Hi Kika

What a maddening case!  I've been trying to look 
up normal levels of estradiol during lactation 
and you're right, it's hard.  I did find a little 
bit on the use of estrogen patches to relieve 
postpartum depression, with apparently no effect 
on milk production, but milk production wasn't 
specifically studied, and I don't believe it.  I 
had a case history published many years ago 
describing what happened to a client who was 
estrogen prescribed patches for this purpose, and 
her milk "turned to water", newborn infant 
bilirubin levels remained elevated and the baby 
failed to gain adequate weight, until the patches 
were removed, but then gained well.  The ref is 
Ball DE, Morrison P, Oestrogen transdermal 
patches for postpartum depression in lactating 
mothers – a case report.  Central African Journal 
of Medicine 1999;45:68-70 and if you're able to 
access the full-text I'd love a copy because I can't seem to!

The other thing which strikes me is that 
progesterone levels were not tested, and they 
might be instructive.  Is it at all possible that 
this mother has a few retained placental 
fragments which are hindering full lactogenesis 
II.  I've known lactation to be delayed for a 
full six weeks and then the mother haemorrhages and then the milk comes in....

Lastly, if the mother is having such frequent 
breast stimulation/pumping, would that not delay 
menstruation - you don't mention how many weeks 
the baby is now, just the CGA (34 weeks) but it 
would be unusual for her to be having periods just yet, wouldn't it?

Just thinking out loud .... Please keep us posted...

Pamela Morrison IBCLC
Rustington, England
-------------------------------------------------------------
I am working with the mother of a preemie who is having big time production
issues, and I am at a loss as to what to do next.

The beginning was a disaster because she received no support at all the
first days so she did not start pumping until the third day after her child
was born. I started working with her two weeks after birth, when she was
pumping four times a day with a hand pump and getting about 5 ml per
session.

Production has not gone above 60 ml per day. She is pumping ten times a
day, good double hospital grade pump, right flanges, has support from her
husband and personnel, is doing skin to skin several hours a day. She is on
domperidone. The baby is doing well, she has had no major complications and
is thriving. She is now 34 weeks, and will be discharged next week.

She had a hormone test last week and she has just sent me the results. I am
having a very hard time finding information to interpret them and yes, I´m
a doctor!!!! I cannot find normal levels of some hormones during lactation
in the literature.

The blood was drawn 4 days before her period, so pre-mentrual (end of
lutheal phase). FSH is low (2 mUI/ml), LH is also low (0.4 mUI/ml), 17-beta
estradiol is high (170.2 pg/ml) and prolactin is high (176.3 ng/ml).
Thyroid function is normal.

It seems to me that LH should be higher and that estradiol should be low...
but, as I said, I cannot find normal values in breastfeeding women.

Anuyody have this information or can shed any light?

Thank you,
Kika


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