Contraception and Breastfeeding: 2025 WHO Recommendations

In November 2025, the WHO published an updated document on recommendations for contraceptive use (1).

General Principles regarding Contraception and Breastfeeding

Breastfeeding itself is recognised as an effective contraceptive method (LAM) when three conditions are met: exclusive breastfeeding, amenorrhoea, and infant under 6 months of age. As soon as any one of these conditions is no longer fulfilled, another method must be offered without delay. The document emphasises freedom of choice and informed consent: all methods eligible for a given woman should be discussed (efficacy, side effects, potential impact on lactation, return of fertility), taking into account her preferences, context, and medical eligibility criteria.

Progestogen-Only Methods and Breastfeeding

Progestogen-only contraceptives (implants, injectables, progestogen-only pills) are considered compatible with breastfeeding, including from the immediate postpartum period. A cautionary nuance previously applied before 6 weeks for certain injectable forms has now been relaxed (DMPA moving to the category "can generally be used" in breastfeeding women under 6 weeks postpartum). The recommendations specify that these methods can be initiated within the first days after delivery in a breastfeeding woman, with no clinically significant expected impact on infant growth, while noting the need to monitor bleeding and to explain the possible prolongation of amenorrhoea.

Intrauterine Devices in Breastfeeding Women

Copper and levonorgestrel-releasing IUDs are described as first-line options for long-acting contraception in breastfeeding women. They can be inserted either in the immediate postpartum period (within 48 hours of delivery) or after 4 weeks, taking into account the slightly increased risk of expulsion with post-placental insertion. Between 48 hours and 4 weeks postpartum, insertion is generally discouraged (caution category) unless no acceptable alternative is available, and any suspicion of puerperal infection contraindicates insertion until recovery.

Combined Contraceptive Methods and Breastfeeding

Combined oestrogen-progestogen methods (combined pill, patch, vaginal ring, combined injectables) are not recommended for women who are exclusively breastfeeding during the early weeks, due both to the increased thromboembolic risk in the early postpartum period and to the theoretical risk of reduced milk production. The document recommends deferring the introduction of combined methods beyond 6 weeks postpartum, or even beyond 6 months if breastfeeding remains substantial, and using them only when progestogen-only or non-hormonal methods are unsuitable and the benefit-risk balance is judged to be favourable.

Non-Hormonal Methods and LAM

Barrier methods (male and female condoms, diaphragms, cervical caps, spermicides, vaginal pH regulators) are presented as safe choices for breastfeeding mothers, usable immediately after delivery, with the added benefit of STI protection for condoms. The text notes that the lactational amenorrhoea method (LAM) is a highly effective but temporary method, and that transition to another method, often progestogen-only or an IUD, should be planned as soon as feeds become less frequent, complementary foods are introduced, or the infant reaches 6 months of age.

Emergency Contraception in Breastfeeding Women

For emergency contraception, emergency contraceptive pills (LNG, ulipristal) can be used during breastfeeding. However, the document highlights the need to counsel on breastfeeding management around the time of administration (e.g. potential delay of a feed depending on the molecule and national recommendations) and to initiate a regular method without delay following the emergency episode.

Our Commentary on This Document

This document draws on the existing literature but does not acknowledge that progestogens may also contribute to a reduction in milk supply (2, 3). As male contraceptive methods become increasingly accessible, the postpartum period seems to us an ideal opportunity to relieve mothers of this mental burden.

REFERENCES

WHO Selected practice recommendations for contraceptive use, 4th ed.
Elise Armoiry. blog My Baby Moon. Contraception: impact de la pilule sur l'allaitement
Hmaj-Wierzchowska K, Wszołek K, Tomczyk K, Wilczak M. Safety of Progestogen Hormonal Contraceptive Methods during Lactation: An Overview. Clin Pract. 2024 Jun 4;14(3):1054-1064. doi: 10.3390/clinpract14030083. PMID: 38921261; PMCID: PMC11203090.