HRT when breastfeeding

[Pokhora]

Does anyone know if you can start HRT when breastfeeding? Amazingly I asked my GP and she did not seem to know. My LO is almost 2 but reluctant to wean completely. I would like to start HRT as soon as possible but obviously not if it has side effects for LO.

Why do you think you need HRT?
Breastfeeding mimics menopause so perhaps the best thing to do would be to stop breastfeeding and see how you feel after several months.

I have a genetic condition which causes POI and my last bloods had a FSH of 58.3 and LH of 35.9.

@Pokhora

I have a genetic condition which causes POI and my last bloods had a FSH of 58.3 and LH of 35.9.

Ok, but your doctor didn't mention it might be best to stop breastfeeding to see how your hormone levels are when you're not breastfeeding? I also wouldn't be relying on a gp's knowledge of menopause, as it's often very lacking. I would see a specialist given your condition.

It's very easy to establish this - it's covered in all the patient information leaflets, a quick Google will show you.

It is not recommended that you take hormone therapy ie oestrogen while b/fing as small amounts may cross into the milk affecting quality & taste.

I can't see a rationale for it either. Hormone levels are not the determinant of requiring HT, as they can fluctuate. It seems very unlikely you are at the stage of needing HT, or being perimenopausal so soon after having a baby.

She said that breastfeeding would not have caused the high FSH and LH levels and these would be due to POI. I was just wondering if anyone here has tried HRT when breastfeeding?

What's POI?

You can't have HRT when breastfeeding. It's clearly contraindicated. Medically, it seems completely inadvisable as your hormone levels are in a stage of flux due to breastfeeding & you will not be experiencing peri symptoms.

You need to ask your GP to refer you to a gynae with fertility and menopause specialism.

POI (premature ovarian insufficiency) is only an issue if a) you aren't given HRT to prevent bone loss and heart disease and b) you want another child.

Maybe take a look at The Daisy Network - national charity run by specialist gynaes. You can join for £20 and have access to Q&As, but there are also facts etc on the website, for free.

I can't see a rationale for it either. Hormone levels are not the determinant of requiring HT, as they can fluctuate. It seems very unlikely you are at the stage of needing HT, or being perimenopausal so soon after having a baby.

In women with POI, hormone levels are a guide.

It's quite possible to be in peri 2 years after giving birth as POI is often an inherited condition. Many women conceive in their early 40s when they are in peri.

@Pokhora This is a link to Daisy and this is from the drop down menu 'About POI'.

POI guidelines

You absolutely can have HRT when breastfeeding but it may need the input of a menopause specialist (I.e. A gynaecologist with an interest in menopause). Your GP may be able to contact them for advice and guidance or if they can't they can refer you to the nearest place. There may be a wait though.

It's quite possible to be in peri 2 years after giving birth as POI is often an inherited condition.

Thanks for that jingling I couldn't work out what POI was, stupidly.

However it's not the same as perimenopause & I think the posts here are confusing the two, although symptoms are similar.

There really isn't an issue as a PP said with hormone levels unless they are causing an issue eg osteoporosis or infertility.

Anyway, HRT isn't possible when b/f, but also the point is what symptoms OP is experiencing & dealing with those.

However it's not the same as perimenopause & I think the posts here are confusing the two, although symptoms are similar.

It is! Because ovarian function declines as in normal meno, but just much sooner.

The link to the Daisy Network is a really good source of info if you want to read it.

@wearyofwigan

You absolutely can have HRT when breastfeeding but it may need the input of a menopause specialist (I.e. A gynaecologist with an interest in menopause). Your GP may be able to contact them for advice and guidance or if they can't they can refer you to the nearest place. There may be a wait though.

OP isn't perimenopausal though. POI (my newly discovered acronym!) is not the same at all as peri/menopause.

See here: www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683

Also, while obviously specialists will know exactly what can be prescribed, HRT is contraindicated when b/fing due to trace amounts crossing into the milk & affecting the quality of the milk. This would of course be much less significant for a 2yo though.

But it comes back to why - if you don't have symptoms, treatment isn't required. The hormone levels in themselves are not relevant, rather the effects on the body eg osteoporosis & other symptoms similar to peri.

I'd still be really surprised if a doctor prescribed HT to someone b/fing, but open to correction.

@JinglingHellsBells

However it's not the same as perimenopause & I think the posts here are confusing the two, although symptoms are similar.

It is! Because ovarian function declines as in normal meno, but just much sooner.

The link to the Daisy Network is a really good source of info if you want to read it.

I did actually, thanks for sharing.

It's a bit semantic, I grant you! But POI is characterised as a particular condition occurring under 40, and while is essence the effects are the same as peri, they are not the same condition.

One being a natural part of a female's biology, the other a condition.

In relation to the misapprehension that POI is the same as early menopause, here's the relevant part from the Mayo Clinic link I posted;

Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant. But women with premature menopause stop having periods and can't become pregnant

I'm a gynaecologist. HRT can be prescribed when breastfeeding. Whether it's appropriate for this individual will be up to their treating physician. Menopause doesn't need to be a diagnosis based on bloods, it can be clinical.

