Background: To investigate the breastfeeding rate in new mothers with polycystic ovary syndrome (PCOS). Show
Methods: Case-control study. Thirty-six women with PCOS and 99 controls matched for age, gestational length and parity, answered a questionnaire. Breastfeeding at one-, three- and six-months postpartum was registered and the two groups were compared. In the women with PCOS, androgen levels through pregnancy were analysed and related to breastfeeding rate. Results: At one-month postpartum, 27 (75%) of the women with PCOS were breastfeeding exclusively, whereas five (14%) did not breastfeed at all. Among controls, 88 (89%) were breastfeeding exclusively and two (2%) did not breastfeed (p=0.001). At three- and six-months postpartum, breastfeeding was equal in the two groups. Problems with sore nipples and seeking professional lactation support were also equal. Dehydroepiandrosterone-sulphate levels at gestational week 32 and 36 showed a weak negative association with breastfeeding in PCOS women. Breastfeeding rate was not associated with maternal gestational levels of androstenedione, testosterone, sex-hormone binding globulin, or free testosterone index in PCOS. Conclusions: Women with PCOS appear to have a reduced breastfeeding rate in the early postpartum period. Possibly, gestational dehydroepiandrosterone-sulphate might negatively influence breastfeeding rate in women with the syndrome. Skip to content Home Articles Our Picks Find IBCLC Membership
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
PCOS and breastfeedingDue 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:
Making more milk with PCOSIf 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: MetforminAuthors 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). DomperidoneDomperidone (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:
Myo-inositolMyo-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.
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 treeMoringa 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:
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 breastfeedingMaking More Milk: The Breastfeeding Guide to Increasing Your Milk Production has more detailed information on herbs considered useful for increasing milk supply including:
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 breastWhile 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 riskMothers 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:
Further informationIn 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. SummaryPolycystic 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. Browse by CategoryNow Reading Polycystic Ovary Syndrome and Breastfeeding 17 Mar, 2020 Can you produce milk with PCOS?Mothers with PCOS may struggle to produce enough milk or some may make an overabundance of it. Women with a diagnosis require careful monitoring by a health care provider before and after the birth of their baby.
Is breastfeeding harder with PCOS?Researchers are finding that breastfeeding with PCOS might be challenging for some women, as it's linked to low milk supply. The cause of this is still being studied and identified, but may be linked to the following: Insulin resistance. Women with PCOS may gain weight due to insulin resistance and metabolic issues.
Does metformin help with milk supply?Metformin is sometimes used as a galactogogue in women with reduced milk supply, but there is no evidence that it is effective. Metformin should be used with caution while nursing newborn and premature infants and those with renal impairment.
Does PCOS affect breast growth?Some women with PCOS do not experience normal breast development during puberty, ending up with small, underdeveloped breasts or large, pendulous breasts that have less than the normal amount of glandular tissue inside.
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