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Subject:
From:
Alesha R Walby <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 9 Mar 1998 16:16:23 -0600
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---------- Forwarded message ---------- 
 Hello, I am a nursing student at the University of North Dakota.  
I am interested to know the effects of hormone replacement therapy on 
breastfeeding.
 During one of our clinical rotations in the maternity unit, I was 
caring for a 41 year old primipara.  The interesting thing about her case 
is that she began having menopausal symptoms at the age of 26 and she was 
diagnosed with insensitive ovary syndrome.  At this time, she was started 
on hormone replacement therapy (premarin and provera).  Now at the age of 
41, she became pregnant with twins.  The mother stopped taking hormones 
when she found out she was pregnant.  Neither the mother nor the fetuses, 
experienced any complications during the pregnancy or delivery.  The 
mother did experience a significant blood loss (1000mL) during delivery.  
The mother was interested in breastfeeding her twins but she experienced no 
breast changes during pregnancy and her milk still had not come in by the 
fourth postpartum day.  Her babies were being supplemented with formula 
at the hospital and were sent home with instructions to continue 
supplementation.  The mother was sent home on reglan and with 
instructions on how to do breast compression.  A plan was made to 
follow-up on her and her babies status.
 In reviewing the literature, I wasn't able to come across any
information on the effects of hormone replacement therapy on 
breastfeeding so I focused on the effects that oral contraceptives have 
on breastfeeding.  In doing this, I found much support that estrogen 
decreases the milk supply and duration of breast feeding and 
milk-suppression is related to the dose and length of usage of estrogen 
(American Academy of Pediatrics, 1981; Erwin, 1994; Koetsawang, 1987; & 
Kora, 1969).  Since this mother was not currently on estrogen, there 
obviously is some other reason why her breasts weren't responding 
appropriately during her pregnancy.  Is it possible that her breasts 
didn't respond to the effects of the placental hormones appropriately 
during pregnancy (down regulation of receptors)? Or could it be that her 
body is just not responding to or producing adequate amounts of the 
pituitary hormones, prolactin and oxytocin?    
 I was curious to know if any of you have come across this type of 
situation in your practice?  If so, what was the outcomes?  I would 
appreciate your thoughts on this issue and any other comments or 
questions you may have.  Thank You, Alesha Walby, College of Nursing 
Student (University of North Dakota).  ([log in to unmask])

 American Academy of Pediatrics.  (1981).  Breast-feeding and 
contraception.  _Pediatrics,68(1), 138-139.

 Erwin, P.C. (1994).  To use or not use combined hormonal oral 
contraceptives during lactation.  _Family Planning Perspectives,26(1), 26-30.

 Koetsawang, S. (1987).  The effects of contraceptive methods on 
the quality and quantity of breast milk.  _Int. J. Gynaecol. Obster,25 
Suppl, 115-127.

 Kora, S.J. (1969)  Effect of oral contraceptives on lactation.  
_Fertility and Sterility,20(3), 419-423.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

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