Breastfeeding and Menopause: Understanding Hormonal Intersections Across Life Stages

The hormonal shifts of menopause and the demands of lactation typically occur during separate life stages. However, in some cases, these processes overlap, raising important clinical questions for individuals lactating in their 40s or beyond. The successive or simultaneous experience of perimenopause and breastfeeding, though less frequently discussed, represents a complex and hormonally nuanced chapter in women's health.

The relationship between breastfeeding and perimenopause includes how lactation interacts with hormonal balance, the timing of menopause, and the physiological capacity for milk production beyond the standard reproductive window. For those considering hormone replacement therapy (HRT) during this time, questions often arise about its safety while breastfeeding.

Systemic HRT is usually not recommended due to potential risks, but local estrogen treatments may be an option for managing vaginal symptoms. It's also important to note that breastfeeding can cause menopause-like symptoms, such as hot flashes or vaginal dryness, because of low estrogen levels during lactation. Understanding these effects, along with current clinical guidelines, is essential for making informed decisions.

Can breastfeeding cause menopause symptoms?

Breastfeeding can trigger a unique hormonal state that, for some women, may feel similar to that of menopause onset.

The Role of Estrogen and Other Hormones in Lactation

Lactation depends on a coordinated hormonal system. Estrogen helps stimulate the growth of breast tissue during pregnancy, preparing the body for nursing. However, once lactation begins, estrogen levels must drop for prolactin and oxytocin to take effect.⁽¹⁾

• Prolactin: The pituitary gland produces this hormone essential for milk production. Its levels rise when a baby suckles or when the breasts are manually stimulated.⁽¹⁾

• Oxytocin: This hormone causes the milk to be released from the milk ducts. It also helps the uterus contract after childbirth.⁽¹⁾

• Estrogen and Progesterone: While these hormones are vital during pregnancy, their levels must decline after birth to allow the lactation hormones to function optimally.⁽¹⁾

During the breastfeeding period, prolactin levels rise. This suppresses two other hormones: gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH), which causes estrogen and progesterone levels to drop. In most cases, these hormone shifts cause a temporary state of infertility, known as lactational amenorrhea. This state is a natural effect of nursing that can delay the return of regular menstrual cycles.⁽¹⁾⁽²⁾For those who continue breastfeeding beyond a year — often called extended or prolonged breastfeeding — lactational amenorrhea may last longer. And while it’s completely safe, it can stir up symptoms that may feel identical to those of menopause onset.

Hormonal Side Effects of Breastfeeding

Some symptoms that may arise during long-term breastfeeding include the following:⁽²⁾

• Vaginal dryness

• Lower sex drive

• Irregular periods or no periods at all

• Bone density loss

• Sleep issues (more related to motherhood than breastfeeding)

• Hot flashes or night sweats (not common)

However, it’s important to know that the hormonal effects from breastfeeding typically subside and go back to normal once nursing stops, including a return to normal bone density. In contrast, the changes from perimenopause are part of the gradual transition that continues over time.⁽²⁾

Interestingly, recent evidence from the Nurses' Health Study II revealed that women who had children and breastfed for longer were less likely to go through menopause early. For example:⁽³⁾

• Women with three full-term pregnancies had a 22% lower risk factor of early menopause than those who had never given birth.⁽³⁾

• Breastfeeding exclusively for seven to 12 months was associated with the greatest reduction in early menopause risk.⁽³⁾

This suggests that hormones involved in breastfeeding may help protect the ovaries from aging too quickly. One possible reason is that women who breastfeed have fewer ovulation cycles over their lifetime, which may help preserve their supply of eggs.⁽³⁾

Overlap of Perimenopause and Breastfeeding

Perimenopause generally begins in a woman's late 30s to early 40s and can last up to 10 years or more. In this window, it’s not uncommon for some individuals to conceive and breastfeed while already in the early phase of the menopause transition.

Estrogen and progesterone levels fluctuate and gradually decline during perimenopause. When this life stage overlaps with breastfeeding, the result may be a compounding of hormonal signals, often leading to an increase in symptoms. 

As prolactin suppresses estrogen during lactation, perimenopause brings its own decline in estrogen levels, causing symptoms like vaginal dryness, spotting, and low libido to become more noticeable. These coinciding sensations can be physically and emotionally challenging because they make it difficult to tell whether the body is reacting to lactation or is transitioning into menopause.⁽²⁾

Is lactation possible after menopause?

