What is a Galactagogue?

A galactagogue—from the Greek “galacta” which means milk—is a food, herb or drug that increases the production of breast milk. Most mothers won’t need to take galactagogues because there are many ways to increase or maintain a breast milk supply without using herbs or medicines. If you are worried about your milk supply and whether your baby is getting enough milk, see an IBCLC lactation consultant for a full assessment and have a look at How to Make More Breast Milk for self help ideas.

This article

This article looks at some of the popular herbs, food and medications that are often suggested as galactagogues, and where to find information on their use and safety in lactation.

Do I need a galcatagogue?

Milk production is usually naturally regulated by supply and demand—your baby demands it and your breasts supply it. Not only will most mothers not need a galactagogue, some mothers have induced lactation for adopted babies or relactated for their own baby after a break simply by pumping and supplementing their baby at the breast.

If your milk supply is still not increasing despite good positioning and attachment, plenty of skin-to-skin contact, breast compressions, frequent breastfeeds or regular pumping you may wonder whether to try a galactagogue. Before doing so, a consultation with a breastfeeding specialist can be invaluable to help maximise the breast milk you are making. Bear in mind that galactagogues won’t normally increase a milk supply on their own, efficient milk removal by a baby or a pump will still be needed. The Womanly Art of Breastfeeding explains:

One option to speed things along is to use a galactagogue, an herb or medication that increases milk production. It is important to take these ONLY after you’re nursing or pumping regularly to remove the milk that they will help create. When it comes to building a supply, galactagogues are the frosting on the milk removal cake. They never substitute for milk removal itself. Many mothers have been successful in increasing their milk by nursing and expressing alone, so it is worth trying this before you go to galactagogues.

Herbal galactagogues

Herbs have been used to help milk supply for thousands of years. Although there isn’t much scientific research on their effects, many mothers who have taken them felt they helped increase their milk supply.

Many of the herbs and foods used to help milk supply today were recorded in a book some 2000 years ago by a Greek physician Dioscorides. They included herbs for increasing milk supply, helping the let-down (milk ejection reflex), keeping the milk “fresh”, and herbs to help with mastitis, engorgement, weaning and even relactation. Therefore the idea of using herbs is not new, but how effective they are and their safety in large amounts has had little research.

Discuss with your doctor

The quality of herbal products can vary a great deal, so it is important to buy them from a reputable source. Herbal preparations can vary in their strength, purity, allergic potential, how they affect blood sugars and insulin resistance and their ability to react with other drugs¹. Many herbs can have side effects, particularly if taken in medicinal doses, so it’s important to know how they work, what dose to take and whether or not they may be suitable for you. If you are considering taking herbs for milk supply, seek the advice of someone qualified and knowledgable and check with your doctor in case any herb or combination of herbs are not compatible with your medical history. The Womanly Art of Breastfeeding explains:

If you choose to use a galactagogue, it’s important to tell your doctor, even if she or he disagrees with your use of it, because there is always the possibility that it can interfere with other medications or cause reactions. Avoid herbs that can decrease your supply, such as parsley, sage, and peppermint (in large quantities), and mediations such as pseudoephedrine, hormonal birth control (especially when introduced before four months postpartum), bromocriptine, ergotamine, and Methergine.

Avoid herbs during pregnancy

Sheila Humphrey author of The Nursing Mother’s Herbal recommends avoiding most herbs during pregnancy as they could cause miscarriage. Pregnant mothers considering taking a galactagogue should always discuss this with a knowledgable medical professional.

I recommend caution when using herbs during pregnancy, particularly the first and early second trimester. Many of the herbs used to increase milk supply (fenugreek and blessed thistle, for example) are also uterine stimulants; they may have strong enough actions to cause a miscarriage.

Herb safety during lactation

Resources with up to date information on individual herb safety while breastfeeding include:

• Lactmed, a database from the US National Library of Medicine, includes a “Summary of use during lactation” for each entry.
• e-lactancia, a website run by Spanish paediatricians has information on herb compatibility with breastfeeding (available in Spanish and English).

