Q: I utilize progesterone therapy in my chiropractic/acupuncture practice but cannot find information about the use of it postnatal. I have a patient who had great success with eliminating fibroids with progesterone use and quit mid-pregnancy, which allowed the fibroids to return. I want to start her on the therapy again, but want to confirm the safety with breastfeeding. Can you point me in the direction to find such information? I would greatly appreciate it.

A: The general wisdom among doctors who use bioidentical hormones is that progesterone cream, in small, physiologic (what the body would make) doses is OK if needed. A typical physiologic dose would be 15 to 30 mg daily. “If needed” situations might include post-partum depression or estrogen dominance symptoms. Most doctors don’t start women on progesterone until a few months after birth, to be sure that breastfeeding is well established. Theoretically progesterone could reduce milk flow.

Fibroids tend to shrink when the overall hormonal milieu is low, and grow when it’s high, so it’s likely that the mid-pregnancy return of the fibroids was due to the high progesterone and estrogen levels that occur in the second and third trimesters. Since hormone levels are low after pregnancy and during breastfeeding, she may not even need the progesterone to keep the fibroids small.

According to conventional medicine, it’s OK to give women hormonal contraceptives while breastfeeding; in fact some doctors will even implant the progestin-containing Mirena IUD right after birth. It’s been shown that some of the progestins do reach breast milk. Since progestins are essentially toxic to grown women, I can’t imagine how they could possibly be OK for a nursing infant who is exquisitely sensitive to hormone effects. There has certainly been no in-depth research into how progestins might affect an infant’s health in the long term, beyond a few months of tracking weight and growth.

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