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Thread: Involution and discomfort

  1. #1
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    Default Involution and discomfort

    I had a previous post that went off in another direction. Is it normal to have a lot of discomfort during involution if you weaned very gradually. We kept nursing until my daughter said there was no milk... for a few weeks.

    All of a sudden I feel full and I am very sore. It was recommended that I pump to try to relieve the discomfort. But all I get is a thick yellow/white discharge on my nipple. It still seems like there is more in there too. I pumped a second time and got more.

    My gynecologists related some of this to my recent treatment for hypothyroidism and told me I could be lactating again. That is why I guess they told me I could try to pump to make sure I was not getting an infection.

    Someone else told me this could be involution. But, does involution cause such discomfort?

    Any suggestions???
    Jaime
    First time mommy to Lucy Madison, born 8/25/2010.

  2. #2
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    Default Re: Involution and discomfort

    I was not clear on involution, so I pulled out my breastfeeding text and here is what it says.

    From Breastfeeding Answers Made Simple, lactation textbook by Nancy Morhbacher.

    "As baby weans, the glandular tissue in the breast involutes, which means the milk-making glands shut down and the breast reverts to it's pre-pregnancy state. First the milk-making cells (lactocytes) die, and then the fat cells in the breast differentiate to fill the space they occupied, changing the internal landscape of the breast. (Watson, 2006) As milk production slows and stops, the milk increases in sodium, chloride, fat, and protein and decreases in lactose and potassium (Hartmann & Kulski, 1978).

    After complete weaning, mothers can usually express milk for at least 6 weeks (Kent, 2007). Anecdotally, women have reported being able to express a little milk for years after lactation ended."
    -BAMS, 2010.

    So, your meds are not causing involution. If your doctor is correct, and it makes sense, they may be causing you to make more milk than you were previously. Because you have weaned, your breasts had (possibly) begun the involution process. That might explain the look of the milk you are able to express. If your breasts are making more milk, and it is not being extracted, that would certainly be a possible explanation of the discomfort. Because your breasts are heavy with milk, and possibly there are even plugs?

    That is why I guess they told me I could try to pump to make sure I was not getting an infection
    They told you to pump to make sure you were not getting an infection? Or to prevent infection?

    Again, as I said in your other thread, if you think you perhaps have an infection or anything wrong with your breasts, you might want to be examined by your hcp. While this could be related only to milk production, it is important to rule out any more serious possibilities.

  3. #3
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    Default Re: Involution and discomfort

    So...everyone goes through involution. If so, has anyone else been this uncomfortable?

    I had nursed my daughter for 3 years 8 months and 19 days...well, she snuck back on one more time to see if she could get any more milk. But, that was the problem. She kept asking me why the milk was all gone and she was saddened. We have just worked through that...I found out about the hypothyroidism and trying to get regulated with meds, changing diet and exercising more. But, after starting Armour about 2 weeks ago my breasts started to get uncomfortable and I feel like they are just getting worse. I posted in the other post...I felt like they were leaking today too. Just worried that if the new meds are working and my hypothyroidism is subsiding a bit...could my milk be coming back? Hence the discomfort. And, if so, should I pump a little bit and eventually let myself dry up? My daughter would love milk if I produced it again but I am not sure if that is the right thing to do for her emotionally. I loved nursing...so, I would nurse her again in a heart bear. But, I would also like to get pregnant again since I just turned 35.

    How would I know if this stuff was puss or if it was involution milk? I do not have any streaks or redness and I do not believe I have a fever. I can physically see the plugs but wasn't sure if that was normal after weaning. So bummed about all of this.
    Jaime
    First time mommy to Lucy Madison, born 8/25/2010.

  4. #4
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    Default Re: Involution and discomfort

    So...everyone goes through involution
    Yes, exactly! It's a normal part of the lactation experience, and some people think that this interlude of cell death may be why women who nurse are less likely to get breast cancer than those who never breastfeed. It's possible that involution clears out some precancerous cells. Neat, right?

    If so, has anyone else been this uncomfortable?
    Not me. And I haven't heard a lot of complaints from moms who weaned gradually. Moms who weaned abruptly, when they still had lots of milk, yes- but not the ones who weaned slowly.

    Just worried that if the new meds are working and my hypothyroidism is subsiding a bit...could my milk be coming back?
    This seems really unlikely to me. Thyroid hormones do affect supply. But the master regulator of milk production is prolactin, which is produced in your pituitary gland. The way it works is that when a baby nurses, you respond by producing oxytocin. Oxytocin stimulates your pituitary to make prolactin, which travels to the breast and stimulates milk production.

    What's missing in your picture is the stimulation of the breast. You haven't been nursing or pumping until just recently, so there should be no reason for milk supply to bounce back up. This makes me think that the soreness you are experiencing may come from something other than being full of milk... But what?

