Saturday 16 February 2019

Dear Dr Nina: Can I be perimenopausal while still breastfeeding?

Hot flushes and urinary symptoms can occur when you are perimenopausal
Hot flushes and urinary symptoms can occur when you are perimenopausal

Nina Byrnes

Q I am a 44-year-old woman, currently breastfeeding a one-year-old. As well as the usual exhaustion that accompanies working full-time, I am always hot. Even when people around me are cold, I feel like I am overheating. I am not getting much sleep - about four hours unbroken with maybe another hour or so here and there. Should I be worried about this? Could I be in perimenopause while breastfeeding or is it just a symptom of exhaustion? Does overheating mean something else?

Dr Nina replies: It can be hard to juggle new parenting and full-time work. I am not surprised that you feel tired. Breastfeeding is a great choice and you are reaping many benefits. It helps you lose baby weight. You can burn several hundred extra calories a day through breastfeeding alone. The hormone oxytocin released during feeding encourages the womb to shrink back to its normal size.

Breastfeeding reduces the risk of osteoporosis in later life. Those who breastfeed for two or more years of their life have a 24pc reduced risk of developing breast cancer. Breastfeeding may also reduce the risk of cancer of the womb and ovaries and it enhances the strong bond and emotional connection between mom and baby.

It is important if you are busy that you prioritise eating well and drinking plenty of fluids daily or you will feel even more tired than usual and your milk supply may suffer.

Menopause heralds the end of fertility. You are considered menopausal when a full year has passed since your last menstrual period. The average age of menopause is 52 with a range from late-forties to mid-fifties. It's not impossible that your symptoms are due to perimenopause. This starts up to 10 years prior to the end of menstruation. During this time, periods may change or become more erratic. Hot flushes and urinary symptoms occur in some. Other symptoms may include vaginal dryness, skin changes, weight gain, and mood changes.

Perimenopause could occur while breastfeeding. The hormones that control breastfeeding are brain-based, whereas fertility and menstruation rely on functioning ovaries and oestrogen.

It is most likely that you are suffering from menopausal-like symptoms due to breastfeeding. After childbirth and during breastfeeding, women's oestrogen levels can drop to lower levels than usual. These low levels of oestrogen can cause symptoms that mimic menopause. Low oestrogen levels cause hot flushes, vaginal dryness and all the other symptoms you describe. Finally, under- and over-active thyroid can occur post-pregnancy. This may also cause changes in perceived body temperature along with symptoms such as fatigue and skin changes. I would advise a-check up with your GP.

Simple blood tests can rule out thyroid or other disorder. Lifestyle measures may help make your symptoms more manageable. Wear loose cotton layers, use fans, avoid spicy foods and take a cold drink to manage hot flushes. Putting facecloths in the freezer and keeping one beside the bed at night can help relieve nocturnal symptoms.

When you stop breastfeeding, you will see whether these symptoms are transient or whether menopause is on its way.

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