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Hello, I am a nursing student at the University of North Dakota.
I am interested to know the effects of hormone replacement therapy on
breastfeeding.
During one of our clinical rotations in the maternity unit, I was
caring for a 41 year old primipara. The interesting thing about her case
is that she began having menopausal symptoms at the age of 26 and she was
diagnosed with insensitive ovary syndrome. At this time, she was started
on hormone replacement therapy (premarin and provera). Now at the age of
41, she became pregnant with twins. The mother stopped taking hormones
when she found out she was pregnant. Neither the mother nor the fetuses,
experienced any complications during the pregnancy or delivery. The
mother did experience a significant blood loss (1000mL) during delivery.
The mother was interested in breastfeeding her twins but she experienced no
breast changes during pregnancy and her milk still had not come in by the
fourth postpartum day. Her babies were being supplemented with formula
at the hospital and were sent home with instructions to continue
supplementation. The mother was sent home on reglan and with
instructions on how to do breast compression. A plan was made to
follow-up on her and her babies status.
In reviewing the literature, I wasn't able to come across any
information on the effects of hormone replacement therapy on
breastfeeding so I focused on the effects that oral contraceptives have
on breastfeeding. In doing this, I found much support that estrogen
decreases the milk supply and duration of breast feeding and
milk-suppression is related to the dose and length of usage of estrogen
(American Academy of Pediatrics, 1981; Erwin, 1994; Koetsawang, 1987; &
Kora, 1969). Since this mother was not currently on estrogen, there
obviously is some other reason why her breasts weren't responding
appropriately during her pregnancy. Is it possible that her breasts
didn't respond to the effects of the placental hormones appropriately
during pregnancy (down regulation of receptors)? Or could it be that her
body is just not responding to or producing adequate amounts of the
pituitary hormones, prolactin and oxytocin?
I was curious to know if any of you have come across this type of
situation in your practice? If so, what was the outcomes? I would
appreciate your thoughts on this issue and any other comments or
questions you may have. Thank You, Alesha Walby, College of Nursing
Student (University of North Dakota). ([log in to unmask])
American Academy of Pediatrics. (1981). Breast-feeding and
contraception. _Pediatrics,68(1), 138-139.
Erwin, P.C. (1994). To use or not use combined hormonal oral
contraceptives during lactation. _Family Planning Perspectives,26(1), 26-30.
Koetsawang, S. (1987). The effects of contraceptive methods on
the quality and quantity of breast milk. _Int. J. Gynaecol. Obster,25
Suppl, 115-127.
Kora, S.J. (1969) Effect of oral contraceptives on lactation.
_Fertility and Sterility,20(3), 419-423.
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