On Tue, 27 May 1997, you wrote:

> I'm working with a 39 year old mother with a 6 week old fully breastfed baby.
>  She had one ovary with a tumor removed several years ago, then had her
> second ovary removed during her fifth month of pregnancy, also with a tumor.
> ...
> The reasons given for weaning are:  1. Estrogen may decrease her milk supply
> (so will weaning, says mom).  2. Baby is a boy and doctor does not give OCPs
> to mothers of boys.  3.  Endocrinologist says she must wean.
> ...
> My question is: ... Is there any reason for her to have a hysterectomy before she exhibits
> difficulties with the endometrial lining?  (That's another one of the
> doctor's recommendations.)

Of course, I am not an expert on surgical menopause, only a public health
doctor... but I feel your client is right on the money:
1. Mom would have estrogen in her system, and replacement therapy (by
opposition to birth control pills, much stronger) only replaces the estrogen
that would be there is the ovary had not been removed.
2. Same: if boys would suffer from the estrogen in Mommy's milk ... we
would not be here, would we ?
3. Upon the inspiration of dr Newman: ask his (endocrinologist)
references... but I bet he cannot produce many !
Finally, about the endometrial lining, hormone replacement therapy does
include progesterone during the second half of the cycle, to "normalize"
the endometrial lining, and eliminate the risk of
endometrial cancer due to "unopposed" (i.e. by progesterone) estrogen
replacement. Of course, if the nature of her tumors forbid adding
progesterone to the treatment, your client would then have increased risk
of endometrial cancer and should consider hysterectomy. However, if she
could take progesterone, the issue is resolved.

Hope it helped,

Louise Denhez, M.D., M.P.H
Chargee d'enseignement clinique
Departement de medecine sociale et preventive
Montreal, Quebec, Canada