@wearyofwigan

I'm a gynaecologist. HRT can be prescribed when breastfeeding. Whether it's appropriate for this individual will be up to their treating physician. Menopause doesn't need to be a diagnosis based on bloods, it can be clinical.

I'm really surprised to read that @wearyofwigan, because all the info online- by that I mean reputable research papers- says the opposite (that HRT isn't to be used when breastfeeding.) Can you clarify, just for interest?

Younger women with POI are often offered the CCP as an option.

Thanks for all the replies. That is interesting wearyofwigan. Can you tell me if there are any side affects for the baby or is it just the case that my milk supply may decrease? Is it the case that HRT will just top up my oestrogen levels to what they would have been without POI so in theory it should not affect LO?

He is 22 months now and I would stop breastfeeding him but he is very keen to carry on and I would rather wait until he is ready if possible.

I am getting a lot of symptoms that I hope HRT would help address, very frequent hot flushes day and night, joint pain, weight gain, no periods for 4 months plus I am worried about osteoporosis as my gran had this.

is it just the case that my milk supply may decrease?

I don't believe it impacts supply; it may affect the quality of the milk, due to small amounts crossing into the milk.

I am getting a lot of symptoms that I hope HRT would help address, very frequent hot flushes day and night, joint pain, weight gain, no periods for 4 months plus I am worried about osteoporosis as my gran had this

HRT would help most of these symptoms. Blood tests are not required, you can address the symptoms.

I would expect any GP / gynae would wait to make decisions until you had finished breast feeding (tho I note Wigan's expertise on this).

HRT does not do anything about weight gain; however with better sleep & energy you might be able to exercise more / eat better.

Osteoporosis is something that can be avoided by regular weight-bearing exercise, as well of course as being managed medically.

In your situation I would consider weaning. That's a great amount of time feeding, and it's quite hard to know what symptoms are being caused by potential perimenopause / breastfeeding. I fed all mine & definitely felt worn out towards the end. I think it would have an impact on how you feel.

Osteoporosis is something that can be avoided by regular weight-bearing exercise, as well of course as being managed medically.

Sadly, it's not as simple as that.

There are many factors involved in osteoporosis, including frame size, genetics, and lifestyle.

Exercise alone does not halt bone loss. It's a common misconception that if women only walk a lot and do some exercise they will be okay.

Walking to help bones has to be at a minimum of 4mph which is much faster than most people walk.

@Pokhora The NICE guidance pinned at the top of this forum includes advice on POI in the 'diagnosis' section.

It is possible that breast feeding for 2 years will skew your blood tests because breast feeding inhibits ovulation. (Hence why it's considered a type of contraception. Thought not that reliable!)

You need to ask for a referral to a gynae who knows about POI, and take it from there.

I have been in the same situation as you - bf’ing toddler and suffering menopausal symptoms (early menopause in my teens / diagnosed as POI) I’d been on HRT pre child (egg donation) and managed to control symptoms because I was breastfeeding (high oestrogen). However, as DD fed less, oestrogen levels dropped and I suffered massively with symptoms. I held out as I didn’t want to take HRT and BF (nor was it actually given as an option by my GP) and nudged DD to stop by 30 months old.

I remember wanting to stop at the 2 year mark but she was quite full on, held out and actually it was my DH who said you’re sacrificing your own health now (symptoms were horrendous). I think in the mist of being a parent, you forget yourself and I needed that prompt to put myself first for the first time in 2 years.

Perhaps put a timeframe on it, might help you work towards weaning DC off bf.

@JinglingHellsBells

I know 🙄

That's why I said 'can' as in, it may be. It's also why I mentioned medical management.

Regardless of the cause, it is absolutely the case that most women fail to do enough exercise, especially weight-bearing and if they did, they would greatly protect themselves, notwithstanding the factors you mention.

You need to ask for a referral to a gynae who knows about POI, and take it from there.

That definitely seems like a good idea

@Pokhora

Thanks for all the replies. That is interesting wearyofwigan. Can you tell me if there are any side affects for the baby or is it just the case that my milk supply may decrease? Is it the case that HRT will just top up my oestrogen levels to what they would have been without POI so in theory it should not affect LO?

He is 22 months now and I would stop breastfeeding him but he is very keen to carry on and I would rather wait until he is ready if possible.

I am getting a lot of symptoms that I hope HRT would help address, very frequent hot flushes day and night, joint pain, weight gain, no periods for 4 months plus I am worried about osteoporosis as my gran had this.

This is such a niche area that you really need to see and discuss this with a menopause specialist (I'm not one). It wouldn't be appropriate for me to give medical advice online.

But I have seen and do know of women who are breastfeeding on HRT. The doses of oestrogen in HRT are less than those used in the COCP and that is deemed safe in breastfeeding from 6 weeks post partum although anecdotally it may affect supply.

That's really interesting @wearyofwigan that you have experience of so many women BF and on HRT - only 10% of women use HRT anyway, so they must be disproportionally represented and presumably new mums in their 40s perhaps?

Are you working in the UK as a gynae? Are you currently working in the NHS? (Just out of interest.)