Breastfeeding and HRT

It is possible to be perimenopausal while breastfeeding so discover your options for treating your symptoms

It can be hard to distinguish between postnatal and perimenopausal symptoms
The effect of HRT in breastmilk
How vaginal hormones can treat a range of symptoms – postnatally and for perimenopause

It can be common for symptoms of perimenopause to start in your mid-to-late 30s or early 40s, when you may still be fertile and having periods. Many women therefore seek treatment – especially hormone replacement therapy (HRT) – well before the average age of menopause which, in the UK, is 51.

Increasing numbers of women are starting families later in life too, and may be relying on fertility support such as IVF to help with this. Phases of life don’t neatly stop and then another starts – there can be overlap between perimenopause and pregnancy. In addition, if you choose to breastfeed for more than a year, you may reach the point where you become perimenopausal or menopausal while you are still breastfeeding your baby.

Dr Wendy Jones, a pharmacist with a special interest in the safety of drugs in breastmilk, runs the website Breastfeeding and Medication. She says, ‘As many women now give birth later than in the past, due to changes in work and finance, and feed until they and their infant choose to stop, I have received a substantial increase in questions from mothers experiencing signs of early menopause.’

Breastfeeding during perimenopause

It can be difficult to access effective and safe treatment for your perimenopause or menopause if you have recently given birth or are breastfeeding. In addition, hormone levels drop after childbirth and during breastfeeding, which can result in symptoms that often mimic those experienced during perimenopause, such as hot flushes, headaches, or joint pains. The psychological symptoms of perimenopause and menopause, such as low mood, irritability and trouble sleeping, are also familiar features in the postnatal period.

‘Medical understanding of perimenopausal symptoms can be poorly understood, and probably more so if the woman is breastfeeding as well, particularly outside of the perceived “normal” timeframe,’ says Dr Wendy Jones.

For this reason, it’s helpful to keep track of your periods (if you have them) and log all your symptoms on the balance app, in preparation for an appointment with your healthcare professional. This will help convey to your clinician the range of relevant information relating to your hormones, especially if you’re tired and might struggle to remember everything in the moment.

RELATED: A guide to period tracking

Taking HRT while breastfeeding

HRT often contains the hormones oestradiol, progesterone and testosterone. These are similar but have less risks and side effects than the hormones found in the combined oral contractive pill, which can be prescribed to women who are breastfeeding. HRT contains much lower amounts of these hormones, and body identical HRT (transdermal oestradiol, micronised progesterone and testosterone) mimic the natural hormones that your body produces. Although there are some studies that suggest the these hormones can pass into breastmilk, there is no evidence that this leads to any effects on the baby as they are the same as natural hormones.

Dr Wendy Jones says, ‘There remains no conclusive research on the passage of HRT medication into breastmilk but, anecdotally, HRT has been used by nursing women without impact on the infant or breastmilk supply.’

Dr Wendy Jones says, ‘If you take HRT when breastfeeding, there is a possibility of reduction in milk supply as the oestrogen content may inhibit the production of prolactin (the hormone that is responsible for the production of breastmilk). However, it appears anecdotally that there is less impact from using transdermal preparations, such as a gel, patch or spray, instead of taking oral HRT. The decision to take HRT should be that of the lactating mother, after discussion with her healthcare professional.’

Using vaginal hormones while breastfeeding

Local hormones (that are placed directly into the vagina) can be prescribed when breastfeeding, usually to help with the healing of stitches after childbirth, prolapses, or ongoing vaginal dryness. Breastfeeding can reduce natural vaginal lubrication for some women, so vaginal dryness can become a particular problem for those who are already in perimenopause.

Clinicians may prescribe vaginal hormones in the form of a pessary, cream, gel or silicone ring.

Written by
Dr Louise Newson

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28 Jan 2022

4 minute read

Written by
Dr Louise Newson

Dr Louise Newson is a GP and pioneering Menopause Specialist who is passionate about increasing awareness and knowledge of the perimenopause and menopause, and campaigns for better menopause care for all people.