HRT while breastfeeding?

[RedPandaFluff]

Posting in Chat in the hope of getting visibility!

Has anyone taken HRT while breastfeeding? I had donor egg IVF due to premature ovarian failure and have been on HRT for years, except when I've done IVF cycles, during pregnancy and breastfeeding.

I had to stop breastfeeding my first after 4-5 months as I was overwhelmed by hot sweats, sense of impending doom, brain fog etc. it was awful, I felt so guilty switching to formula (irrational I know), but my quality of life was very low.

I had my second baby a few weeks ago and once again I'm miserable - especially with the hot sweats, which are really frequent. I spoke to two of the doctors at my GP practice because all the research I've done indicates that HRT can be taken while breastfeeding, in the same way that the contraceptive pill can, however they're saying a flat no.

Any experiences out there?

https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/continuous-combined-hormone-replacement-therapy-hrt-tablets-capsules-and-patches/pregnancy-breastfeeding-and-fertility-while-taking-continuous-combined-hrt/#:~:text=If%20you%20are%20breastfeeding%2C%20combined,unless%20a%20specialist%20recommends%20it.

Sorry for the ridiculous link, but possibly useful to see why GP reluctant

Could you refer them to your sources- presume you are looking at Breastfeeding Network and similar? You could ask them to contact UK DILAS for specific advice https://www.sps.nhs.uk/articles/advising-on-medicines-during-breastfeeding/

Or if you get in touch with your local infant feeding team (via HV) they might be able to support/advocate for you.

Best wishes OP hope you can reach the right solution for you.

Yes! We are a very rare breed it seems! I'm 35 and my DD has just turned two. I was on femoston 2/10 after surgical menopause, stopped when I was going for my FET and then back onto femoston 1/10 in the first few months and then read an article by a pharmacist with a particular interest in drugs and their interaction in breastmilk who suggested a transdermal approach so moved to patches.

I deffo could do with a higher dose and now my DD is 2 and I'm starting to think about weaning, I'm being referred to a consultant at the menopause clinic to hopefully have some long term management.

https://www.balance-menopause.com/menopause-library/breastfeeding-hrt/#:~:text=Dr%20Wendy%20Jones%20says%2C%20%E2%80%9CIf,for%20the%20production%20of%20breastmilk).

https://breastfeeding-and-medication.co.uk/fact-sheet/the-menopause-and-breastfeeding

Hi @thedevilinablackdress - I think this is why I'm confused; it seems to be okay to take oestrogen and progesterone in the combined contraceptive pill, but not HRT . . . which is strange because the doses in HRT are lower, from what I understand!

@CelticPromise I'm ashamed to say that, instead of presenting my argument and putting my case forward as I would in my professional life, I just burst into tears in sheer dismay and disappointment! I'm going to have to ask for another appointment and get a grip of myself!

@linziere only a few of us now but it sounds like this will be a growing "problem"/enquiry, eh? I have oestrogen gel and I'm so tempted to start using a small dose, given that transdermal application is thought to be better. I am worried that it will reduce my milk supply, though. I'm struggling as it is because my body rarely functions as it's supposed to. Well done for managing to breastfeed for so long - it's tough under normal circumstances!

I would imagine the fact it is more common for women to be taking contraceptives while breastfeeding makes research more grounded.

Would it be worth making an appointment with a menopause clinic?

I'm going to have a look for a clinic, @Marblessolveeverything, although I bet it will be months before I can get an appointment.

I have private health cover through work, I wonder if there's any referrals possible with that. Must have a look. Bet it's an exclusion!

Just a small update in case anyone is reading this thread in the future.

I was really struggling with hot sweats but didn't want to give up breastfeeding, so did lots of research. I concluded from everything that I'd read that the main risk I'd be taking if I took HRT while still breastfeeding would be that the oestrogen would reduce my milk supply. With that in mind, I've started using a small amount of oestrogen gel (half my usual dose) and over a week in I haven't noticed any issue with supply. It has also massively reduced the hot flushes. So I'm going to keep going for now!

Not sure if you've read this:

breastfeeding-and-medication.co.uk/?s=HRT+&submit=

But yes main issue is oestrogen inhibiting milk production which can be an issue in the early days (hence why combined pill not recommended) but after 2 years your supply will be well established.

Oestrogenisation of infant.

its mini pill when bf not cocp

This isn’t straightforward as others have said a combination of rarity and it involving breastfeeding means there’s not much evidence for anyone to go off. I’m a bit concerned from what you’ve said that you might be using the oestrogen without a progestogen? The concern there would be an increase in the risk of endometrial cancer associated with unopposed oestrogen use, this is a proven risk. Apologies if I’ve misunderstood.

You can’t compare the oestrogen in a combined pill with the oestrogen in HRT. One is oestradiol and one is ethinyloestradiol.

Also you need progesterone with your oestrogel. You shouldn’t be using the gel alone.

I did it! Just oestrogen gel (I don't do well with progesterone) which my gynaecologist was fine with and fully risk-assessed. I had mine for PMDD.
Totally fine, no ill effects, BF to 23 months and DS is now a lovely healthy four year old.
We're a rare breed indeed but not nonexistent.

@RedPandaFluff just seen your update (sorry, I should have read instead of jumping in!) I'm glad it's working out for you so far. I started on the gel when I'd been BF for 1 year and the gynaecologist who prescribed it said that the amount of milk DS was drinking (just night feeds by then) and the size of him now meant the risk was negligible.
Obviously everyone's different but she had no concerns about us doing this.

Sorry, I should have mentioned that I will oppose the oestrogen with progesterone at regular intervals.

I'm also looking at a private consultation with a specialist - endocrinologist possibly - to talk all this through with. I accept the risk of reducing milk supply (although La Leche League said they've never had someone report this to them in the surveys they've done) but not the risk of any effect on DD, so although I'm having to do this at the moment to save my sanity, if a specialist tells me to stop, I absolutely will.