Hi everyone. I'm concerned about this mom, and I'm looking for input to 
see if I'm handling this ok.

Mom is 17 and has a 4.5 month old exclusively breastfed baby. Mom has been 
bleeding vaginally since the birth of the baby. Blood has seemed like an 
ongoing period: at times it's a lot, at times it lighter, sometimes bright 
red, sometimes brown. At about 13 weeks (4 months, one week), mom stopped 
bleeding for about 2 days, then started bleeding a lot and it tapered off 
again. About a week later she stopped for 3 - 4 days only start again and 
again it was heavy at first tapering off until none today.  She has had 
blood tests, ultrasounds, paps all coming up negative for anything. Mom is 
not anemic. Doc said she can try the mini pill which will probably take 
care of the problem or she can wean. This doctor has been encouraging and 
supportive of breastfeeding but is concerned for mom's health (in mom's 
words). Mom went to buy mini pill but it was not covered by insurance and 
could not buy them that day... as an aside the pharmacist told mom that 
she had also bled for 5 months pp while breastfeeding and the mini pill 
would do the trick.  Since mom was not able to buy the mini pill that day 
she decided to go 2 days with no bfeeding/or pumping. Mom stopped bleeding 
but is now engorged.  I advised mom she has to relieve the engorgement or 
risk mastitis not to mention what formula may do to baby. Mom was glad 
there was an excuse to breastfeed again as she doesn't want to quit. I've 
been doing some research and my concern now is that while yes, the mini 
pill will solve the obvious - it will probably take care of the bleeding; 
is it possible that its masking something else? I mean, why is she 
bleeding so much for so long? Could this be a problem with the pituitary?  
I read in Ruth Lawrence's Breastfeeding a Guide for the Medical 
Profession, that it's the sucking that controls amenorrhea, so could there 
be a problem with the nerves that take the info from the areola to 
pituitary?  Also, I had never heard of a mom bleeding for so long while 
exclusively breastfeeding and here not only is my client bleeding like 
this but the pharmacist she happens to meet had the same experience. Is 
this more common than I think or the books let on?

Any information, lessons, experiences will be greatly appreciated.

Sarah Muñoz, IBCLC
Miami-Dade WIC Breastfeeding Program

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