Breastfeeding and fertility

[brownelf]

Hello, I'm brand-new on this forum and came here because while researching my problem on the internet, I came across this very old thread:

http://www.mothering.com/community/t/265661/progesterone-supplements

I don't know if any of the people on that thread are still around here, or if they will see my post, but I'm hoping that someone here can help me.  Here's my situation:

My daughter is 28 months old, I don't want to wean her, and she doesn't want to wean.  I'm a strong advocate of child-led weaning and will tandem nurse if my daughter wants it.

I didn’t get my cycle back till my daughter turned 2; the month before her second birthday, I gently coaxed her to nurse a *little* bit less during the day, and hey presto, my period immediately returned.  We started trying to get pregnant, and here’s what’s been happening:

In September, I had a very strong feeling that I’d conceived, and a few very mild pregnancy symptoms, but my period came just a few days late.  I was still fairly sure that I’d had at least a chemical pregnancy, even though I never took a pregnancy test.

This month, my period was a week late, and I finally decided to take a test.  It was one of the ones that tell you how much time has passed since conception (and yes, I know they’re not 100% accurate, but hear me out).  I tested positive, but it said I was only 1-2 weeks past conception even though I’m 100% sure it must have been at least 3 weeks.

About an hour after taking the test, I started bleeding pretty heavily—bright red blood and heavier than a normal period, so I’m pretty sure it was an early miscarriage.

I’m beginning to suspect that my progesterone levels are just too low right now to sustain a pregnancy past the first few weeks, because of Ru’s nursing. Low hormone levels would also explain why the test said I was only 1-2 weeks past conception.

Right now, Ru is down to nursing 3 times during the day: morning, naptime, bedtime, but the huge problem is that she nurses constantly, CONSTANTLY at night.  We’re working on cutting that down; my lovely husband put her in the wrap last night and walked her around every time she asked to nurse, and he plans to do this every night if necessary.  I’m feeling terrible about it, somehow—even though I know that she’s still getting love and cuddles and that she’ll be fine and I can nurse her when she wakes up, I still feel terrible.  I know that in traditional co-sleeping cultures toddlers wake up to night-nurse until the age of 3 or 4 and so I can’t help feeling that I’m denying my little girl something she needs.  Even if she doesn’t need it physically because she eats lots, she must somehow need it psychologically or she wouldn’t be asking for it.  (I’m thinking aloud here—I know I’m not necessarily being logical, and maybe I just need a stern-yet-kindly talking-to.)

On the other hand, I’m in my mid 30s and I also can’t wait forever to have a second baby.  I don’t know whether I should be supplementing with hormones in some way; I live in France where I’m very, very unlikely to find a doctor who is supportive of bf-ing during pregnancy or of tandem nursing.  I’m going to see a doctor on Friday anyway, but I’m pretty sure she’ll tell me to wean completely.  I can't do that.  Honestly, if I have to choose between weaning my daughter and never having another child, I don't know which I'll choose.

But I can't shake the feeling that my body just needs some extra progesterone.  I fall pregnant very easily, no problems there, but just can't seem to sustain the pregnancy past 5 weeks + a few days.  After reading the old thread I posted above, I'm even more convinced that my problem could be solved with progesterone supplementing.  I know it would lower my milk supply, but so would normal pregnancy, and I don't think this will bother my daughter; she's so attached to comfort nursing that I think she would keep nursing until the baby arrived and my supply came back.  I guess I'm looking for other mothers on here who used progesterone while breastfeeding: what did your doctors tell you?  Did anyone have recurring early miscarriages and then manage to sustain a pregnancy using progesterone while breastfeeding?

Thanks in advance for reading -- I know this post is ridiculously long!

[AdinaL]

You could try some of the over the counter progesterone cream?  If you are seeing a doc, I would get my P4 level checked to see what it was like during the luteal phase.  Have you been charting at all? Do you know how long your luteal phase is?