    And, if so, should I pump a little bit and eventually let myself dry up?
    If the discomfort is so intense that you really can't stand it, go ahead and pump or nurse. The only potential downside is that pumping or nursing creates more milk, and if being full is the source of the soreness, you're going to perpetuate that problem.

    How would I know if this stuff was puss or if it was involution milk?
    I think you have to go by symptoms. If you spike a fever, start feeling generalized aches and pains, see redness on the surface of the breast, feel a lot of deep breast pain- then you're heading into mastitis territory.

    I do not have any streaks or redness and I do not believe I have a fever. I can physically see the plugs but wasn't sure if that was normal after weaning.
    Seeing plugs after weaning is not typical. I'd keep a very close eye on them, and watch for those other symptoms.

    ETA: Vibration can sometimes help break up the plugs and allow milk to flow. So if you have a personal massager or electric toothbrush, try holding that against the breast and seeing if anything changes.


    So bummed about all of this.
    Sorry, mama.
    Last edited by @llli*mommal; June 28th, 2014 at 05:11 AM.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  5. #5
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    Default Re: Involution and discomfort

    Okay, I take it back! Apparently there is a strong linkage between hypothyroidism, high prolactin, and galactorrhea (that is, milk production not associated with pregnancy or nursing).

    This is an interesting article: http://www.aafp.org/afp/2012/0601/p1073.html. Here's the relevant bit: "Hypothyroidism has been associated with hyperprolactinemia and galactorrhea,3 likely because of elevated thyrotropin-releasing hormone levels resulting from less negative feedback from the thyroid hormone. This in turn stimulates PRL secretion directly by activating thyrotropin-releasing hormone receptors in the lactotrophs4 or indirectly by regulating hypothalamic dopamine release."

    ETA: Based on the above, high prolactin/galactorrhea should become less of a problem when normal thyroid function is restored.
    Last edited by @llli*mommal; June 28th, 2014 at 06:24 AM.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  6. #6
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    Default Re: Involution and discomfort

    Thank you so much!

    I have called everyone I can think of locally...our local lactation dept., my gynecologist, my general physician...and no one seems to know what to tell me. It is sooo frustrating to feel so messed up. Our local lactation told me that if I was by chance hypothyroid when nursing that I would then more than likely not produce enough milk. I told her that I took blessed thistle and fenugreek for the first year and then fenugreek the second year and nursed often and pumped after every session. I was determined to make this work! LOL

    The only time my TSH was tested before recently was when I was about 2 months pregnant and it was normal. Recently, my daughter had said that the milk went away and I just thought that was normal after almost 4 years of nursing. But, with other symptoms especially the intolerable to cold...I asked my doctor to test me. When it came back positive...I asked him to check my antibody levels for Hashimotos. That came back positive. I am not sure if the hypothyroid started after having my daughter or when the milk supposedly stopped but I am so worried about everything. I just feel so...not normal.

    We would like to have another kiddo and decided that if it happens, it happens back in Oct-Nov of last year. With my daughter I was pregnant in a month...but I as also younger. I was 30-31 and now I am 35. I have had people throw out menopause too and I just want to cry. If genetics have anything to do with it...my mom did not hit that stage until her late 40s/50s.

    I feel so broken and now I am afraid I waited too long to try again for another kiddo. But, I was too busy enjoying my daughter and I did not want to take anything away from her. I have very little help..well, no help other than my husband when he is not working. I do a lot with my child, I run a photography business and also do web design and am managing a 2nd property we are trying to get ready to rent. I am always busy and I feel that I am always stressed. I am trying to change that, but it is really hard.

    I have very fibrous breast tissue and always have gone for extra breast exams because I always felt like I felt something. Everytime I was just told I have dense tissue and that I was fine.They have never done a mammogram even though my gram (dad's side) had breast cancer. Doctor felt that was more environment than genetics...she was from Europe and she smoked her whole life. But, self breast exams always make me think I feel something. When nursing I would swear I felt a lump, then I would nurse and it would go away. So, I figured that was my milk ducts and really have not done many breast exams while nursing. I would obviously feel them when nursing since I would massage them.

    I tried speaking to the few folks who did nurse that I know but none of them nursed as long as I did. And, none of them have any clue about what I am talking about with involution. Heck, I do not know what I am talking about with involution...lol. I thought about trying to pump again but not sure if I should. I am still on the lowest does of Armour and I do not get tested for my TSH levels for another 2 months yet. But, I feel that my clock is ticking and all of this work to get regulated is going to make me miss my window to have another child if I haven't already. As I said before...with the Hashimotos...I have gone pretty much gluten free which I read may make me less dependent on the meds. As long as I do not eat gluten. And...I have started exercising more.

