JOSEPH S. SANFILIPPO, MD, MBA Dr. Sanfilippo is professor of OBG and reproductive sciences at the University of Pittsburgh and vice chairman of reproductive sciences at Magee-Womens Hospital in Pittsburgh. He also serves on OBG Management’s Board of Editors.
In select patients, low-dose OCs can be initiated 6 weeks postpartum, provided the woman is breastfeeding exclusively—no bottle supplements—and both mother and infant are in good health. If the patient is not breastfeeding, OCs can be initiated as early as 2 weeks postpartum.
Although new contraceptives have been introduced—including a vaginal ring containing EE2 and etonogestrel (3-keto-desogestrel), and a transdermal contraceptive containing EE2 and norelgestromin (17-deacetylnorgestimate)—no studies demonstrating their safety and efficacy in lactating women are available.
Conclusion
According to preliminary evidence, the new generation of OCs has many advantages over the higher-dose pills. Ultra-low-dose formulations are effective and generally associated with a lower incidence of estrogen-related side effects. Although more research is needed, these OCs are safe for healthy nonsmokers. However, in other populations, such as women with risk factors for coronary artery disease, they may not be advisable.
It is important to know the androgenicity of different progestins, as well as their effect on sex-hormone-binding globulin, since this is paramount to determining the amount of free, clinically significant androgen levels in the circulation.
Patients also should be counseled about the noncontraceptive benefits of OCs, including a lower incidence of ovarian and endometrial cancers, PID, and dysmenorrhea, and enhanced BMD.
Dr. Sanfilippo reports that he receives grant/research support from Pfizer, Eli Lilly, and Wyeth and serves on the Speakers’ Bureaus for Ortho, Wyeth, Eli Lilly, and Pfizer.
