When it comes to menstruation and breastfeeding, just about anything can be considered normal. Some moms get their periods when the baby is two or three months old, even if they are exclusively breastfeeding. Other moms may be partially breastfeeding and not get their cycle back until they wean. It just depends on the mother and how sensitive she is to the hormonal influences of breastfeeding. It may also be influenced by how often the baby is nursing, if the baby is supplemented with bottles, if the baby takes a pacifier, how long the baby sleeps at night, and if solids have been introduced.

Once menstruation returns, it may be irregular for a while as mother continues to breastfeed. There may be some nipple tenderness associated with the onset of the cycle as well. Once the cycle returns, mother *is* fertile. She can also be fertile BEFORE the first cycle. Fertility is influenced initially by the amount of time baby is at the breast.

Hormonal changes associated with the cycle may bring about the following temporary conditions: tender nipples, irritability, unsettled feeling, , or increased moodiness in mother; headaches (often associated with PMS); a slight dip in milk supply (usually not a big problem); slight change in taste of mother's milk.

If there is a significant dip in supply, mom can use the usual methods suggested for boosting supply. She can also add a calcium/magnesium supplement to her diet when ovulation occurs and continue it through the first or second day of her period. If mother just experiences some nipple tenderness during ovulation or at the onset of her period, the herb Evening Primrose Oil may be helpful.

Birth Control

While most breastfeeding advocates recommend nursing mothers avoid hormonal forms of birth control, there are a few options available that are considered compatible with breastfeeding.

Most doctors will suggest the breastfeeding mother use Micronor, commonly called the "Mini-pill". Micronor is a progestin-only pill. This means that the problems, particularly reduction in supply associated with combined pills (containing estrogen) are usually avoided, but this doesn't hold true for every mother. For this reason most experts suggest mother wait at least six weeks, or until her milk supply is well established before beginning any form of hormonal birth control. Estrogen-containing contraceptives should be avoided till at least after the 6th month and once the baby is well-established on solid foods.

Some mothers have considered using an IUD, or Intrauterine device. The Copper IUD is non-hormonal and is considered compatible with bf. Mirena is a plastic device that has a tiny storage system of a hormone called Levonorgestrel (progestin hormone). This hormone is also used in contraceptive pills such as Eugynon, Logynon, Microgynon, Ovran 30, Ovranette and Trinordial. In the Mirena, however, a much lower dose is released than when you take the Pill (about 1/7th strength), and it goes directly to the lining of the womb, rather than through the blood stream where it may lead to the common progesterone-type side effects. It is not supposed to interfere with milk supply but moms are urged to wait until they have a well established milk supply before starting this or any horomonal birth control.

The Depo Provera shot has been used because it has no estrogen, but is not recommended by many breastfeeding advocates because if the mother DOES have an adverse reaction (drop in milk supply) she cannot just "stop" this, but must wait for it to work out of her system.

More information on breastfeeding and birth control :

http://www.parksville.net/wellness/1098/breastfeed101598.htm

http://www.kellymom.com/health/meds/birthcontrol.html

http://www.parentsplace.com/expert/lactation/archive/0,,239843,00.html

Vaginal Dryness

Many breastfeeding mothers experience vaginal dryness, resulting in difficulty "making love". It may be almost impossible for some mothers if the dryness is extreme. It is important to understand that vaginal dryness is related to the hormonal influence of breastfeeding, and it is not a permanent problem. It is, in fact, part of nature's "birth control".

Taking extra time for foreplay can be helpful, and being romantic goes a long way in helping each other through a difficult time

To ease vaginal dryness, products like Astroglide, Replens, or regular KY-jelly is fine to use. In extreme cases, a vaginal estrogen cream is used. A couple of examples include Estrace and Estratab, both of which have been approved by the American Academy of Pediatrics for use in breastfeeding mothers. Estrogen therapy has the potential to lower your milk supply. Although estrogen suppositories don't seem to affect supply the way oral estrogens do, most experts advise that lactating women avoid any estrogen until at least the 6th month postpartum and once the baby is well-established on solids due to the risk of it lowering milk supply.

Premarin is another popular cream, but mothers may want to avoid using it due to the controversy surrounding it's manufacturing process.