How quickly will galactagogues work?

Authors Marasco and West say that it typically takes at least two to five days to notice a difference in milk supply and if there is no change by seven days it probably isn’t going to work for an individual mother. Medications that increase prolactin may have the best success rate when used in the first three weeks after birth with at least two weeks of treatment. Some mothers will only need galactagogues for a short time such as a week to a month and once they have a full milk supply can gradually reduce their dose over one to two weeks. Others find galactagogues are helpful longer term.²

Which herbs increase breast milk?

There are many herbs reported to help breast milk supply. Some herbs are thought to play a role in stimulating mammary growth (glandular tissue in the breast), or giving hormonal support in some way. A useful resource that covers the choice of herbs and their role in breastfeeding in more detail is Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production.

Popular herbal galactagogues

Popular herbs in the breastfeeding literature include:

Fenugreek seed (Trigonella foenum-graecum) is one of the best known and most popular galactagogues. It is a common middle-eastern spice and one of the oldest medicinal herbs known. Some authors advocate using it in conjunction with blessed thistle (see below). The Academy of Breastfeeding Medicine say that there is likely a significant placebo effect (the belief in a treatment bringing positive results) with fenugreek³. See Will Fenugreek Increase Breast Milk? for much more information including possible side effects for the mother and baby.

Blessed Thistle (Cnicus benedictus) is recommended by Canadian paediatrician and breastfeeding specialist Jack Newman as a galcatagogue to be tried in conjunction with fenugreek. It is traditionally used for indigestion, loss of appetite and milk production. E-lactancia classifies the safety of blessed thistle during lactation as “very low risk”. ⁴ Blessed thistle is not recommended in pregnancy and Hale’s Medications and Mothers’ Milk Online [paywall] states it lacks justification as a galactagogue and may cause allergic reactions in the mother.

Milk thistle (Silybum marianum) has traditionally been used as a food (peeled, tender shoots) and in medicine for liver and gallbladder issues (Marasco and West, 2020). E-lactancia classifies the safety of milk thistle during lactation  as “very low risk” and discusses the precautions for use ⁵ and see the Lactmed entry for Milk Thistle for further references.

Nettle or Stinging Nettle (Urtica urens or U. dioica) has a long history as a powerful galactagogue along with various other medicinal uses. It contains all the essential nutrients and this may be how it supports lactation. See Lactmed for further information on the use of stinging nettle when breastfeeding.

Goat’s rue (Galega officinalis) belongs to the legume family with alfalfa and fenugreek and is widely used as a galactagogue across the world. Goat’s rue is often suggested for insufficient glandular tissue and breast surgery situations as it is reported to stimulate breast growth. Goat’s rue contains galegin—a herb that the drug metformin was originally developed from. Authors West and Marasco say that goat’s rue can be helpful for low milk production related to insulin resistance, hypoplasia (underdeveloped breasts), Polycystic Ovary Syndrome (PCOS) or gestational diabetes (Marasco and West, 2020). For more information including precautions to note see Lactmed and e-lactancia⁶.

Shatavari or Wild asparagus (Asparagus racemosus), has been used traditionally for infertility and milk production. It is a different plant species from the asparagus commonly used as a food. Further information and a discussion of studies on using shatavari when breastfeeding can be found at Lactmed.

Fennel (Foeniculum vulgar) is a popular European galactagogue and may help the let-down reflex (Marasco and West, 2020). Fennel seed is said to increase milk supply and improve mother’s digestion. In Mother Food, a book by Hilary Jacobson, the author suggests a baby’s digestion may also be improved through her mother’s milk if the mother takes Fennel. However fennel can cause allergic reactions and excessive use has been linked to toxicity in the breastfed baby⁷. E-lactancia cites fennel’s compatibility with breastfeeding as “high risk” ⁸.

