---------- 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.