/15.07. 2015 Abstract Full text (link to original source) Full text (in our servers)
  6. Berens P, Labbok M; Academy of Breastfeeding Medicine. Protocolo clínico de la ABM n.º 13: Anticoncepción durante la lactancia, revisado en 2015. Breastfeed Med. 2015 Full text (link to original source) Full text (in our servers)
  7. Mwalwanda CS, Black KI. Immediate post-partum initiation of intrauterine contraception and implants: a review of the safety and guidelines for use. Aust N Z J Obstet Gynaecol. 2013 Abstract
  8. Bahamondes L, Bahamondes MV, Modesto W, Tilley IB, Magalhães A, Pinto e Silva JL, Amaral E, Mishell DR Jr. Effect of hormonal contraceptives during breastfeeding on infant's milk ingestion and growth. Fertil Steril. 2013 Abstract Full text (link to original source) Full text (in our servers)
  9. Urzica D, Gales C, Zamfir C, Nechifor M. The influence of oral steroidal contraceptives on magnesium concentration in breast milk. Magnes Res. 2013 Abstract
  10. CDC. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep. 2013 Abstract Full text (link to original source) Full text (in our servers)
  11. Espey E, Ogburn T, Leeman L, Singh R, Ostrom K, Schrader R. Effect of progestin compared with combined oral contraceptive pills on lactation: a randomized controlled trial. Obstet Gynecol. 2012 Abstract
  12. Hall KS, Trussell J, Schwarz EB. Progestin-only contraceptive pill use among women in the United States. Contraception. 2012 Abstract
  13. de Melo NR. Estrogen-free oral hormonal contraception: benefits of the progestin-only pill. Womens Health (Lond Engl). 2010 Abstract
  14. Centers for Disease Control and Prevention (CDC). U S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep. 2010 Abstract Full text (link to original source) Full text (in our servers)
  15. [No authors listed] Intrauterine devices: an effective alternative to oral hormonal contraception. Prescrire Int. 2009 Abstract
  16. Taneepanichskul S, Reinprayoon D, Thaithumyanon P, Praisuwanna P, Tosukhowong P, Dieben T. Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants. Contraception. 2006 Abstract
  17. Díaz S. Contraceptive implants and lactation. Contraception. 2002 Abstract
  18. Reinprayoon D, Taneepanichskul S, Bunyavejchevin S, Thaithumyanon P, Punnahitananda S, Tosukhowong P, Machielsen C, van Beek A. Effects of the etonogestrel-releasing contraceptive implant (Implanon on parameters of breastfeeding compared to those of an intrauterine device. Contraception. 2000 Abstract
  19. Lawrie TA, Hofmeyr GJ, De Jager M, Berk M, Paiker J, Viljoen E. A double-blind randomised placebo controlled trial of postnatal norethisterone enanthate: the effect on postnatal depression and serum hormones. Br J Obstet Gynaecol. 1998 Abstract
  20. [No authors listed] 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 Abstract
  21. WHO 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 Abstract
  22. Shaaban MM. Contraception with progestogens and progesterone during lactation. J Steroid Biochem Mol Biol. 1991 Abstract
  23. Vido I, Cepický P. [Pharmacologic arrest of lactation. Comparison of Deprenon, lisuride, terguride and mestranol]. Cesk Gynekol. 1989 Abstract
  24. Betrabet SS, Shikary ZK, Toddywalla VS, Toddywalla SP, Patel D, Saxena BN. ICMR Task Force Study on hormonal contraception. Transfer of norethisterone (NET) and levonorgestrel (LNG) from a single tablet into the infant's circulation through the mother's milk. Contraception. 1987 Abstract
  25. Cooke ID, Back DJ, Shroff NE. Norethisterone concentration in breast milk and infant and maternal plasma during ethynodiol diacetate administration. Contraception. 1985 Abstract
  26. West CP. The acceptability of a progestagen-only contraceptive during breast-feeding. Contraception. 1983 Abstract
  27. Fotherby K, Towobola O, Muggeridge J, Elder MG. Norethisterone levels in maternal serum and milk after intramuscular injection of norethisterone oenanthate as a contraceptive. Contraception. 1983 Abstract
  28. Koetsawang S, Nukulkarn P, Fotherby K, Shrimanker K, Mangalam M, Towobola K. Transfer of contraceptive steroids in milk of women using long-acting gestagens. Contraception. 1982 Abstract
  29. Melis GB, Strigini F, Fruzzetti F, Paoletti AM, Rainer E, Düsterberg B, Fioretti P. Norethisterone enanthate as an injectable contraceptive in puerperal and non-puerperal women. Contraception. 1981 Abstract
  30. Lönnerdal B, Forsum E, Hambraeus L. Effect of oral contraceptives on composition and volume of breast milk. Am J Clin Nutr. 1980 Abstract Full text (link to original source) Full text (in our servers)
  31. Toddywalla VS, Mehta S, Virkar KD, Saxena BN. Release of 19-nor-testosterone type of contraceptive steroids through different drug delivery systems into serum and breast milk of lactating women. Contraception. 1980 Mar;21(3):217-23. Abstract
  32. Seth U, Yadava HS, Agarwal N, Laumas KR, Hingorani V. Effect of a subdermal silastic implant containing norethindrone acetate on human lactation. Contraception. 1977 Abstract
  33. Saxena BN, Shrimanker K, Grudzinskas JG. Levels of contraceptive seroids in breast milk and plasma of lactating women. Contraception. 1977 Abstract
  34. Giner Velázquez J, Cortés Gallegos V, Sotelo López A, Bondani G. [Effect of daily oral administration of 0.350 mg of norethindrone on lactation and on the composition of milk]. Ginecol Obstet Mex. 1976 Abstract
  35. Pilawski Z, Olszewska D, Piernikowski Z, Pronicki B. [Lactation inhibition with chlormadinone and mestranol]. Wiad Lek. 1973 Abstract
  36. Karim M, Ammar R, el-Mahgoub S, el-Ganzoury B, Fikri F, Abdou I. Injected progestogen and lactation. Br Med J. 1971 Abstract Full text (link to original source) Full text (in our servers)
  37. Balmer HC, Macdonald DJ. Hormonal therapy for suppressing lactation. Can Fam Physician. 1971 Abstract Full text (link to original source) Full text (in our servers)
  38. Kamal I, Hefnawi F, Ghoneim M, Abdallah M, Abdel Razek S. Clinical, biochemical, and experimental studies on lactation. V. Clinical effects of steroids on the initiation of lactation. Am J Obstet Gynecol. 1970 Abstract
  39. Billingsley FS. Lactation suppression utilizing norethynodrel with mestranol. J Fla Med Assoc. 1969 Abstract
  40. Kora SJ. Effect of oral contraceptives on lactation. Fertil Steril. 1969 Abstract
  41. Gillibrand PN, Huntingford PJ. Inhibition of lactation with combined oestrogen and progestogen. Br Med J. 1968 Abstract Full text (link to original source) Full text (in our servers)
  42. Kaern T. Effect of an oral contraceptive immediately post partum on initiation of lactation. Br Med J. 1967 Abstract Full text (link to original source) Full text (in our servers)
  43. Nickerson CW, Berkman VO. Lactation inhibition by norethindrone with mestranol. Rocky Mt Med J. 1967 Abstract

Total visits

4,621

Help us improve this entry

How to cite this entry

Do you need more information or did not found what you were looking for?

   Write to us at elactancia.org@gmail.com

e-lactancia is a resource recommended by Academy of Breastfeeding Medicine from United States of America

Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM