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Polycystic Ovary Syndrome (PCOS) and Breastfeeding
By Nancy Howat BSc (Hons), and Hilary Jacobson, CH.HU.SI.
For many women with polycystic ovary syndrome (PCOS), fertility issues may have been a real problem. It can then seem that to then be faced with further difficulties when trying to breastfeed is even more unfair. As a medical writer I felt a strong need to communicate any help and information I was able to find to other mothers who may be having problems. My co-author Hilary Jacobson experienced low milk supply as a result of PCOS and it was this experience that led to her work with low supply mothers and also her research into the foods and herbs that can be useful during lactation. In this article we will provide some basic information for mothers who suspect that PCOS may be the cause of problems in their breastfeeding relationship.
What is polycystic ovary syndrome (PCOS)?
PCOS is a hormonal imbalance that is thought to affect between 10 and 15% of women. It can affect women in many different ways. The range and severity of symptoms is so variable that there is no globally accepted clinical definition of PCOS. Rather, a diagnosis must be made from a combination of symptoms. These can include an irregular or late onset of the menstrual cycle, fertility problems, recurrent miscarriages, excessive body or facial hair, head-hair loss, acne and weight problems. Insulin resistance and blood lipid abnormalities are also very common. Gestational and adult-onset diabetes can also occur.
PCOS is now seen as a potential marker for heart disease in women due to insulin issues. It is therefore very important to get a timely diagnosis of PCOS, to seek treatment, and to enact lifestyle changes that can improve a mother’s health now and in the future.
While PCOS symptoms usually start in adolescence, in some women they do not develop until their early to mid-twenties. While PCOS is treatable, and long term improvement is obtainable, there is not a cure.
Why is PCOS thought to have an effect on milk production?
According to Lisa Marasco 1, the IBCLC whose breakthrough research revealed the connection between PCOS and low milk supply, there are several different ways that PCOS could potentially interfere with breastfeeding.
What can be done to regulate milk production in women with PCOS?
Lisa Marasco1 has found that approximately one third of women with PCOS have normal milk supply. One third has an overproduction of milk. Another third have some degree of low supply, but only one third of these again (one ninth of women with PCOS) will have a real struggle to produce any milk at all.
Working with a breastfeeding expert such as an IBCLC or La Leche League Leader can be helpful in developing a strategy for your particular situation.
It is worth remembering that although the following advice can improve milk production in many women with PCOS, it may not be possible for all mothers with PCOS to achieve a full supply. This is not a failing on the mother’s part. Any breast milk is beneficial.
Lifestyle and diet:
Women with PCOS often have severe sugar cravings, and dealing with these cravings can be quite challenging. Certain supplements such as the minerals chromium and vanadium can help. Insulin resistance, a key symptom of PCOS, plays a role in sugar cravings. It is worthwhile to follow dietary principles to improve insulin sensitivity: Avoid foods that lead to a sharp spike in blood sugar, and prefer foods with a so-called low glycemic index (GI). It is best to begin with dietary changes before pregnancy. Do not use a no-carb or extremely low-carb diet long-term, as these can lead to nutritional deficits. If you do need to eat a low-carb diet for a while to treat an extreme case of insulin resistance, do so under the guidance of a nutritionist who specializes in PCOS.
Useful books include The New Glucose Revolution Guide to Managing PCOS: The Essential Guide to the PCOS-Glycemic Index Connection (New Glucose Revolution) by Jennie Brand-Miller, Kate Marsh and Nadir R. Farid, and also The GL Diet by Nigel Denby.
Breastfeeding is a time when all mothers naturally tend to crave sugar. Remember that breastfeeding removes sugar from the blood, making a breastfeeding a different situation from other times. For instance, diabetics frequently see improvement while breastfeeding because breastfeeding naturally lowers their blood sugar. This removal of sugar requires a regular tanking of new sugar from food that contains more natural sugar, higher on the GI list, such as fruit, starchy grains, and sweet vegetables. A mother’s sugar craving while breastfeeding is actually the body’s call for naturally sweet whole foods such as barley, millet, rice, carrots, beets, yams, sweet almonds, and fruit that also, as a side-benefit, boost a mother’s milk supply.
