I have a patient, G3P1113, who is nursing her 14 month old without
difficulty. She has been amenorrheic since the baby's birth. Her
pregnancies were achieved with Clomid and Metformin respectively. She
normally does not menstruate without progesterone or metformin. Mom is aware
of the potential carcinogenic effects of unopposed estrogen in PCOS and is
concerned about the amenorrhea. She would rather not take progesterone in
the doses required due to concern about its potential effect on supply.
Metformin is a viable choice for her at this point.
So my questions:
At what point would you assume the amenorrhea is not related to lactation?
(Baby nurses 4-5 times/24 hours on an average day)
Would progesterone have the same effect on a mature milk supply that it has
in the early months?
Thanks,
Leigh Fredholm MD, FAAFP
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