Is the use of combined oral contraceptives in the postpartum period as safe as the use of oral progestins?
DOI:
https://doi.org/10.32385/rpmgf.v25i1.10587Keywords:
Contraceptives, Oral, Safety, Postpartum PeriodAbstract
Introduction: Hormonal Contraception (HC) after childbirth is a public health issue of global importance, with repercussion for both mother and child. Objectives: To determine the safety of Combined Oral Contraceptives (COCs) and Progestogen-only pills (POPs) in postpartum women and breastfed children. Methods: The author searched MEDLINE, Guidelines Finder, National Guideline Clearinghouse, Canadian Medical Association, Infobase, The Cochrane Library, DARE, Bandolier, TRIP, InfoPoems and Scientific Societies, using the MeSH terms: Contraceptives, Oral; Safety; Postpartum Period; and the term Postpartum. The search was limited to articles published between January 2000 and April 2008 in English, Portuguese, French and Spanish. The categories of the World Health Organization Medical Eligibility Criteria for Contraceptive Use (WHOMEC) were used to compare results. The Strength of Recommendation Taxonomy (SORT) of the American Family Physician was used to assess the Level of Evidence. Results: Two meta-analysis, one systematic review, two evidence based reviews and five guidelines met the inclusion criteria. Safety for Women: there is theoretical concern regarding the association between COCs use up to three weeks postpartum and the risk of thrombosis. POPs can be related with the development of Type 2 Diabetes Mellitus in breastfeeding Women. Safety for breastfed children: there is evidence that there is no consistent change in breast milk production, child growth or weight, with the use of HC. Conclusion: The finding that pharmaceutical companies conducted most of the trials on oral contraceptives raises concerns about potential commercial biases. It would be advisable to do high quality, long-term, controlled and randomised studies about the safety of COCs and POPs in the postpartum period.Downloads
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