I asked about this at my 6-week check up after the birth of our first child and discussed it at length with my ob/gyn. He suggested the progestin only pill to me and I raised with him my ethical concerns regarding the way it changed the lining of the uterus, and the possible abortive effect it might have on any conceived child. He told me that he would recommend it, as it was progestin (the hormone that sustains a pregnancy), and he told me that there was a higher chance of me getting pregnant while taking it as opposed to the combination pill, as it didn't have an abortive effect on any conceived child. He went so far as to say that it had in fact been prescribed to women who had certain infertility issues, as it helped them to have enough progestin in their bodies to sustain a pregnancy.
This made sense to me because during my second pregnancy my progestin levels had been closely monitored due to the loss of our first pregnancy. He said that, while solely breastfeeding, the progestin only pill simply sustained the conditions already in place in a woman's body due to the nursing. Instead of an effectiveness of 85%, the regulated levels of progestin could be up to 93% effective. He did warn me that it was only suitable to take while I was nursing, and he was only happy to give me a prescription for as long as I intended to breastfeed. He also told me that as soon as I stopped nursing, I was to stop taking the mini-pill.
The prescription he gave me was for "Micronor", and the generic for it I found out is "Nora-Be." I tried to find out about Micronor on the internet, and the only information I found that indicated it would have an abortive effect was at a drug store site, that had simply cut and pasted the general information about combination birth control pills. All other sites indicated it might be appropriate for nursing mothers.
Answered by Dr. William Toffler, EPM Volunteer
The so-called mini-pill is the least reliable in suppressing ovulation. Therefore, its mechanism of action is more likely to be post-ovulatory—that is, abortifacient.
Taking progesterone (in a progesterone deficient state) to support an early gestation is clearly different than taking a pill on a cyclic basis with withdrawal from the active hormone for 7 days each month. Withdrawing exogenous hormone for 7 days (as happens with the mini-pill) may well cause withdrawal bleeding which really represents sloughing of the lining of the womb. Thus, the mini-pill does not suppress ovulation reliably and often "works" by a post-ovulation effect—either thinning and/or causing a sloughing of the lining of the womb.
In fact, at least two OB-Gyns on Focus on the Family's Physicians Resource Council (who are not particularly concerned about birth control pills in general) absolutely agree that the mini-pill is more likely to allow breakthrough ovulation; thus, they will NOT prescribe the mini-pill to postpartum mothers (or to anyone else for "contraceptive" purposes).
