Q&A: surgical meopause and breastfeeding

Kelly writes:

"Here's a doozy! My sister will need to undergo surgery that will put her in surgical menopause (she's 36). She is desperate to know if anyone has been through a similar situation and has advice or tips for her about what to expect, what to do and what not to do.

Additionally, she will be in the hospital for 3-5 days, and is still nursing a three month old. Again, any tips?

Also - is there anything important she needs to be aware of or plan for when nursing a baby after menopause? Is it possible?

I'm hoping some of your readers will have some info."

No kidding that this one is a doozy. It's actually two questions in one, and I've got real suggestions for one and mere speculation for the other. Let's start with what I know.

The easy question is about how to manage the nursing while in the hospital. She's going to need to pump, pump, pump like the wind before she goes into the hospital to get up as much of a stash as possible. While she's in the hospital she's obviously not going to be able to keep up the same nursing schedule, even if someone can bring her the baby a few times a day (who even knows if the hospital will allow that). And she may be taking medications that aren't compatible for nursing, so it's possible that she won't be able to nurse at all while she's in the hospital.

The trick is to make sure there's plenty for her baby to eat while she's in the hospital (either pumped milk or formula or a combination), and to keep her milk flowing while she's in the hospital. She should arrange ahead of time to rent a hospital pump while she's there, and pump as often as she can. If she has to pump and dump because of medication it'll be a shame but not a tragedy, because the goal is just to keep her supply up so she can nurse again when she gets home and doesn't have meds in her system.

(I'm going to assume her baby switches back and forth between breast and bottle, since you probably would have mentioned that if it were a problem. It's possible that the baby will develop a preference for the bottle if she's in the hospital for awhile. To try to mitigate that the people feeding the baby should use the slowest-flow nipples they can find, and then your sister should spend tons of skin-to-skin time together in the weeks after she comes home from the hospital.)

There's great information about breastfeeding when a mother has surgery at (where else?) Kellymom.com at http://www.kellymom.com/health/illness/mom-surgery.html.

Now for the question I don't know the answer to (but you know I'm going to take a stab at it anyway), which is will she be able to nurse after surgical menopause. My guess is that she will be, because nursing itself produces hormones that give the body the feedback loop to keep producing more milk. Nursing  also supresses the hormones that regulate a menstrual cycle, so my non-scientist guess is that the hormones that won't be there after the surgery aren't involved in the production of milk.

Now, clearly I'm talking out of my hindquarters, so someone with actual knowledge of the relationships of all the kinds of hormones to each other needs to step in and tell us all the real answer. Who's got a real answer for us?

Comments

[Katherine]

I thought the menopause part of the question was really interesting. I knew I had recently read an article about elderly women in Britain still working as wet nurses but I couldn't find the article.

I did a little research online and found a relevant article:

http://www.asklenore.info/breastfeeding/
induced_lactation/menopause_protocol.html

Best quote from the article:

A woman does not need a uterus or ovaries
in order to breastfeed. All she needs are breasts and a functioning pituitary.

So it sounds like she should be able to continue to breastfeed. The article is actually about inducing lactation in a menopausal **adoptive** mother. Now that's dedication to breastfeeding.

The article discusses medicines and herbs that may or may not be helpful for this situation. It would probably be worthwhile to line up lactation consultant before the surgery to help with anything that crops up.

[flea]

My understanding is also that in people with early surgical menopause they give hormone treatments - often until the estimated age of real menopause would be, and in most people at least to ease the transition. I would imagine any hormone needs for breastfeeding could be part of the hormone replacement therapy, and the Ob/Gyn who is supervising should be able to give a real answer.

[sue]

Something which isn't often talked about in general is the idea of partial breastfeding. I have extremely low supply on my own due to a prior breast surgery. With my first, I didn't have enough to completely feed my daughter, so I quit, on the advice of my pediatrician's lactation consultant . With my second, I was much more determined to breastfeed, as I think the failure of my nursing relationship really contributed to my PPD and early difficulty with bonding. Here's what I've found to be of use if she does have trouble (better to have the info and not need it than not have it)

*using an at-breast supplementer like the Medela SNS or Lact-aid will allow someone to offer the milk that she makes along with formula - this saved my nursing relationship wit my second, since he never got the opportunity to prefer bottles over me

*herbal supplements are very helpful. The ones made by Motherlove are vey good (I take More Milk Plus and Goat's Rue)

**prescription medications can make all the difference in the world. There are two available - domperidone and Reglan. Domperidone isn't widely available in the US - I order it from Vanuatu. But it's generally recommended over Reglan for long term use since Reglan has been associated with deression (and who needs that?)

*Many doctors, even really good supportive OB's and pediatricians (and many LC's) will be completely in the dark about her situation. Because they don't know how to help, they'll prboably advise quitting and switching to a bottle. And I'm guessing (from how I think I would feel) that she'll be grieving enough over the loss of one aspect of her identity at such a young age that she won't want to lose a very improtant relationship with her child at the same time.

Dr. Jack Newman is the foremost authority (that I know of) on breastfeeding through difficult circumstances (biologically speaking). He's based in Toronto and quickly and personally answers his e-mail. If this woman needs help, Id highly recommend contacting him - he has a wide range of lactation professionals who he can refer her to. Just Google his name and you'll get his website and address.

Two websites, lowmilksupply.org and bfar.org are very helpful for womn who experience supply difficulties. They also have support forums (fora) to help women who are in the middle of their experience.

I'm guessing she's probably going to experience a dip (significant) in her milk supply. I know that postmenopusal women nurse their adoptive babies, but they do it with a *lot* of pharmeceutical help. I'm on a similar regime and I'm taking about 30 pills/day just for help with making milk. It's not cheap or easy, but definitely worth it (and, on a selfish note, better than PPD)

Oh, my insurance said they would cover a pump if one of us had to be in the hospital - she might try getting them to buy her a nice one.

Good luck!

[Rachel H.]

Milk production is stimulated by the hormone prolactin, which is produced in the pituitary gland in the brain. Letdown is controlled by oxytocin, also from the pituitary.

So, although you need the female hormones from the ovaries to grow breasts and prepare them for lactation, once you have them in place -- the pituitary can support lactation on its own.

[SarcastiCarrie]

I was just thinking about how they usually slap a hormone patch on you before you leave the hospital (I think with the complete hysterectomy you wake up from surgery with it already on). I think it would be just estrogen (since you don't need the protective effects of the progesterone if you don't have a uterus). If I'm not mistaken, the reason you take the mini-pill for birth control while nursing is because estrogen would drop your milk supply. SO, if the standard protocol is to give you estrogen to calm hot flashes and whatnot, she will need to have in BIG LETTERS everywhere on her chart and maybe even on one of those colored wristbands that she should not get the estrogen patch while in the hospital (and it needs to be written down since she may not be awake to stop it during surgery). I know that a lot of people just know what standard is and will do it because thats what we do, and if she doesn't need it, it needs to be very clear to all doctors and nurses that will come into contact with her.

[Shandra]

I was going to recommend Jack Newman too - he seems the mostly likely person to know who to ask, and he will most likely answer quickly.

I am totally about BFing and am extended-nursing my son, but I did want to say too that if for whatever reason she ends up having to do partial formula, or even go to formula, she will need equal love & support for that too. A nursing relationship is wonderful and she has had a chance to have one already with her baby, and I really do hope she can continue - but if not I hope she will not feel like a bad mother!

[Cheap P90X]

Its like you read my mind! You appear to know so much about this, like you wrote the book in it or

something. I think that you could do with some pics to drive the message home a little bit, but

other than that, this is great blog. A great read. I will certainly be back.