Polycystic Ovary Syndrome and Breastfeeding

Polycystic ovary syndrome (PCOS) is quite a common hormonal disorder affecting fertility and general health potentially affecting 2.2–26% of women depending on the criteria used¹. Originally known as Stein-Leventhal Syndrome, it encompasses a group of symptoms (a syndrome) and different symptoms might be seen in different women. Common issues include:²³⁴

• high levels of male hormones (androgens) which can cause excessive hair growth on face and body
• irregular ovulation and periods affecting fertility due to disruption of reproductive hormones
• cysts in the ovaries
• an increased risk of developing diabetes, hypertension, unusual breast development and other health issues
• can be associated with obesity, insulin resistance (cells can’t use insulin properly) or inflammation.

PCOS and breastfeeding

Due to the hormonal disruption, some women with PCOS may have insufficient glandular tissue (IGT) or problems with their milk supply ⁵. 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 can help with this and will be a great support to help 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.

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 galactagogues (special foods, herbs or medications) have helped some mothers increase their milk supply. There is an overview of popular herbs and medications that may help milk production in What is a Galactagogue? Although some galactogenic herbs are well known—such as fenugreek—there are many others. Some are said to specifically help with hormonal imbalance or promote development of glandular tissue making these of particular interest to mothers with PCOS and low milk supply. Herbs, foods and medications that may be suggested as being useful for PCOS and breastfeeding include:

Metformin

Authors Wambach and Riordan describe metformin during pregnancy as the drug of choice for treating PCOS, saying it can help mothers conceive, reduce early miscarriage and gestational diabetes, and doesn’t appear to cause birth abnormalities ⁶. With regard to breastfeeding however, they cite a study by Vanky et al ⁷ that suggested metformin had no impact on milk supply. And another study did not find metformin helped milk supply in women with low milk production and signs of insulin resistance.⁸ Marasco and West note some flaws in Vanky’s analysis and say that research is still underway to determine how metformin may help lactation, noting that there are many anecdotal stories of modest to large improvements⁹.

E-lactancia rates the use of metformin during lactation as being “very low risk” to the breastfed baby ¹⁰ and you can read more about the safety of metformin in lactation at Lactmed (Metformin, 2018).

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 in recent years. However, some physicians have spoken out about these restrictions ¹¹¹². Useful places with further reading to share with medical professionals include:

• The Use of Domperidone in Inadequate Lactation (2014) The National Infant Feeding Network
• Domperidone and Breastfeeding. The Breastfeeding Network
• Domperidone, Getting Started, Dr Jack Newman
• Domperidone, e-lactancia, 2019 [accessed Nov 2019]—rates the use of domperidone during lactation as being “very low risk” to the breastfed baby

Myo-inositol

Myo-inositol is a natural substance, found in plants and animals, which may help to regulate insulin in a similar way to metformin and may be useful for mothers with PCOS ¹³¹⁴¹⁵.

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.

E-lactancia rates the use of myo-inositol during lactation as being “very low risk” to the breastfed baby ¹⁶. For further reading see 7 Benefits of Myo- Inositol for PCOS, PCOS Diva, 2012.

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. E-lactancia rates the use of malunggay during lactation as being “very low risk” to the breastfed baby ¹⁷. However Hale’s Medications and Mothers’ Milk [paywall; accessed 17 March 2020] explains that the effect of moringa in breast milk has not been studied so should be used with caution.

Goat’s rue (Galega officinalis)

Marasco and West, 2019 (p 229) say that goat’s rue is a good general galactagogue and may be particularly appropriate if a mother has PCOS or had gestational diabetes. They explain that it contains galegin which is the herb that metformin was originally developed from. Lactmed cautions:

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.

E-lactancia rates the use of goat’s rue during lactation as being “low risk” to the breastfed baby ¹⁸.

Other herbs for polycystic ovaries and breastfeeding

Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production has more detailed information on herbs considered useful for increasing milk supply including:

Saw palmetto is another herb reputed to reduce excessive body hair, a symptom of high testosterone, as well as stimulate breast growth and lactation. One PCOS parent who tried saw palmetto reported a tripling of their previously 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 as too much may decrease prolactin.

E-lactancia currently rates the use of saw palmetto during lactation as being “low risk” to the breastfed baby ¹⁹ however chasteberry is classed “high risk” ²⁰.

Supplementing at the breast

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

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 (from Mobi Motherhood), the authors discuss more of the symptoms and associated disorders of PCOS. They include a detailed explanation of 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.

Summary

Polycystic Ovary Syndrome (PCOS) is quite a common hormonal disorder. Due to disruption of hormones, some women with this syndrome may have insufficient glandular tissue (IGT) or problems with their milk supply. There are several medications, herbs and foods reputed to be helpful for low milk supply associated with PCOS. Always discuss taking herbs or medications with your health professional.

The information above should not be construed as medical advice. Always discuss taking any herbs or medications with your doctors and check the latest research on side effects and compatibility with breastfeeding in resources such as Lactmed, Hale’s Medications and Mothers’ Milk and e-lactancia.