Alfalfa leaf (Medicago sativa) is a very nutritious herb full of minerals, numerous vitamins and essential and non-essential amino acids. Alfalfa is said to be phytoestrogenic and contain thyroid releasing hormones which may be how it stimulates prolactin and milk supply (Marasco and West, 2020). One study reported alfalfa made symptoms of lupus worse (an autoimmune disorder)⁹. E-lactancia classifies alfalfa’s use during breastfeeding as “high risk” ¹⁰.

Nursing teas

Combinations of herbs are sold commercially as mothers’ milk teas and may be effective for some mothers. However taking multiple herbs at the same time is not necessarily better for milk supply. With so little research available some authors note that there is the possibility that some herbs may cancel each other out and it may be better to try one at a time (Marasco and West, 2020, p 234). See the next section for places to find recipes that may support milk production.

Food as a galactagogue

Can diet affect milk supply?

Special milk promoting foods have been eaten by breastfeeding mothers for more than 2000 years across all cultures. Such cultures strongly believed that diet affected the quality and abundance of breast milk. Although some experts think that dietary galactagogues might work by a placebo effect—several authors make a connection between traditional milk-making (lactogenic) foods and breast milk supply and composition (Marasco and West, 2020; Jacobson, 2007).  Author Hilary Jacobson argues that eating the right essential fatty acids (EFAs) could potentially change mothers’ milk from skimmed to fuller fat and increase milk volume. For a further discussion about how fat content in breast milk can change see Best Breastfeeding Diet and Foods to Avoid.

Milk-making food

Many foods are traditionally associated with increasing milk supply. Frank Nice, pharmacist and breastfeeding advocate provides a list:

Many herbals and foods are commonly used for their galactogogue properties. The list is quite extensive and includes alfalfa, almonds, anise, asparagus, barley, basil, beets, borage, caraway, carrots, chaste tree fruit, cherries, chicken broth/soup/stock, chickpeas (garbanzo beans), coconut, coriander seeds, cumin, dandelion, dill, fennel, fenugreek, flax seeds, garlic, ginger, goat’s rue, green beans, hibiscus, hops, lemon balm, lentils, lettuce, malunggay (moringa), marshmallow root, millet, molasses (black strap), mung, mushrooms, nettle, oat straw (oats), papaya, peas, pumpkin, quinoa seeds, red clover, red raspberry, rice, sage, seaweed soup, sesame seeds, spinach, sunflower seeds, sweet potatoes, thistles, turmeric, and vervain.

Breastfeeding recipes

A number of books claim to offer galactogenic recipes:

• Mother Food by Hilary Jacobson, 2007
• The Galactagogue Recipe Book by Frank Nice and Myung Nice, 2017
• A Fountain of Gardens: 21 Effective Galactagogues to Promote Lactation, Enrich Breast Milk Supply, and Improve Let Down, Jennifer Maiden, 2017

Medications as galactagogues

There are no drugs specifically licensed as galactagogues or for “making more milk”. However there are a few drugs which are known for causing extra or spontaneous milk flow (known as galactorrhea) as a side effect of their intended medical use. For example domperidone and metoclopramide are usually prescribed for stomach problems such as sickness or reflux but can influence milk supply. Most of the medications that can help milk supply are thought to work by indirectly increasing prolactin levels (a hormone important in producing breast milk) in the body.

Which medications can increase breast milk?

Prescription drugs such as domperidone, metoclopramide, metformin and sulpiride are said to have an effect on milk supply. Discuss with your health professional whether they might be suitable for your specific situation and medical history and see a short summary about each below. For the latest information on each drug’s compatibility with breastfeeding or potential side effects, check with your doctor and refer to the resources in the next section.

