Oestrogen creams and pessaries seem to be prescribed with increasing frequency to breastfeeding women to help with healing of sutures, prolapses or for ongoing vaginal dryness. There is little research evidence to guide a discussion of compatibility with breastfeeding.
Breastfeeding does seem to have an effect on natural vaginal lubrication for some and basics products such as KY Jelly®, Replens®, Sylk® and other products may help.
But for others oestrogen creams may be prescribed by the GP or an obs and gynae consultant.
It is known that vaginal absorption of oestrogen results in measurable amounts in milk (LactMed, Hale).
In Nielson’s study 6 lactating mothers were given vaginal suppositories (pessaries) containing 50 or 100 mcg of oestradiol. Levels of oestradiol were measurable in milk whilst before application of the pessaries the levels was below that of detection. According to Nielson a ratio of transfer of estradiol from plasma to milk during physiologic conditions is calculated to be less than 100:10. Peak levels were found in milk between 3 and 11 hours after application but was inconsistent and irrelevant with ongoing use. Outcome data is not given in the data that I have been able to access.
Nilsson S, Nygren KG, Johansson ED. Transfer of estradiol to human milk. Am J Obstet Gynecol. 1978;132:653-7.
Hale says vaginal absorption is greater than oral and quotes Chollet who studied atrophic vaginitis in post menopausal women. It is unclear what relevance this has to brestfeeding
Chollett J. A., G. Carter, et al. (2009). “Efficacy and safety of vaginal estriol and progesterone in postmenopausal women with atrophic vaginitis.” Menopause 16(5): 978-983.
Levels of oestradiol in the 2 most commonly used products are:
Ovestin – One applicator-dose contains 0.5 mg estriol.
Vagifem contains 10 mcg estradiol per vaginal tablet
neither product is licensed to be used in lactation.
Anecdotally some mothers have reported that their supply has dropped but by no means everyone.
Many mothers experience raised blood pressure it seems. Is this due to our busy lifestyles, more mums giving birth at an older age? Who knows but it causes a lot of confusion. The drug normally initiated if a mother has symptoms of pre-eclampsia is labetolol. It is usually continued after delivery until the BP has settled. Virtually none passes into breastmilk. However, some mothers with poor circulation may notice sore, white nipples where the supply to the tip is decreased . If this happens the drug may need to be changed. Prolonged high BP in pregnancy can lead to restricted growth of the baby who may be born sleepy. Rather than just monitoring blood glucose levels the baby should be helped to attach to the breast and feed regularly or be given colostrum by spoon or syringe. A drop of colostrum can work magic.
Later blood pressure rises can be treated with enalapril, amlodipine and felodipine which are all compatible with breastfeeding according to expert sources. The NICE Guidelines NG 133 (2019) can also guide good practice.
The data for this fact sheet is taken from my book Breastfeeding and Medication which provides more detail and references to studies. Please consider buying a copy for future reference.
these learning outcomes are aimed at pharmacy students but provide a valuable CPD tool for qualified pharmacists. Please note the link to training materials on this page
still time to register and listen
I have decided to stop travelling around as much to deliver presentations at conferences. Just feeling a little too jaded and yes I will admit old. But have decided instead to share the contents via this website in the hope that it can spread good practice further and more easily. Happy to answer any questions if you email firstname.lastname@example.org
If you find it useful maybe you would like to buy my book – on Amazon shorturl.at/kpuyI
Looking at online CPD modules this week sponsored by formula manufacturers has prompted me to make this information I wrote for a pharmacy magazine ( who haven’t responded), available freely on line. Please share with pharmacies and pharmacists as widely as possible. Would be useful for their CPD as well as increasing knowledge on breastfeeding and drugs in breastmilk. Would be supported by a copy of Breastfeeding and Medication in every pharmacy
One of the questions that frustrates me is “Can I continue to breastfeed immediately after a VQ scan, they think I may have a clot on my lungs? I’ve been told I have to stop feeding for 12 hours”. Most of these mothers have very young babies – often under 2 weeks so to dump that precious milk for 12 hours is really tough. There hasnt been enough time to build up expressed milk so necessitates the use of formula and a very premature end, against mum’s wishes usually, to exclusive breastfeeding.
The evidence is really hard to find. One option is to request a CT scan after which breastfeeding can continue as normal. The #dontsaystoplookitup poster refers just to CT and MRI scans and not to VQ scans
This information is from my book “Why Mother’s Medication Matters”
I am aware that most pharmacists do not receive any training on breastfeeding during their undergraduate studies. My own PhD studies showed that most of us gained our knowledge from our own personal experiences. As breastfeeding is acknowledged as a major public health area I have begun to prepare some training material for professionals – starting with my own. This is intended to provide a basic understanding of how pharmacists and their staff can help to support new mothers as part of their everyday working practice. More detailed presentations will follow on drugs in breastmilk. If you find this useful and want to know more please buy a copy of Breastfeeding and Medication