Levonelle™ (levonorgestrel), when originally marketed was licensed to be given to women during breastfeeding. However, the patient information leaflet in the packet now suggests that women should not breastfeed for 8 hours. This is not supported by research and breastfeeding can continue as normal.
The tablet should be taken as soon as possible after unprotected intercourse – up to 72 hours after. The longer the interval between intercourse and taking the tablet the greater is the chance that it will not be effective. No contraception has a 100% success rate. If vomiting occurs soon after taking the tablet medical advice should be sought as soon as possible.
The next period may be early or late and barrier contraception should be continued until the next period. Levonorgestrel can be purchased over the counter from a pharmacist as well as being prescribed by a GP, pharmacies, family planning clinic or accident and emergency departments.
Should the next period be delayed more than 5 days further medical advice should be sought. Levonelle™ is reported by the manufacturers not to show evidence of teratogenicity even if it fails to prevent pregnancy. However emergency hormonal contraception should not be used if there is any possibility that the woman is already pregnant.
In a cohort study of 71 women who took levonorgestrel as a postcoital contraceptive no obvious decrease in milk supply was found after the drug was used according to maternal reports. 75% of mothers re-initiated breastfeeding before 8 hours after the dose. None noticed any adverse effect in their infants (Polakow-Farkash 2013). One study demonstrated that levonorgestrel passes into breastmilk but in minimal quantities (Jatlaoui 2016). Polakow-Farkash reports that the study findings support the safety of using levonorgestrel as an emergency contraceptive during lactation without the need for withholding breastfeeding.
The recommendation to avoid breastfeeding for 8 hours comes from a study by Gainer (2007) where 12 exclusively breastfeeding mothers received a single 1.5 mg dose. Levonorgestrel concentrations were found to peak in milk 2-4 hours after the dose was taken. Milk/plasma ratios averaged 0.28. The estimated infant dose of levonorgestrel was only 1.6 µg during the first 24 hours. If the mother interrupts breastfeeding for 8 hours, this dose was reduced to only 1 µg. The authors recommended that to limit exposure, the mother should not breastfeed for the first 8 hours, or at most 24 hours. However, the amount in milk after 24 hours was only 0.09% of the total dose which is insignificant.
For other options of emergency contraception
A copper intra-uterine contraceptive can be inserted up to 5 days after intercourse as an alternative method of emergency contraception.
Women who do not wish to expose their baby to any medication may wish to consider how frequently they are breastfeeding and therefore the likelihood of ovulation. Factors which can be taken into consideration are whether she is still exclusively breastfeeding or has introduced solids or complimentary feeds which make it more likely that she is ovulating. She and her partner also need to consider the consequences of a subsequent pregnancy for them.
References
Hale TW and Krutsch K. Medications and Mothers Milk
Jatlaoui, Tara C. Riley H,. Curtis KM 2016 Contraception ,2016;93(2): 93 – 112Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception
Polakow-Farkash S, Gilad O, Merlob P et al. Levonorgestrel used for emergency contraception during lactation-A prospective observational cohort study on maternal and infant safety. J Matern Fetal Neonatal Med. 2013;26:219
World Health Organization . Medical Eligibility Criteria For Contraceptive Use: Fifth Ed. 2015. www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/
Gainer E, Massai R, Lillo S, Reyes V, Forcelledo ML, Caviedes R, Villarroel C, Bouyer J. Levonorgestrel pharmacokinetics in plasma and milk of lactating women who take 1.5 mg for emergency contraception. Hum Reprod 2007; 22(6):1578-1584.Highlight
E lactancia https://e-lactancia.org/breastfeeding/levonorgestrel-emergency-contraceptive/product/
SPS https://www.sps.nhs.uk/articles/levonorgestrel-1500-microgram-tablets-for-emergency-contraception/
