The Mini-Pill: Birth Control for Breastfeeding Moms
What is the mini-pill?
Mini-pills are contraceptive pills that contain only progesterone (no estrogen). They are commonly used in combination with breastfeeding to prevent pregnancy. Progesterone only contraceptives do not affect lactation if begun after the true milk is established, nor do they have adverse effects on child growth or development.
If a woman is exclusively breastfeeding (or nearly so) the combination of correct use of the mini-pill and breastfeeding is highly effective in preventing pregnancy.
Once breastfeeding intervals routinely exceed 6 hours, solids are introduced, or daily bottles are used, the contraceptive effectiveness of the mini-pill and breastfeeding is reduced. At this time, the pregnancy rate for mini-pills can approach 1 out of 200 users. At this point, many women will change to combined oral contraceptive pills.
The mini-pill works mostly by causing thickened cervical mucus. Standard oral contraceptives, on the other hand, work by preventing ovulation.
The mini-pill does not protect against sexually transmitted infections.
How should I use the mini-pill?
Mini-pills can be started three weeks post-partum. They can be started on any day.
To be effective they must be taken every day and, as close as possible, at the same time every day.
Studies show the cervical mucus thickening effect to be greatest for the first 4 hours after taking the pill. If you generally have intercourse in the evening, you should take your pill in the evening to be most effective.
There is never a "pill-free interval" with the mini-pill. Unlike combined (standard) oral contraceptives there is no placebo week. Take every pill in the pack and start your next pack as soon as you finish the previous one.
What should I expect when taking the mini-pill?
When taking the mini-pill you can expect to have a variable bleeding pattern.You might have regular periods every month, spotting, irregular periods, or no periods at all.
If you normally have periods while taking the mini-pill then suddenly stop having periods, check a pregnancy test and contact the office.
Once you stop taking the mini-pill, fertility returns immediately, unless another birth control method is started.
Are there any negative effects of the mini-pill?
Some women experience breast tenderness with use of the mini-pill.
Occasionally women will report symptoms of depression.
Weight gain is not normally a problem with the mini-pill, however some women report this.
What are the positive effects of the mini-pill?
The mini-pill can help prevent an unplanned pregnancy.
Many women experience lighter periods with less cramping, or no periods at all.
What should I do if I miss a pill?
If you miss one pill, take it as soon as you remember. Take today's pill at the same time.
If you are more than 3 hours late taking your pill you must use back-up birth control (condoms, diaphragm with spermicide, or abstinence) for the next 2 days (48 hours).
If you miss two or more pills in a row your chances of getting pregnant increase. Restart your pills as soon as possible and take 2 pills each day until you are caught up. Use a back-up method for 2 weeks.
If you had intercourse without protection because you missed pills, you may be able to use Plan B emergency contraception to help prevent pregnancy. Call your doctor's office or contact your pharmacy (Plan B is now available over-the-counter at many pharmacies for women over the age of 18). Plan B must be used within 72 hours of unprotected intercourse to be effective.
Warning signs
If you have any of the following symptoms, contact your doctor's office:
Severe lower pelvic pain
Delayed period after several months of regular periods
