The association of progesterone, infant formula use and pacifier use with the
return of menstruation in breastfeeding women: a prospective cohort study.
Ingram J, Hunt L, Woolridge M, Greenwood R.
Centre for Child and Adolescent Health, University of Bristol, Hampton House,
Cotham Hill, Bristol BS6 6JS, UK.
Objectives: This study sought to explore hormonal and postnatal factors,
which are associated with the return of menstruation in breastfeeding mothers.
Design: A prospective cohort study in Bristol, UK. Ninety-one breastfeeding
mothers of mixed parity were recruited at community-based antenatal clinics.
Eighty-five mothers completed all stages and informed us about the return of
menstruation. Data were collected from interviews and questionnaires antenatally,
immediately postnatally, and 1 week, 4 weeks and 6 months later. Blood samples
were taken at all time points except at 6 months. Associations between hormone
levels, postnatal factors and the return of menstruation were explored using
univariate and multivariate statistical survival analysis. Results: Sixty-five
(76%) mothers were still breastfeeding at 6 months and 46 (54%) of these were
fully breastfeeding (not giving formula milk); 21 (32%) mothers started
menstruating in the first 6 months whilst they were still breastfeeding and 14 were
fully breastfeeding at 6 months. Survival analysis modelling showed that
formula use ( [Formula: see text]; 95% [Formula: see text], 9.67), pacifier (dummy)
use ( [Formula: see text]; 95% [Formula: see text], 7.84) and lower postnatal
progesterone levels ( [Formula: see text] ) each made a significant
contribution to the chance of earlier resumption of menstruation. Prolactin and
oestradiol levels showed no associations with the return of menstruation. Conclusions:
Higher postnatal progesterone levels are associated with delayed
menstruation; while the use of pacifiers and infant formula milk are associated with an
earlier return to menstruation.
Eur J Obstet Gynecol Reprod Biol. 2004 Jun 15;114(2):197-202.
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
Maternal-Child Adjunct Faculty Union Institute and University
Film Reviews Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative
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