Domperidone (Motilium). This drug has historically been used for controlling sickness, indigestion and reflux but more recent safety concerns recommend it only to be prescribed for nausea in future. It is not licensed for use as a galactagogue and is not available in America. Maternal side effects may include dry mouth, itching, headache and abdominal cramps. Useful documents that discuss the use of domperidone in lactation include:

• ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision, Academy of Breastfeeding Medicine, 2018
• Drug Treatment of Inadequate Lactation, UK Drugs in Lactation Advisory Service (UKDILAS), Specialist Pharmacy Service, 2016
• Galactagogues, GP Infant Feeding Network (UK), 2017
• The Breastfeeding Network’s statement Domperidone and Breastfeeding, 2017
• Health Canada Advisory on Domperidone, 2012
• Pharmacological Management of Low Milk Supply with Domperidone: Separating Fact From Fiction, Grzeskowiak and Amir, 2014
• The National Infant Feeding Network’s statement The Use of Domperidone in Inadequate Lactation, 2014
• Canadian paediatrician Jack Newman’s Domperidone, 2016.

Marasco and West write that most mothers respond to domperidone within 48 hours to seven days and seems to work best when started in the first four to six weeks after birth. (Marasco and West, 2020).

Metoclopramide (Maxolon, Maxeran, Reglan). This drug has several uses but mainly it is used for patients with reflux. Side effects for the mother may include gastric cramping, diarrhoea, mood swings, headache and depression¹¹. For a full discussion of trials of its use in lactation see the Academy of Breastfeeding Medicine’s Clinical Protocol #9

Metformin (Glucophage). This drug stabilises blood sugar in non insulin dependent diabetics and is used to treat polycystic ovary syndrome (PCOS). Metformin is thought to improve milk supply for some PCOS mothers. Maternal side effects may include headache, dizziness, nausea, abdominal pain, hypoglycaemia and vitamin B12 deficiency¹².

Sulpiride (Eglonyl, Equemote, Dolmatil, Sulpor). This drug is primarily an anti-depressant and antipsychotic but may increase breast milk production during breastfeeding as a side-effect. Sulpiride is used to help lactation in Zimbabwe, South Africa and Chile, but is almost never used in the U.S.A., Europe or Australia. Maternal side effects may include physical symptoms such as tremors, slurred speech, feeling restless or anxious and sedation¹³.

How can I found out more about the effects of medicines on me or my breast milk?

See Medications and Breastfeeding for a list of resources offering current information about specific medications in lactation. A selection of these include:

• Hale’s Medications and Mothers’ Milk Online, 2019 [paywall]
• Lactmed, a drugs and lactation database from the US National Library of Medicine. Includes some herbs.
• e-lactancia, provides information about drug and herb compatibility with breastfeeding in Spanish and English. See e-lactancia’s About us page for more information.
• The Specialist Pharmacy Service has a free online database of drugs used in the UK, does not include herbs.

Note: no online resource should be a substitute for advice from your own medical professionals.

Which galactagogue?

The Academy of Breastfeeding Medicine (ABM) has a clinical protocol discussing the use of galactagogues. It recommends caution saying that galactagogues should never be used to replace normal breastfeeding management by a breastfeeding specialist. They conclude:

ABM [Academy of Breastfeeding Medicine] cannot recommend any specific galactogogue at this time

There remain selected indications for the use of galactogogues, but the current data are insufficient to make any definitive recommendations. A number of high-quality studies have found domperidone to be useful in mothers of preterm infants, although there is concern about rare, but significant, adverse effects. Herbal galactogogues are problematic because of lack of regulation of preparations and insufficient evidence of efficacy and safety.

Summary

There are many herbs, foods and medications reputed to help a milk supply. However, all herbs and medications can have side effects, particularly in medicinal doses, and to be effective, galcatagogues also require efficient breast drainage. Galactagogues should not therefore be used as a substitute for careful breastfeeding evaluation by a breastfeeding specialist. There are several ways to increase or maintain a milk supply without using herbs or medicines. If you have a low milk supply, work with your IBCLC lactation consultant to identify the most likely reasons and to find the best management plan to increase your breast milk. If a mother wishes to try a galactagogue, she should discuss this with her health professional first.