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Prolactin and the return of ovulation in breast-feeding women

Published online by Cambridge University Press:  27 September 2011

Barbara A. Gross
Affiliation:
Endocrine Unit, Department of Medicine, Westmead Centre, Westmead, NSW, Australia
Creswell J. Eastman
Affiliation:
Endocrine Unit, Department of Medicine, Westmead Centre, Westmead, NSW, Australia

Summary

Cross-sectional studies in Australia and the Philippines and a longitudinal prospective study in a selected Australian sample of breast-feeding mothers have shown that basal serum prolactin (PRL) concentrations are elevated during 15–21 months of lactational amenorrhoea.

A predictive model of serum PRL levels and return of cyclic ovarian activity during full breast-feeding, partial breast-feeding and weaning has been developed from the results of breast-feeding behaviour and serum PRL, gonadotrophin and oestradiol measurements in 34 mothers breast-feeding on demand for a mean of 67 weeks.

Breast-feeding patterns influence serum PRL levels. Important factors during full breast-feeding are the age of the baby, the longest interval between feeds at night and total 24-hr suckling time, and following the introduction of supplements, the mean interval between feeds, together with the total 24-hr suckling time and the number of solid supplements per day.

The precise mechanisms whereby breast-feeding regulates cyclic ovarian activity remain unknown. Gonadotrophin secretion appears to be quantitatively normal, but qualitative changes, secondary to altered hypothalamic activity, may be the most important factor. A direct inhibitory effect of PRL on ovarian follicular development and steroidogenesis remains possible.

Ovulation with a normal luteal phase is probable for 30% of breast-feeding mothers before the first menses, but is unlikely before 6 months, provided breast-feeding is frequent day and night.

Measurement of serum PRL is a sensitive index of the return of menstruation and fertility during lactation in the population studied.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1985

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