When breastfeeding, the need for reliable contraception can quickly arise, even if your period has not returned yet. At the same time, it is completely natural to be extra mindful of what hormones can mean for milk production and for your baby. Here you will find practical, evidence-based guidance for discussing birth control pills and breastfeeding with your doctor and choosing a solution that suits your situation.

"Birth control pills" can refer to different types of hormonal contraception. This is particularly relevant when breastfeeding, as some birth control pills contain estrogen, while others only contain progestogen.

In Danish healthcare advice, it is often emphasized that progestogen-only pills (mini-pills) are typically the preferred choice during breastfeeding, as they are generally considered to have a lower risk of affecting milk supply than combination pills with estrogen. What is best for you depends, among other things, on how long it has been since birth, whether breastfeeding is well-established, and whether you have other risk factors (e.g., blood clot risk) that your doctor needs to consider. (Sources commonly used in Denmark: Sundhed.dk/Lægehåndbogen.)

It helps to know:

• How old your baby is and whether you are exclusively breastfeeding or partially breastfeeding
• Whether you have previously experienced side effects from hormonal contraception
• Whether you have migraines, high blood pressure, or a history of blood clots (relevant for type selection)

Breastfeeding itself can provide some protection against pregnancy, but it is only reliable under specific conditions (the LAM method), and it is not suitable for everyone. If you want to avoid pregnancy, it is usually a good idea to choose a method you can rely on in your daily life.

In addition to birth control pills, you can discuss alternatives with your doctor, such as an IUD, condoms, or other progestogen-based methods. The point is not that there is one right choice, but that you get a solution that matches your body, your breastfeeding journey, and your need for security.

Mini-pills (progestogen-only) are often mentioned as a suitable choice for breastfeeding mothers precisely because they do not contain estrogen. For many, this means they can start without being as concerned about a possible impact on milk production as they might be with combination pills.

However, some mini-pills require very regular intake to maintain their effectiveness. If your daily life is unpredictable with awakenings and irregular routines, be sure to tell your doctor so you can choose a method that realistically fits your day.

Combination pills contain both estrogen and progestogen. During breastfeeding, estrogen can, in some cases, be associated with reduced milk production, especially if started early, before breastfeeding is stable. Therefore, in practice, other options will often be chosen first during the early breastfeeding period, and combination pills will only be considered later if it makes sense for you and is deemed safe by your doctor.

If you have previously been happy with combination pills, you can bring this preference to the consultation, but expect that timing and your overall risk profile will be an important part of the assessment.

Hormonal contraception can cause side effects, whether you are breastfeeding or not. Contact your doctor if you experience symptoms that concern you, or if you experience:

• Significant decrease in milk supply that cannot be explained by changes in breastfeeding patterns
• Heavy or persistent bleeding
• Signs of a blood clot (e.g., sudden swelling/pain in leg, shortness of breath, chest pain)
• Severe headache or visual disturbances

It is also relevant to seek help if you are unsure whether your contraception method suits your breastfeeding and your daily life.

Do not stop or change on your own without a plan if you want to avoid pregnancy. Instead, agree with your doctor:

• When a new method will be effective
• Whether supplementary protection is needed during a transition period
• What to do if you miss a pill

When you are breastfeeding and also need to remember contraception, small practical things can make everyday life easier. Many choose a nursing bra without underwire to avoid pressure on the breast and to provide comfortable support while the body changes. If you want to simplify breastfeeding in daily use, you can see Pregnancy and nursing bras. If you often leak milk, nursing pads can also be a discreet help in everyday life.