    If I did not have the Hashimotos I would honestly think I would need to get my pituitary gland scanned for any issues or tumors which could cause the hypothyroidism too. Especially if my prolactin levels are off. But, doctors office is closed today...so I cannot do anything like that until Monday. I even pages my gynos office last night but I guess since I am not pregnant they do not see it as an emergency.

    The sad part is that I am just soooo depressed. I thought I was finally getting back on track. Now, not so sure. I am a very natural-type person. I do not take any medication unless I absolutely have to... I tried going without pain meds after my c-section and probably only take 1-2 tylenol a year. I try to buy organic, no high fructose corn syrup, no artificial sweeteners and now no gluten. I am the bad mom who never gives her kid juice, soda..etc. and only buy milk to go with the water from our filter.

    With that being said....all of this stuff is happening and I so do miss nursing my daughter even though I am proud we got as far as we did. Thinking I may never nurse again has me even more depressed.

    I really appreciate you trying to help me. It does not seem that anyone, other than this forum is actually listening to me. I did not pump before bed last night because I would often get very sensitive at night when pumping. I was already sore so I did not want to cause myself more discomfort. I still feel weird today and I am still concerned I may have milk in there. But, not sure if I should pump and draw out more of that stuff.

    I looked at google images and I did take pics of myself. However, this is not me but looks like what I have except it is a bit more yellow. And, it is coming out of both breasts. https://edc2.healthtap.com/ht-stagin...peg?1386641220

    I just hope I am not going to get an infection if I do not pump it out. I see a white dot on my nipple now...as I used to when I had a blocked duct that I would work out.
    Jaime
    First time mommy to Lucy Madison, born 8/25/2010.

  7. #7
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    Default Re: Involution and discomfort

    I guess I am still unclear on when you stopped nursing and what your specific concern is about the breasts issue. I am trying hard to listen to you, but I wonder if you have been listening to me. Because you seem very concerned about pumping and I am not sure why.

    If I was pumping something out of my breasts and was not sure it was milk, I would have it tested.

    No one can tell you that the pain you are feeling is normal. Even if they did have pain, it is not necessarily related to your situation. But I have been doing this a long time, and I can say with some confidence that NO, it is not typical for a mother to have pain after weaning if she nurses for a long time and weans very gradually. The entire involution process I have personally gone through, without knowing anything about it, without noticing a thing.

    On the other hand, it is not typical that at the moment of weaning, mom is put on a medication that might increase milk production in that mother by reversing the issue that was possibly causing low production.

    If you want to nurse your daughter again...why don't you, assuming she will? Is the medication you are on contraindicated?

    Menopause? At 35? Give me a break. That is so rare its not even funny. Anyone who says that to you deserves to be called the idiots they are. And, yes, as far as menopause timing, Genetics have a LOT to do with it.

    If you are feeling so badly, it may be a reaction to your meds, or it may be that the meds are not doing what they should?

    It's not fair, but sometimes we have to push really hard to get the health care we need.

  8. #8
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    Default Re: Involution and discomfort

    We finally stopped nursing around May 19th after 3 years 8 months and 19 days. My daughter wanted to try for milk one more time but said no milk so she stopped even though she was bummed and would keep asking. I actually think the last few months (maybe since the end of March/April she was trying to get milk but said she wasn't. I would see a little bit on my nipple occasionally but not much. Around the same time I decided to be tested for hypothyroidism and I am hypothyroid. I was started on Levothyroxine had a reaction (itchy) and doctor said to wait it out. Had my levels tested again and they were still high so he bumped me up to 50mcg instead of the 25mcg I was on and not only was I very itchy but I had a slew of other reactions including migraines twice a day and I usually never get headaches. That is when I decided to switch to Armour. On June 12th I started on the lowest dose of Armour. Since I started taking the Armour I do feel better but my breasts have been sore as if they felt full (not to the touch...that hasn't happened in years) but very uncomfortable as if they would if I was late nursing my daughter. I did not see it as a side effect of the medicine so I shrugged it off. I finally called my local lactation consultant who told me to call my gynecologist. I did and she said to take Vitamin E twice a day and to make sure I had a well-fitting bra. That was only a few days ago..maybe 2 but being that I had my period at the time I thought maybe that had something to do with it....even though it never has before. Then yesterday I felt even more uncomfortable and thought my bra was wet as if I was leaking. I looked at my nipple and there was a little crust on both as if something had dried. So, I called local lactation again and they said that I might want to try to pump since it was very uncomfortable to see if I am lactating again and to relieve the discomfort. She also said I should get my prolactin levels tested. I called my gynecologists office and the nurse there said she thought I should try pumping too because I was concerned of a possible infection. I had blocked ducts while nursing but never mastitis. So yesterday afternoon after my husband came home from work I went upstairs and pumped with my double medela. Instead of milk, I got a very thick yellowy substance that just sat on my nipple. Not a lot but some on both nipples. I took off the pump, wiped it...and when I put pressure on my nipple...more came out. So, I tried pumping again on low and the same stuff came out. I again wiped it and it looked on my nipples...particularly my one nipple like it used to when I had a blocked duct...there is a white dot on my nipple. So, not knowing if I should keep pumping or leave it alone I tried to get in touch with local lactation but they were not around and my gynecologists office never called back so I did nothing. It is still uncomfortable today and the white dot is still there.