[brownelf]

Thanks, AdinaL -- yes, I'm seeing a doctor tomorrow, it's just that I'm not terribly optimistic that she'll be supportive of bf-ing while pregnant, so I'm trying to gather as much information as I can in preparation.

To be honest, I haven't been charting meticulously, because I had no problems getting pregnant with my first child and didn't really anticipate this problem -- in fact, I still don't have problems *getting* pregnant, I only have problems *staying* pregnant!  But even if I haven't been properly charting, I've been paying attention to other signs of ovulation and I think my luteal phase is 12 or 13 days, though I can't be 100% positive.  If I did have a luteal phase defect, though, could I still have reached 5 weeks + a few days?  I've been trying to research this too, but am not sure; I thought a luteal phase defect meant you'd only have chemical pregnancies and that your period would be on time or only a few days late, not more than a week late.  But maybe I'm mistaken?

I do of course plan to start charting more carefully now.

As for the OTC progesterone cream, I'm considering it, but I'm not sure about the dosage.  How do you measure the dosage to be certain you're getting the right amount?  Obviously, if I were pregnant and breastfeeding I'd want to be very careful messing around with hormones on my own and wouldn't want to risk the health of either my nursing toddler or my developing baby.  I've looked at the creams online and can't figure out how you're meant to know how much progesterone you're getting....

[AdinaL]

In addition to seeing the doc, I'd chart really well for a couple of cycles to get a good picture of how long your luteal phase is, but if you have been conceiving, then chances are it is fine.

The doctor will likely tell you to wean your child to get pregnant, especially if as you say, they aren't supportive of nursing while pregnant.

The progesterone creams are usually in a pump that meters out a dose. One pump = one dose.  They are pretty mild, unlike shots, suppositories or pills.  

[JMJ]

I'm so sorry to hear about your loss(es).  It's still considered to be a luteal phase defect if you are low in progesterone and are getting pregnant and then having recurrent miscarriage.  Are you having spotting at any other time throughout your cycle, like brown bleeding after your period or spotting before you start your period?  Are you taking your temperature at all?  (A weak temp rise at ovulation is a sign of a LPD.)  These may be signs of low progesterone.  Additionally, if you are temping and notice that your temp is not staying up after ovulation when you are pregnant, you will want to supplement with progesterone because it might be able to prevent a miscarriage.  Charting will give you many more clues as to what is going on and if low progesterone is actually your problem.

It is quite reasonable to suspect low progesterone while breastfeeding because progesterone and prolactin are somewhat antagonistic towards each other.  That is a large part of why many women have difficulty conceiving while breastfeeding and why most women will lose their milk at some point in pregnancy.  Besides supplementing with progesterone, there are other things that you can do that could help tip the balance in favor of progesterone.  Vitamin B6 is used to treat women with high prolactin to help them conceive and has helped many breastfeeding women conceive.  It may have the effect of reducing your milk supply slightly, but it sounds like you're ready for that.  Also, since progesterone is fat-soluble, if you are underweight (or even a healthy weight is not enough for some women), you may be able to conceive just by gaining a few lbs.  While breastfeeding, I had to gain a couple lbs over my pre-pregnancy weight from my first in order to conceive.  Being overweight can also be a problem.  Additionally, time helps.  If you're cycling and having 12-13 day LP's and being able to successfully conceive, it is likely that your body is almost ready to sustain a pregnancy, and within a few more cycles, you'll be there.

[brownelf]

JMJ, I can't thank you enough for your kind and helpful message. 

I was surprised and relieved that the doctor didn't suggest that I wean my daughter.  She did acknowledge that breastfeeding may be keeping my progesterone levels low, and she wrote me a prescription for progesterone pills.  They're the type of pill that you take for 10 days of your cycle -- since I have about a 30-day cycle, her instructions were to take the pill from day 18 to 28.  It's synthetic progesterone, of course, and some of it does pass into the breastmilk, but she said it would only be a tiny amount and that I could take the pill immediately after a nursing session to minimise the effects on my nursing toddler.