While rare, lactation after menopause is biologically possible. Historically, menopausal women sometimes served as wet nurses, providing breast milk when the mother was unfit to do so or when she selected a household worker to do so on her behalf. 

In modern times, an individual who undergoes an emergency hysterectomy postpartum may breastfeed even without a uterus. This is because the hormonal system remains intact, allowing for continued lactation without the onset of surgical menopause.

Milk production is driven not by reproductive age, but by hormonal cues. In order to lactate, functioning ovaries and a uterus are not needed, only a well-functioning pituitary gland. Because of this, postmenopausal individuals have successfully lactated through a process known as induced lactation, which can include the following:^(1)(2)(4)

• Taking low-dose hormones like estrogen and progesterone for a short time, followed by a withdrawal period

• Using medications called galactagogues to boost milk production

• Regularly stimulating the breasts through pumping or nursing

In extremely rare cases, a person might begin making milk after menopause without trying to. This can happen when the body produces too much prolactin, often due to an issue with the pituitary gland (called a prolactinoma) or as a side effect of certain medications.⁽⁵⁾

The physiological possibility of producing breast milk after menopause has contributed to a growing interest in hormonal lactation support and menopause breastfeeding success stories, particularly when it comes to late-in-life parenting or adoption.⁽⁴⁾ 

Can HRT be prescribed while breastfeeding?

In most cases systemic hormone replacement therapy (HRT) is avoided while breastfeeding because it can interfere with prolactin and reduce milk supply. However, not all forms of HRT carry equal risk.

• Local estrogen as an exception: Low-dose vaginal creams or other topical treatments for symptoms like dryness or urinary discomfort are sometimes considered compatible with breastfeeding, as they involve minimal systemic absorption..⁽⁴⁾

• Key decision factors: A physician will assess whether HRT is appropriate based on severity of menopausal symptoms, age of the nursing infant and current milk supply, type and dosage of hormone therapy being considered, and personal health history, including any hormone-sensitive conditions⁽⁴⁾

Decisions about using HRT during lactation should be made in consultation with a certified menopause specialist who can weigh the risks and benefits for both the parent and the infant. Once a child transitions from breastfeeding to formula or regular foods, HRT can become an appropriate option for managing menopause symptoms.

Risks and Benefits of HRT During Breastfeeding

Risks

• Systemic estrogen therapy may suppress prolactin and reduce milk supply.

• Small amounts of estrogen may pass to the nursing infant.

• Most clinicians avoid systemic HRT until after breastfeeding ends.^(1)(2)(4)

Benefits

• Local estrogen therapy may relieve vaginal dryness, pain during intercourse, or urinary symptoms without affecting milk supply.⁽⁴⁾

• Estrogen has been used to help induce lactation in non-menopausal cases, such as adoptive breastfeeding.

Medical supervision is essential in these cases, and individual assessment is key. If menopausal symptoms are significantly impacting quality of life and non-hormonal therapies are ineffective, local low-dose estrogen therapy may be considered.

Winona's expertise is in helping menopausal individuals. For that reason, Winona doctors do not prescribe HRT to help women induce lactation. 

Navigating Menopause Symptoms While Breastfeeding

Because both stages affect hormone levels in different ways, dealing with menopausal symptoms while breastfeeding can be challenging. The body’s natural hormone changes during breastfeeding can make menopause symptoms feel stronger and disruptive. 

Supportive strategies may include the following:⁽²⁾⁽⁶⁾

• Vaginal moisturizers or lubricants

• Diets rich in phytoestrogens and calcium

• Pelvic floor therapy

• Adequate sleep (when possible) 

• Psychological support or therapy

• Stress management (to regulate cortisol and reproductive hormones)

These non-hormonal methods may not fully resolve symptoms, but they can improve quality of life and provide valuable support until HRT becomes an option. 

Symptoms like hot flashes, night sweats, and mood shifts should be checked by a healthcare provider to figure out whether they are caused by breastfeeding or perimenopause. A provider who understands both breastfeeding and midlife hormone care can help create the best plan for support.

The Intersection of Lactation and Menopause

Both breastfeeding and menopause involve profound hormonal changes. When these phases overlap — due to extended nursing, later-in-life pregnancies, or induced lactation — the hormonal fluctuations can be complex. Recognizing these shared symptoms and underlying mechanisms can support a clearer understanding of this unique life intersection.

As research continues to evolve and clinical care becomes more tailored, individuals can receive support through personalized approaches that address both their breastfeeding goals and the hormonal challenges of midlife.