Fertility and lactation
Potts, M.
Ippf Medical Bulletin 11(1): 2-3
1977
ISSN/ISBN: 0019-0357 PMID: 12335017 Document Number: 445563
Inhibition of ovulation during breast-feeding seems due to the release of catecholamines in the hypothalamus, which in turn elevates the level of circulating prolactin by the anterior pituitary. This prolactin release is associated with low levels of luteinizing hormone release, but seems to have no effect on follicle stimulating hormone release. Prolactin appears to also inhibit ovarian release of estrogen and uterine bleeding does not take place. This response may be even more related to environmental stresses than realized. A woman who is protein-deficient has less milk volume and the baby must suck harder. This stimulates the nipple more, increasing prolactin release. In traditional societies the lactation spacing is more efficient than many modern methods of birth control. Use of contraceptives during lactation poses problems. A woman who uses oral contraceptives and then stops returns to ovulation more quickly than a woman who does not use such contraception during lactation because gonadotropins are stored in the pituitary and then released when the oral contraceptives are stopped. Combination contraceptive pills should not be given earlier than 6 months after delivery and progestagen alone may be more appropriate for lactating women. Depo-Provera appears to elevate prolactin levels which may explain why it may increase quantity of breast milk and is also associated with prolonged periods of amenorrhea and galactorrhea after administration. Promotion of breast-feeding would be advantageous for birth control, but it is difficult to persuade women to continue to breast-feed in urban areas.