Barbara wrote, "Does anyone have any information on an estrogen patch used
for PPD called  Estradiol  transdermal systems.   Dosage is     .05mg per day.
Mother is nursing a 2 1/2 month old.      Anything I've read advised
against nursing  if this is used."

Yep.  One of our OBs prescribes Estrogen patches occasionally to prevent
post partum depression and tells moms he has references to support their use
during lactation, in particular that they *do not* exert a negative effect
on breastfeeding.  However, I don't share his confidence, and have been
unable to find the "research" he describes. I documented one client
receiving this Tx very carefully.  3rd baby (a boy) she had BF lst baby for
just a few weeks, second one for longer, and had lots of contact with LLL
while BF the previous baby so she was highly motivated and she knew what she
was doing (unlimited access to breast, no dummies, extra water, anything
else). The patches were used from Day 1 to Day 28 post partum. Nobody
suggested not breastfeeding.  Baby appeared to obtain sufficient quantities
of milk (lots of swallowing, adequate urine output), but remained jaundiced
and had borderline weight gain in spite of very frequent breastfeeding and
receiving mother's own expressed hindmilk as a supplement. I concluded that
the quality was affected (possibly fat and protein content?)  Once mom came
off the patches the rate of gain was something like three times what it had
been and the jaundice disappeared.

There are so many other ways of treating postpartum depression - why use
hormonal preparations that are known to have an adverse effect on lactation?
If this Tx is suggested to current clients I suggest that the mom explore
other alternatives first, and if she does go with it, to monitor baby's rate
of gain very carefully to ensure that he "gets enough".

BTW I would be grateful for any references you have Barbara, as I have found
very little specifically relating to estrogen patches.

Pamela Morrison IBCLC, Zimbabwe
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