Polycystic Ovary Syndrome and Breastfeeding

Polycystic ovary syndrome (PCOS) is quite a common hormonal disorder affecting fertility and general health for up to 15% of women (West and Marasco, 2009). Originally known as Stein-Leventhal Syndrome, it encompasses a group of symptoms —a syndrome—so that different symptoms will be seen in different women. Common issues include high levels of male hormones (androgens), irregular ovulation, multiple cysts on the ovaries, infertility, and about half of all cases are linked to obesity. Various hormones can be affected and there is an increased risk of developing diabetes, hypertension, unusual breast development and other health issues:

PCOS often causes higher levels of androgens (male hormones), oestrogen, cholesterol, and insulin (due to insulin resistance); it also causes lower progesterone (due to lack of ovulation) and disrupts other reproductive hormones as well. Hypothyroidism may also be present.

PCOS and breastfeeding

Due to the hormonal disruption, some (not all) women with PCOS may have insufficient glandular tissue (IGT) or problems with their milk supply (Marasco et al, 2000). As there are many other factors that can contribute to a low milk supply including poor breastfeeding management, it is important not to assume the cause is PCOS without checking for other Reasons for Low Milk Supply. Your IBCLC lactation consultant will be a great support to help you with latch, breastfeeding position, getting off to a good start and knowing How to Make More Breast Milk. Planning for an active labour and natural birth can also avoid any delays in your milk coming in. The ways PCOS can sometimes influence milk production are summed up in the following excerpt:

some women with PCOS may have more difficulty producing adequate milk because the breast tissue fails to undergo the normal physiological changes during pregnancy needed to prepare for lactation or perhaps because not enough breast tissue existed prior to pregnancy. Women with PCOS have low levels of progesterone, which is needed for alveolar growth and breast tissue development. Insulin also plays a role in milk production, and having insulin resistance [a side effect of PCOS] may contribute to lactation problems in women with PCOS.

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Making more milk with PCOS

If PCOS seems to be the likely explanation for your low milk supply, addressing any underlying hormonal imbalances with your doctors i.e. levels of male hormones, insulin resistance, prolactin or thyroid levels will be important. In addition to the suggestions in How to Make More Breast Milk, pumping more milk and trying galactagogues (special foods, herbs or medications) can further help with milk supply. There is an overview of popular herbs and medications that may be useful in What is a Galactagogue? Although some galactogenic herbs are well known—such as fenugreek—there are others. Some are said to specifically help with hormonal imbalance (e.g. shatavari, see Lactmed  search “wild asparagus”) and some may promote development of glandular tissue (e.g. goat’s rue; see below) making these of particular interest to mothers with PCOS and low milk supply.

Some herbs, foods and medications that may be useful for polycystic ovary syndrome and breastfeeding include:

Metformin

Wambach and Riordan, 2015 describe metformin as the drug of choice for treating PCOS :

[Metformin] facilitates conception, appears to reduce first-trimester miscarriage and gestational diabetes, does not appear to cause birth defects, and appears to be safe [for the nursing infant] in the first six months of infancy.

They cite a study (Vanky et al, 2012) that suggested metformin had no impact on breastfeeding however West and Marasco say:

There has been informal feedback that [metformin] has helped some women significantly, some modestly and some not at all. Dosages vary, typically starting at 500 milligrams and working up to 1,000 to 2,500 milligrams daily; if you have taken metformin previously, ask your doctor about trying the dosage that was initially needed to improve your symptoms.

You can find more information about metformin and PCOS in Polycystic Ovary Syndrome (PCOS) and Breastfeeding  and metformin in lactation at Lactmed (search “metformin”).

Domperidone

Domperidone (Motilium) is a prescription medicine historically used for controlling sickness, indigestion and reflux in some countries (not available in U.S.). It can help milk supply in some mothers by indirectly increasing prolactin levels (a hormone involved in milk production). Safety concerns about the drug have restricted its use recently however, some well known breastfeeding friendly physicians have a few qualms about these restrictions—see Official Statements From Prominent Physicians. Jack Newman, a Canadian paediatrician and breastfeeding author has a fact sheet on domperidone which may be useful to discuss with your doctor.

Myo-inositol

Myo-inositol is a natural carbohydrate which helps to regulate insulin in a similar way to metformin and may be useful for mothers with PCOS (Ciotta et al, 2011; Tais, 2012).

Treating women with myo-inositol or DCI has been shown to reduce androgen levels, help restore ovulatory function, lower blood pressure, and decrease triglyceride levels.

For more information see De-Mystifying Myo-Inositol, PCOS Diva, 2012 and Myoinositol (e lactancia).

Malunggay (Moringa oleifera) or drumstick tree

Moringa is a nutritious tree native to India and grown in tropical areas. It is used as an important food source in many countries and its leaves, bark, flowers, fruit, seeds, and root are used to make medicine.

Malunggay may have a similar effect to domperidone on milk production see Lactmed ( search “moringa”) for references and a discussion of the research.

Goat’s rue (Galega officinalis)

West and Marasco, 2009 (p133) suggest that goat’s rue is especially suited for low milk production related to PCOS. They explain that it contains galegin which is the herb that metformin was originally developed from.

Lactmed cautions ( search goat’s rue):

Although it has a long history of use as a galactogogue, very limited scientific data exist on the safety and efficacy of goat’s rue in nursing mothers or infants. In general, goat’s rue is well tolerated, but it might cause hypoglycemia, so caution should be used in women taking antidiabetic drugs.

Other herbs for polycystic ovaries and breastfeeding

There are many more herbs considered useful for increasing milk, refer to The Breastfeeding Mother’s Guide to Making More Milk for more detailed information:

Saw palmetto is reputed to reduce excessive body hair, a symptom of high testosterone. One PCOS mother who tried saw palmetto reported a tripling of her low milk production. Chasteberry has long been used for PCOS and for milk production, and a few PCOS mothers feel it has helped them, but it must be dosed carefully by an herbal practitioner as too much may decrease prolactin.

Supplementing at the breast

While your situation may not enable exclusive breastfeeding, the suggestions above will help maximise your supply and you may be interested to explore a way of feeding top-ups via a thin tube at your breast instead of a bottle—see Supplementing at the Breast and Homemade Supplemental Nursing Systems.

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Oversupply?

Some mothers with PCOS have oversupply of breast milk. Speak to your IBCLC lactation consultant and see Oversupply of Breast Milk for more information on managing this situation.

Diabetes risk

Mothers with PCOS have an increased risk of diabetes—increasing the genetic risk of diabetes for their babies. The Australian Breastfeeding Association explains how breastfeeding can help both mother and baby:

Women with PCOS have an increased risk of developing type 2 diabetes, later in life. As well, babies born to mothers with PCOS have an increased genetic risk of developing type 2 diabetes. Since breastfeeding helps to protect a mother and her baby from developing type 2 diabetes later in life, this makes breastfeeding for a mother with PCOS of particular importance.

Further information

In Polycystic Ovary Syndrome (PCOS) and Breastfeeding, Howat and Jacobson, discuss more of the symptoms and associated disorders, a detailed explanation for how PCOS can reduce milk supply, tips for dealing with sugar cravings, diet, useful books, stress management and more suggestions for herbs that may help with milk supply.

The information above should not be construed as medical advice. Always discuss taking any herbs or medications with your doctors and check side effects and compatibility with breastfeeding in one of the resources in Medications and Breastfeeding.

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