I do plan to do some more research on the possible side effects on my daughter before starting this pill.  My feeling is that if I'm already taking this pill, I wouldn't want to take Vitamin B6 on top of that (?).  I'd heard about Vitamin B6 and fertlity, and had already been considering it as an option, but I was really surprised that this doctor didn't know anything about it.  I think my three options now are:

1) the prescribed pill;

2) Vitamin B6

3) waiting and allowing time to do its work, while also reducing the number of nursing sessions per day.

If I knew for sure that it would only be 2-3 cycles before I'd be able to sustain a pregnancy, I'd definitely choose option (3).  But I don't know that, and I know that when I was waiting for my period to return, there were signs that it was imminent for at least 4 or 5 months before it actually came back.  I'm not underweight; I'm more or less at a healthy weight, though I was the thinnest I'd ever been when my daughter was 12-18 months old and have now regained some of that weight.  I don't know that gaining more weight than this will help.  I do plan to begin charting carefully either way, just to have a better idea of what's going on, but I'll probably end up going with either option (1) or (2), depending on what I can find out about this pill.

Thanks very much once again to both of you for reading and for offering advice.  If you have any additional thoughts on the matter, I'd love to hear them.

[JMJ]

It's such a relief when you find a physician who is supportive of the choices you're making.  I'm glad to hear you had a good experience.

As far as waiting goes, you're right, it could take just a few months, or it could take much longer.  It is usually not a really, really long time (like less than 6 months to a year after first PPAF), but for some women, it is longer, and you're right, there are no guarantees.

As far as Vitamin B6 is concerned, it may reduce the amount of time, but there's still no guarantees.  It sometimes takes some time to act, and for some women, it is not enough.  In my own experience, my first PPAF came back in December.  I started targeting Vitamin B6 in foods in March.  I had my first probably fertile ovulation in May, and I conceived in June.  Every woman is different, but sometimes it helps to have an idea of what the timeline could be.  I'm not too surprised that your physician didn't recommend Vitamin B6.  Most MD's are pretty familiar with drugs but not as familiar with more natural treatments that often work about as well as the drugs.

The advantage to Vitamin B6 is that it supports your own body in providing its own natural progesterone.  The advantage to the progesterone pills is that it cuts out a step.  It doesn't rely on your body to start producing more progesterone.  It gives it more progesterone.  Therefore, it will usually act faster, but do know that there are never any guarantees.  If you are charting carefully, I wonder if you have an advantage when it comes to knowing when to take the progesterone supplements.  The reason to only take them the last 10 days of your cycle is that you only need progesterone supplements in your luteal phase.  If you are charting, you can be sure you ovulated before you start taking the supplements, and you might see if you could call your physician to ask how many days post-ovulation would be best to begin.  That way, if you have delayed ovulation one cycle or super-early ovulation in another cycle (cycle variation is very common as your cycle is finding its way back to normal postpartum), you know exactly when to maximize the effect of the supplement.

[brownelf]

Thank you again, JMJ.  That's a really good idea: re charting to know exactly when to take the supplements.  In your first reply, you asked me if I had any spotting or bleeding mid-cycle, and I forgot to answer: I don't.  I've never had any kind of mid-cycle bleeding, before my daughter was born or after my cycle came back.  I have regular 4-5 day periods, about 30 days apart, but I do need to start charting to know about about luteal phase and exact day of ovulation.  Maybe once I start charting I might even have a clearer idea of how close I am to a viable luteal phase.

I'm going to wait a full cycle before trying again, anyway, so in the meantime, I will try to eat Vitamin B6-rich foods, before starting the pill.

