I have a new client today with a problem that i have never had to assist
with before: 2 days ago she had an emercency C-section for worsening
toxemia and during the surgery, also had an unexpected bilateral
oophorectomy because the surgeon found dermoid cysts on both ovaries. She
was gravely ill postop and, although she had indicated that she wanted to
breastfeed this child - her first, her obstetrician prescribed Prempro
daily as HRT. Two doses were given before I was called in because the mom
was comcerned that her milk hadn't come in yet in spite of the baby's
frequent nursing. needles to say, the HRT has been stopped, but many
questions remain.

My research leads me to believe that, altho delayed, her milk should come
in with frequent stimulation. However, how should this mom be maintained
once lactation is well under way? I think that early and exclusive
lactation has some similarities with peri-menopause as far as a
hormonal "climate" goes anyway, but once six weeks has passed, will she
need some form of estrogen to keep other menopausal symptoms at bay? When
is the safest time to resume HRT (if it becomes necessary) without
compromising her milk supply and endangering the infant to high extrinsic
estrogen exposure? Do estrogen and progesterone play any role in
maintenance of lactation after 6 weeks? What will happen to her bone
density if she does not resume HRT until after weaning (whenever that may
be)?

I realize this forum may not be the place where all of these questions can
be answered, but would appreciate input from any consultants who have
encountered similar problems. There must be plenty of women out there who
have required some kinds of hormone therapy to initiate and maintain a
pregnancy and plenty of them must have breastfed. How do women with non-
functioning ovaries manage?.

Thanks in advance. Vee Peterson, RNC, IBCLC

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