Last update March 21, 2022

Ethinylestradiol

Low Risk

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

Synthetic estrogen that has a similar action as estradiol. Used in combination with progestogens for contraception. Daily oral administration.

ESTROGEN and related drugs are excreted into the breast milk in no or small amount.

Its pharmacokinetic data (high percentage of protein binding and very wide volume of distribution) explain the negligible or null passage into breast milk observed. (Betrabet 1986, Nilsson 1978)

Estrogens, alone or associated with progestogens, have been used in the treatment of excess milk production(Johnson 2020) and to suppress lactation (Piya 2004, Balmer 1971), although with very little effectiveness. (Kaern 1967)

There is evidence (albeit inconsistent) that estrogen-containing pills may decrease milk production or the duration of breastfeeding, especially if given during the first few weeks postpartum with a daily dose equal to or greater than 30 micrograms (0,03 mg) diarios. (WHO 2002, AAP 2001, Moretti 2000, WHO 1988, Nilsson 1986, Tankeyoon 1984, Díaz 1983, Peralta 1983, Croxatto 1983, Guiloff 1974, Kaern 1967)

Treatment with high doses of estrogens during adolescence does not affect later ability to breastfeed. (Jordan 2007)

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No short-term or long-term clinical, physical or psychomotor developmental problems have been observed in infants whose mothers were taking combined oral contraceptives (Nilsson 1986), except for a few cases published years ago of transient gynecomastia in infants whose mothers were taking a combined oral contraceptive with ethinyl estradiol. (Madhavapeddi 1985, Nilsson 1978, Marriq 1974, Curtis 1964)

Hormonal contraceptives, both combined and progestogen-only, do not alter the composition of milk, neither in minerals (Mg, Fe, Cu, Ca, P) nor in fats, lactose, proteins or calories. (Urzica 2013, Dórea 2000, 1999 y 1998, Costa 1992)

No study has found negative effects on breast milk production or infant weight gain when combined oral contraceptives (estrogen + progestin) are started after the first 2, or better 6, weeks postpartum. (Tepper 2015, Espey 2012)

During lactation progestin-only drugs are preferred or in combination with estrogen for birth control, but whatever, the ones with the lower doses of estrogen should be used. (CDC 2016, 2013 y 2010, WHO 2015, Berens 2015, CLM 2012)

For the first 6 weeks postpartum, non-hormonal methods are of choise. (Berens 2015, Rowe 2013)

Alternatives

We do not have alternatives for Ethinylestradiol.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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

Ethinylestradiol in other languages or writings:

Groups

Ethinylestradiol belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Ethinylestradiol in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 40 - 60 %
Molecular weight 296 daltons
Protein Binding 99 %
VD oral: 5 - 10; topic: 169 l/Kg
pKa 10.33 -
Tmax oral: 1.5 ± 0.5; topic: 86 ±31 hours
oral: 8 ± 5; topic: 28 ± 34 hours
M/P ratio 0.3 -
Theoretical Dose 0. 0 - 0.000045 mg/Kg/d
Relative Dose 0 - 0.54 %

