If you are trying to induce lactation by pumping and taking Domeperidome as many women do, you need to know that there are times of the month when you will be far more effective in your efforts than others. There are times when you want to really maximize your efforts to jump ahead.

Monthly Cycle is a Miniature Pregnancy:

First you should know that each monthly cycle is a miniature of the hormonal cycle of pregnancy. At the beginning of the month Estrogen rises rapidly. This causes a new lining to begin growing in the Uterus and stops the menstrual period. This rise in Estrogen usually makes a woman feel good and many desire to have sex again. With the beginning of a pregnancy the rise in Estrogen (up to 20x higher than a normal cycle), makes most women experience morning sickness but feel great when they get used to it. Estrogen levels peak just before ovulation. With ovulation Progesterone begins to be produced and rises rapidly. This also corresponds with a second peak in desire to have sex for women. Progesterone dominates over Estrogen in the second half of the cycle although both hormones are high. In pregnancy both Estrogen and Progesterone are high. Estrogen stimulates the uterus to contract while Progesterone causes it to relax, stretch and accommodate the growing fetus. The balance between these two hormones is what causes a healthy pregnancy to go to term and finally go into labor. When a woman has a lot of cramping with the onset of her menses increasing her Progesterone level can often counteract this because this cramping is a parallel to labor. When a woman delivers the placenta following the baby, levels of Estrogen and Progesterone plummet. The ovaries are very quiet at this time and not producing any Estrogen or Progesterone. The hormones have been coming from the placenta. The woman experiences Estrogen withdrawal and this may cause the “Baby blues” or post-partum depression. This normally is of short duration as the mother adjusts to the low Estrogen state. The drop in Estrogen causes Prolactin to rise and her milk comes in about the third day, usually with a bang. She may become engorged with her breasts in overdrive at this time. Back to the monthly cycle- the delivery actually corresponds to the precipitous drop in Estrogen and Progesterone taking place a few days before the onset of the next menses. The drop in Estrogen causes some women to experience Estrogen withdrawal and PMS or Pre-menstrual syndrome. Like post-partum baby blues, she may be moody, cranky and cry easily etc. The drop in Estrogen also causes Prolactin to increase bringing on some fluid retention and breast tenderness, making the breasts feel more glandular. This Prolactin increase causes some pre-lactation changes and readiness for lactation. This corresponds to the post-partum state. At this time the nipples exhibit the greatest sensitivity to stimulation and will put out the greatest amount of Prolactin. Unfortunately the combination of an awareness of an impending menstruation with the moodiness of Estrogen withdrawal and the desire to not have the breasts touched because they are tender tends to minimize any nipple stimulation that may otherwise occur and thus prevent lactation under normal circumstances. The greatest amount of Prolactin release in response to nipple stimulation occurs from about 4 days before menses to about 3 days after. The least response occurs when Estrogen is highest and a woman is fertile- plus and minus about 4 days around ovulation.

Monthly Breast Development

When a girl goes through puberty ovaries start to become active and Estrogen rises. Once she starts ovulating she produces Progesterone. Breast development goes on for several years, often not reaching full development until age 17 to 20. During these years the breasts develop a little with each monthly cycle. The beginning of the cycle Estrogen predominates, after ovulation Progesterone dominates then through the end of the cycle and menses Prolactin dominates. Estrogen turns on a gene set that causes elongation and development of the duct system. Progesterone causes the growth and development of the alveoli and Prolactin remodels the alveoli into more complex, functioning alveoli. Each of these three gene sets, controlled by their respective hormones, can only be active alone. In other words, when the duct system is being remodeled the alveoli are turned off for lactation. When more alveoli are being developed the duct system remains unchanged etc. It is for this reason that sequential hormones are more effective than trying to stimulate with two different hormones at the same time and you should only ask the breasts to do one thing at a time. The sequence of hormones each month causes the breasts to develop a little bit and then the sequence is repeated with the next cycle.

The ability to respond to only one hormone at a time is more clearly illustrated with the Uterus. In the beginning of the month Estrogen causes a lining to develop, then Progesterone causes the lining to mature, developing secretory function with the ability to support a pregnancy. Developing alveoli in the breasts is a similar “secretory” function. If these two hormones do not effect the development of the lining in sequence the lining will not be proper and mature. Problems will occur including infertility and abnormal menses. Progesterone alone, without Estrogen first will result in no lining. Estrogen without Progesterone following will result in a lining that will not detach properly during menses causing difficulty. With the uterus the entire lining that was developed during the past month is shed and it starts over new. With the breasts the development of the last month is retained, but the breasts start over with the new cycle adding to what has been previously developed.

The sequence of hormones is also reinforced by the fact that when the breasts are stimulated by Estrogen during the first part of the cycle the cells put out receptors for Progesterone to cause them to become much more sensitive to the following Progesterone stimulation. Progesterone stimulation then causes the cells to put out Prolactin receptors that cause the breasts to become sensitive to the subsequent Prolactin stimulation. Prolactin stimulation causes the cells to put out Oxytocin receptors that cause the breasts to become sensitive to this hormone as well.

Inducing Lactation:

For women wanting to start lactation induction, the best time would be about 4 days before the onset of menses and stimulate as much as possible all the way through. Suckling during the time of menses usually doesn’t cause immediate milk production- it is delayed by a few days, but it does cause activation of the alveoli so that they will start to produce more milk soon after menses is over. When the alveoli remodel from inactive to active milk production they cannot produce milk. This activity is controlled by a gene set that is turned on by Prolactin. A different gene set is turned on for milk production by the alveoli. Many women have noted that their milk production decreases during menses but then returns at a higher level after, this is why. Women who have the problem of lots of premenstrual symptoms including fluid retention, breast swelling and tenderness have a hidden blessing of breasts that are almost ready to lactate.

When a woman breastfeeds after delivery the elevated Prolactin produced inhibits her ovaries and keeps her in the post-partum hormonal state of low Estrogen and high Prolactin. She is able to produce lots of milk, hopefully. She will also not ovulate or have a menses until a decrease in suckling allows enough escape stimulation of her ovaries to cause her Estrogen to rise. If a woman starts her induction before menses as described above, and stimulates frequently enough, her ovaries can be suppressed enough to allow her to ease directly into a “post-partum state” and not ovulate or perhaps have a menses on her next month. If this woman is blessed with breasts ready to lactate as described above, she very well may be able to lactate significantly within as little as 2 to 4 weeks from onset of stimulation.

Most women do not experience this level of response. What usually happens is stimulation around the time of menses causes some prelactation changes and partial suppression of the ovaries. Estrogen rises and ovulation takes place and the stimulation through about ½ of the month simply is coasting with no actual progress until the time of the increased sensitivity on the next cycle. Some induction changes have occurred however and will accumulate to bring about eventual lactation in typically about 4 months, sometimes longer.

There is something that makes up for the low Prolactin release at the time of ovulation. It is the increased Prolactin receptors that have been put out by the previous months Progesterone. This of course, makes the breasts more sensitive to the lower Prolactin level so that a breastfeeding mother can maintain a steady output even after she resumes ovulation. As you can see… women are complicated.

DrJim

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