    I called my local lactation office and tried to ask about involution to see if this is it. She had no clue what I was talking about She said that she believes that since I am doing better on my meds (even though I doubt I am even close to a correct dose yet since I am on the starter dose) that I am lactating all over again and that stuff is colostrum. I took pictures of it on my nipple but not sure if any of that is appropriate to post or somehow show to anyone who would know what it is. She suggested that I put raw cabbage leaves on my breasts and to turn my back in the shower. She said if I didn't feel better by July 7th to go see my gynecologist because something is not right. I asked her if I should let my daughter nurse again since she had wanted to nurse but now I think she is finally accepting that we are done...and she said no. I should not stimulate them anymore. She kind of made the joke that I don't want to nurse her until college...right? But, I do miss it.

    I have been asked if I could be pregnant and even though my period was a few days late. I got it last Sunday/Monday and I am done with it today. So...it is a little short but everything else seemed normal. So, I am not sure if that warrants taking a test. We have been hoping to get pregnant again soon.

    So...as you can see....I've tried not to look at anything else online since I think I am just confusing myself more. However, I diagnosed myself with hypothyroid and Hashimotos...I just asked them to test me. I am hardly at the doctors unless I do a checkup because normally I am very healthy as is my kiddo. She has still never been sick and I feel very blessed.

    So, right now...I am not sure what to do. So, I have been doing nothing. Should I pump? leave them alone? put on cabbage leaves? take a pregnancy test? I have no clue...I am just uncomfortable and still have that dot on my nipple. I think it was on both but the other one came out. I do think these meds are helping me and I also started a gluten-free diet this past week and increased my exercise. So, I have been feeling good after being on the Armour until all of this so I do not think it is a reaction to the meds.

    Thank you for all of your help and information! I appreciate it more than you will ever know. Right now I am very emotional and feeling helpless. I do have insurance but a very high deductible. So, as a SAHM I try to be cautious on how much I spend and I have been getting blood work done quite a bit lately. Maybe the prolactin should be tested. And, we started "trying" to get pregnant...even if I admit not regularly maybe in October/November of last year so it hasn't been that long. I feel like a lot of people locally are making me feel like I should have started earlier and that now I may be out of luck. I don't believe that. I got pregnant very quick with my daughter (in 1 month) and now that I think my hypothyroidism is getting straightened out...I am hopeful again. I still do have a lot of stress and anxiety even though I think it is getting better and none of that helps either. I just need to figure out my breasts. I am not bashful to send someone a pic of my nipple with the stuff on it but just not sure who or where.

    Thanks so much!
    Jaime
    First time mommy to Lucy Madison, born 8/25/2010.

  9. #9
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    Default Re: Involution and discomfort

    I did just take a pregnancy test and it was negative
    Jaime
    First time mommy to Lucy Madison, born 8/25/2010.

  10. #10
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    Default Re: Involution and discomfort

    Mama, you sound very anxious about so many things. If you can, please try to do what you can to combat the anxiety- do deep breathing, try to stay rested, get some exercise. Increased anxiety can be one of the side-effects of starting thyroid hormone replacement- but it will diminish in time. You just need to get though this initial phase- and I think you want to budget significant time to getting your levels figured out. This isn't a "one pill and you feel better" type of deal. IMO, this is a situation where you don't expect to start feeling partway normal for at least 6 months. I felt it took an entire year before I was back to my old self. And while I can understand your concern about having a second child, I personally feel it's important to get your health straightened out before you even think about conceiving.

    Don't be too surprised that your local lactation office doesn't know what mammary involution is. It's a technical term and you have to really be interested in the science of lactation before you even encounter it. You can have a very good understanding of weaning and still not know anything about the involution process.

    One thing to understand about involution is that you probably never stopped making milk after weaning. You just made very small amounts and you didn't notice them until now. But that is normal- even after weaning your very small supply will have some ups and downs.

    Cabbage leaves and avoiding breast stimulation will result in your milk continuing the drying-up process. Nursing and pumping will reverse it. It's completely up to you how you handle this! We can't tell you what to do about this very personal choice.

    I hear you about the high deductible. Paying those bills is painful, believe me, I know!!! But now is the time to say "f*** the deductible". You need to have data so that you can make the right choices about your health. Otherwise you're choosing blindly, and those decisions are rarely good ones. I think you absolutely do need to have your prolactin levels done, and if you want to be really proactive, go and see an endocrinologist.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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