While breastfeeding, a mother can beat her sugar cravings and maintain steady blood sugar levels by eating and snacking every two to three hours on healthy, whole foods. Getting healthy fats and a source of protein with each meal or snack will also help keep blood sugar levels steady. Mother Food for Breastfeeding Mothers by Hilary Jacobson provides advice on regulating insulin resistance and blood sugar levels through the use of diet and herbs.
As for dieting to lose weight, a common concern of mothers with PCOS, remember that actively trying to lose weight while breastfeeding can damage a shaky milk supply. For low-supply mothers, even a small but sudden weight loss can translate into significantly less milk. Slow and steady does it. There is time ahead to lose weight.
Stress management: Stress levels can have a real impact on your milk production – from difficulty in achieving a let-down to more chronic low supply effects. Some ways to help stress include:
A selection of herbs which help the body prepare for lactation can be started during pregnancy and continued when the baby arrives. Examples of these are alfalfa leaf, red raspberry leaf, nettle, oat straw, dandelion leaf and red clover. For more information on the use of these herbs during pregnancy and breastfeeding, the book Mother Food for Breastfeeding Mothers by Hilary Jacobson is a useful resource. Be sure to read up on herbs before beginning any herbal protocol. The MOBI Herbal contains pertinent information on red raspberry leaf during pregnancy.
One herb which encourages glandular growth in mothers, and is therefore a favorite of PCOS mothers with minimal mammary tissue, is goat’s rue. This herb contains a compound similar to the drug metformin, which is also useful, anecdotally, for the development of glandular tissue.
Metformin is a drug which improves glucose tolerance; it was originally licensed for patients with type II diabetes. Metformin works by reducing glucose production in the liver, and it enhances receptors in the body to the presence of insulin. What it does not do is trigger the production of more insulin. It therefore does not cause low blood sugar, and is considered very safe, though you should only take it with your physician’s approval.
Some women with PCOS find that symptoms return after birth, including weight gain, fatigue and depression. Taking metformin can help with these symptoms.
Recent studies have shown that metformin can also be beneficial in some women with PCOS 2,3. Although the use of metformin has not been assessed in clinical trials for its effects on milk production, anecdotal evidence suggests it could be beneficial.
A study on the transfer of metformin into milk has been carried out. This showed that a nursing baby would receive only 0.28% of the weight adjusted maternal dose – considered quite safe for healthy infants4.
Domperidone (Motilium™) has been used successfully by many women to increase breastmilk production. Studies show that domperidone works to increase milk production and that it is considered safe for both mother and infant5,6. Although domperidone is not manufactured or sold in the United States, it is obtainable from a compounding pharmacy with a doctor's prescription. Domperidone is also available overseas.
To legally purchase domperidone in the United States, talk to your doctor about getting a prescription. Consult Dr. Jack Newman's information found at: http://www.kellymom.com/newman/19a-domperidone1.html and http://www.kellymom.com/newman/19b-domperidone2.html These informational fliers may be printed out and taken to your doctor.
Dr. Newman's thoughts on the FDA standing on domperidone can be found at: http://www.breastfeedingonline.com/OfficialDomStatements.shtml.
About a third of all mothers with PCOS experience pronounced chronic over-supply. This situation can be just as difficult to manage as low milk supply. While the same general advice applies to mothers with PCOS.
Overcoming the tendency to overproduce can take time, up to several weeks in some extreme cases. Hopefully, if you are patient, you will soon see improvement, and you and your baby can enjoy a more relaxed experience at the breast.
Further Help and Information
For general information on PCOS, a useful resource is http://www.verity-pcos.org.uk.
Mother Food for Breastfeeding Mothers by Hilary Jacobson. published by, PageFree Publishing, Inc. ISBN: 1589612299.