[texasfarmom]

Hi brownelf! I just wanted to reply with any info/my experience that might help you. I think JMJ is right on with everything she said. I have been using Progestelle to help lengthen my LP. It is a natural progesterone cream. I've also been taking 60 mg of B6 daily. I spoke with Dr. Eckhart, the dr behind the Progestelle who has done a lot of research on progesterone. I told him about my concern that my DD, who is still nursing, will get the hormone through my breastmilk. He assured me that, even though she would, it was nothing to worry about because she has already been exposed to much higher doses of progesterone while in utero. He also explained to me that Progestelle would have less side effects than the prescription pills. I found that website very helpful, and if you would like to talk to Dr. Eckhart you can e-mail or call the number on the website. I learned a lot!

I decided to try the NPC to not only lengthen my LP, but also because I had two miscarriages before I had my DD. I spoke with my OB at the time and we decided I should take Prometrium during the 1st trimester of my 3rd pregnancy. Well, it helped! :) So, I'm assuming I may need a little help sustaining another pregnancy; I don't want to risk a miscarriage.

Also, I have not seen a drop in my milk supply while taking the B6 or the NPC. Of course, like JMJ said, everyone is different. I'm just hoping my sharing can help you!

[brownelf]

Thank you so much, Texasfarmom.  Yes, everything I've read seems to indicate that there are differences between natural and synthetic progesterone and that the latter may have side effects for both mother and baby.  I can get natural progesterone cream here without a prescription, as well as Vitamin B6.  But to get Prometrium -- which I think is safer than the pill my doctor prescribed (Duphaston) because it's micronized natural progesterone (?) -- I need a prescription as I'm not willing to buy Prometrium illegally on the internet.  I'll ask my doctor if she can switch my prescription to Prometrium; I know that it's available in France so I don't see why she wouldn't be able to change my prescription.  Can I ask if you ever taken Prometrium while nursing an older child?  If so, have you seen any side effects on you or on the nursing child?

When you were taking NPC and Vitamin B6, what dosage of the NPC did you take?  And did you take these throughout your cycle or only during your luteal phase?  At what point in the pregnancy would you switch from NPC + Vitamin B6 to Prometrium?

I'm sorry to ask so many questions; although my doctor is supportive of my nursing my toddler, I think extended nursing and tandem nursing are rare enough here that doctors simply don't know much about it, and I can't get the information I need just from my doctor.  Thank you in advance for anything you can tell me.

[texasfarmom]

Originally Posted by brownelf 

Thank you so much, Texasfarmom.  Yes, everything I've read seems to indicate that there are differences between natural and synthetic progesterone and that the latter may have side effects for both mother and baby.  I can get natural progesterone cream here without a prescription, as well as Vitamin B6.  But to get Prometrium -- which I think is safer than the pill my doctor prescribed (Duphaston) because it's micronized natural progesterone (?) -- I need a prescription as I'm not willing to buy Prometrium illegally on the internet.  I'll ask my doctor if she can switch my prescription to Prometrium; I know that it's available in France so I don't see why she wouldn't be able to change my prescription.  Can I ask if you ever taken Prometrium while nursing an older child?  If so, have you seen any side effects on you or on the nursing child?

I have not taken Prometruim while nursing.

When you were taking NPC and Vitamin B6, what dosage of the NPC did you take?  And did you take these throughout your cycle or only during your luteal phase?  At what point in the pregnancy would you switch from NPC + Vitamin B6 to Prometrium?

I use 20 mg/day of Progestelle during my LP only. I'm sure the dosage may be different for each cream. I use the B6 every day. I won't switch to Prometrium at all during pregnancy. I will continue the B6 at least through the first trimester because it can help with morning sickness. I will continue to use Progestelle probably until about 16 weeks. Dr. Eckhart said he will e-mail his protocol for using the NPC to prevent miscarriage whenever I would like that info.

I'm sorry to ask so many questions; although my doctor is supportive of my nursing my toddler, I think extended nursing and tandem nursing are rare enough here that doctors simply don't know much about it, and I can't get the information I need just from my doctor.  Thank you in advance for anything you can tell me.

Ask away! I'm not an expert, I've just learned a lot from other mammas and doing my own research, but I'm happy to share what I can.