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The Mini-Pill and Breastfeeding - Can I Still Get Pregnant?

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Question: The Mini-Pill and Breastfeeding - Can I Still Get Pregnant?
I have a 4-month-old daughter and have just returned to work. I started seeing my periods a month after my baby's birth and began using the mini-pill for birth control. This is the fourth month and I'm starting to feel some nausea and dizziness. I'm concerned that I might be pregnant but several home pregnancy tests have come up negative.

My worry is that this happened with my first pregnancy. I didn't get a positive pregnancy test until after I was 2 months along. Could this be the same situation?

Also, I'm breastfeeding and plan to for a year. Will that keep me from getting pregnant along with the mini-pill?

Answer:

Since you're using a progestin-only pill, you probably already know that you need to take it precisely as directed and at the same time each day. If you're not sticking with the plan exactly, then chances of a pregnancy increase. Even if you miss just one pill, you'll need to use a back-up method of birth control for 48 hours until you are back on track with the pills. If you made a mistake and then you don't have a period within 45 days, you could definitely be pregnant. And, if you missed more than 2 pills, you shouldn't even try to get back on track with the pills until you've ruled out pregnancy.

In addition, if you're in another country besides the United States, the mini-pill you've been prescribed might be different than what's available here. If you miss a pill, you might need to use a back-up method for up to two weeks. Be sure to contact your health care provider or read the package insert to be sure.

Now, you might be thinking -- what about my breastfeeding? Isn't that my back-up birth control? Perhaps, if you meet the following criteria:

  1. Your baby is 6 months old or younger.
  2. Your baby is fed only breast milk, on demand, without supplements, solids or pacifiers.
  3. Your period hasn't returned.

In your case, while your baby is just 4 months old (which meets the first criterion) your period has returned. I'm not sure about the other two criteria, but you mention that you're back at work which could mean that your baby gets a bottle of formula or perhaps is fed on a schedule if she's in child care. Even if you are pumping, it's not the same as feeding your baby on demand. At any rate, I would not count on the Lactational Amenorrhea Method to prevent a pregnancy at this point. (Learn more about LAM as birth control at About.com Contraception or La Leche League International)

Regarding the dizziness and nausea, these are known side effects of the mini-pill. In fact, there are several side effects of the mini-pill that are also symptoms of pregnancy (like changes in your breasts, weight, mood, sex drive and menstrual flow.) But before you write any of your symptoms off as side effects from your birth control, remember that you know your own past experience. It's definitely possible to get a negative result and still be pregnant. Since this is bringing you flashbacks of your first pregnancy, you should forget what your home pregnancy tests are telling you and head to your doctor to rule out a pregnancy with absolute certainty.

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