References

  1. Johnson HM, Eglash A, Mitchell KB, Leeper K, Smillie CM, Moore-Ostby L, Manson N, Simon L; Academy of Breastfeeding Medicine.. ABM Clinical Protocol #32: Management of Hyperlactation. Breastfeed Med. 2020 Mar;15(3):129-134. Abstract Full text (link to original source)
  2. CDC - Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. CDC - MMWR Recommendations & Reports. 2016 Abstract Full text (link to original source) Full text (in our servers)
  3. 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
  4. Tepper NK, Phillips SJ, Kapp N, Gaffield ME, Curtis KM. Combined hormonal contraceptive use among breastfeeding women: an updated systematic review. Contraception. 2015 Abstract
  5. OMS. Criterios médicos de elegibilidad para el uso de anticonceptivos Quinta edición. Who Library. 2015 Full text (link to original source) Full text (in our servers)
  6. 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)
  7. 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)
  8. Altshuler AL, Gaffield ME, Kiarie JN. The WHO's medical eligibility criteria for contraceptive use: 20 years of global guidance. Curr Opin Obstet Gynecol. 2015 Abstract Full text (link to original source) Full text (in our servers)
  9. WHO. Department of Reproductive Health and Research World Health Organization. Medical eligibility criteria for contraceptive use: 20 years of global guidance. WHO/RHR/15.07. 2015 Abstract Full text (link to original source) Full text (in our servers)
  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. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  12. Urzica D, Gales C, Zamfir C, Nechifor M. The influence of oral steroidal contraceptives on magnesium concentration in breast milk. Magnes Res. 2013 Abstract
  13. 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
  14. CLM - Comité de Lactancia Materna de la AEP. Preguntas frecuentes sobre lactancia materna. Folleto. 2012 Full text (link to original source) Full text (in our servers)
  15. 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)
  16. Jordan HL, Bruinsma FJ, Thomson RJ, Amir LH, Werther GA, Venn AJ. Adolescent exposure to high-dose estrogen and subsequent effects on lactation. Reprod Toxicol. 2007 Abstract
  17. Piya-Anant M, Worapitaksanond S, Sittichai K, Saechua P, Nomrak A. The combined oral contraceptive pill versus bromocriptine to suppress lactation in puerperium: a randomized double blind study. J Med Assoc Thai. 2004 Jun;87(6):670-3. Abstract
  18. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  19. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  20. Dórea JG. Oral contraceptives do not affect magnesium in breast milk. Int J Gynaecol Obstet. 2000 Abstract
  21. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
  22. Dorea JG, Miazaki ES. The effects of oral contraceptive use on iron and copper concentrations in breast milk. Fertil Steril. 1999 Abstract
  23. Dorea JG, Myazaki E. Calcium and phosphorus in milk of Brazilian mothers using oral contraceptives. J Am Coll Nutr. 1998 Abstract
  24. Costa TH, Dorea JG. Concentration of fat, protein, lactose and energy in milk of mothers using hormonal contraceptives. Ann Trop Paediatr. 1992 Abstract
  25. Nilsson S, Mellbin T, Hofvander Y, Sundelin C, Valentin J, Nygren KG. Long-term follow-up of children breast-fed by mothers using oral contraceptives. Contraception. 1986 Abstract
  26. Betrabet SS, Shikary ZK, Toddywalla VS, Patel D, Vaidya P, Saxena BN. ICMR Task Force Study on hormonal contraception. Biological activity of ethinyl estradiol present in the breast milk. Contraception. 1986 Abstract
  27. Madhavapeddi R, Ramachandran P. Side effects of oral contraceptive use in lactating women--enlargement of breast in a breast-fed child. Contraception. 1985 Abstract
  28. Tankeyoon M, Dusitsin N, Chalapati S, Koetsawang S, Saibiang S, Sas M, Gellen JJ, Ayeni O, Gray R, Pinol A, et al. Effects of hormonal contraceptives on milk volume and infant growth. WHO Special Programme of Research, Development and Research Training in Human Reproduction Task force on oral contraceptives. Contraception. 1984 Abstract
  29. Peralta O, Díaz S, Juez G, Herreros C, Casado ME, Salvatierra AM, Miranda P, Durán E, Croxatto HB. Fertility regulation in nursing women: V. Long-term influence of a low-dose combined oral contraceptive initiated at day 90 postpartum upon lactation and infant growth. Contraception. 1983 Abstract
  30. Peralta O, Díaz S, Juez G, Herreros C, Casado ME, Salvatierra AM, Miranda P, Croxatto H. [Effect of a combined oral contraceptive on lactation and growth of the infant]. Rev Chil Obstet Ginecol. 1983 Abstract
  31. Croxatto HB, Díaz S, Peralta O, Juez G, Herreros C, Casado ME, Salvatierra AM, Miranda P, Durán E. Fertility regulation in nursing women: IV. Long-term influence of a low-dose combined oral contraceptive initiated at day 30 postpartum upon lactation and infant growth. Contraception. 1983 Abstract
  32. Díaz S, Peralta O, Juez G, Herreros C, Casado ME, Salvatierra AM, Miranda P, Durán E, Croxatto HB. Fertility regulation in nursing women: III. Short-term influence of a low-dose combined oral contraceptive upon lactation and infant growth. Contraception. 1983 Abstract
  33. Klinger G, Claussen C, Schröder S. [Excretion of ethinyloestradiol sulfonate in the human milk (author's transl)]. Zentralbl Gynakol. 1981 Abstract
  34. Nilsson S, Nygren KG, Johansson ED. Ethinyl estradiol in human milk and plasma after oral administration. Contraception. 1978 Abstract
  35. Guiloff E, Ibarra-Polo A, Zañartu J, Toscanini C, Mischler TW, Gómez-Rogers C. Effect of contraception on lactation. Am J Obstet Gynecol. 1974 Abstract
  36. Marriq P, Oddo G. [Letter: Gynecomastia in the newborn induced by maternal milk? An unusual complication of oral contraceptives]. Nouv Presse Med. 1974 Abstract
  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. 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)
  39. CURTIS EM. ORAL-CONTRACEPTIVE FEMINIZATION OF A NORMAL MALE INFANT: REPORT OF A CASE. Obstet Gynecol. 1964 Abstract

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