Living and Breastfeeding With Low Milk Supply
By Krissi Danielsson
Polycystic ovarian syndrome (PCOS) is a silent villain that can wreak havoc on a woman’s body. It afflicts 10 to 15 percent of the female population with symptoms like fertility problems, acne, weight gain, and various hormone-related complications. While conquering infertility is the first hurdle for many PCOS patients, some mothers with PCOS continue to face difficulties even after their babies are born.
Jennifer Denys of Hobart, Indiana, is one such mother. Her doctors suspected PCOS while she was trying to conceive, but Denys did not receive an official diagnosis until after her daughter’s birth—at which time she also struggled with a seriously low milk supply. “My milk came in about six days after delivery,” she says. “My daughter would want to nurse all the time and was still losing weight.”
With all the overlapping hormones involved in lactation, it makes sense that PCOS would impact breastfeeding.
After meeting with a lactation consultant, Denys used the test weighing method and found that even after nursing for 20 minutes, her 5-week-old baby was only getting about an ounce of milk, far less than she needed. “Mine was a low supply issue,” she says.
Denys continued to nurse her daughter for five months but supplemented with formula after each session in order to assure she got enough to eat. Sadly, the problems Denys encountered are not at all unusual for mothers with PCOS. While the majority of women with PCOS are able to nurse their babies without major difficulty, many struggle with low milk supply.
Lisa Marasco, MA, IBCLC, is a lactation consultant in Santa Maria, California. She has studied the impact of PCOS on breastfeeding and first suspected the connection after seeing two patients within a week show up with low milk supply and similar symptoms. “I looked at their history and found out they both had infertility issues and a diagnosis of PCOS,” she says.
Building on her interest in low milk supply, Marasco decided to investigate the PCOS connection more thoroughly, making it the subject of her Master’s thesis. She studied a group of women with diagnosed lactation failure, and she found that PCOS was indeed a risk factor. Half of the women with lactation failure suffered from obesity, and 67 percent suffered from infertility—both of which are side effects of PCOS. Some women in her study group had never been diagnosed with PCOS but displayed symptoms and turned out to actually have the disorder.
“As it unfolded, I began to realize it was a great big huge spider web,” Marasco says.
With all the overlapping hormones involved in lactation, it makes sense that PCOS—which affects the balance of numerous hormones in a woman’s body—would impact breastfeeding. Marasco emphasizes, however, that PCOS affects all women differently. In a casual survey she conducted in an Internet PCOS support group, a quarter to a third of the respondents had supply troubles, and only a third of those had severe problems. “A whole lot of them do fine,” she says. In fact, in her Internet survey, Marasco found that a percentage of the respondents actually suffered from oversupply.
However, in those that do have low milk supply, the problem may be physical. Generally, the later the onset of PCOS, the better odds a woman has of being able to establish a milk supply. Women with early onset PCOS may have underdeveloped breast glands. In others, Marasco explains, the breasts may develop normally in puberty but fail to go through the required changes in pregnancy that make milk production possible. The breasts may also develop normally, but the milk simply never comes in.
What Can Be Done?
Unfortunately, many doctors—including pediatricians—don’t know much about breastfeeding and tend to unintentionally give mothers bad advice that can contribute to low milk supply. In a lot of cases, the root cause is not an actual inability to produce milk. Sometimes the baby is not nursing efficiently enough to remove the milk, which can cause the supply to go down. In other cases, the mother may be doing scheduled feedings or giving formula supplements without pumping—both of which can impact supply.
“If the milk came in, most of the time it’s going to be a secondary issue,” Marasco says. “If the milk never came in, it’s more likely to be a primary issue. If a baby seems to be eating all the time and the mother is concerned that it’s due to a supply issue, it’s a good idea to examine diaper output, because it can’t come out unless it went in.”
For mothers with PCOS that do experience true milk supply problems, there are a few courses of action that can be beneficial. The first is to ask a doctor about Metformin, the drug commonly used to treat PCOS patients. Metformin is probably most helpful if taken during pregnancy so that it can support the necessary developmental changes in the breasts, but even if it is started after delivery, some women with PCOS have seen a positive impact on the milk supply.
“Most treatments are band-aid approaches,” says Marasco. “Metformin seems to hit deeply at the roots of the disorder, and it’s reported that multiple symptoms seem to improve in women who respond to treatment.”
Since thorough studies have not yet been done on how Metformin could impact babies, many doctors are hesitant to prescribe it to breastfeeding women. However, Marasco points out that a study by Tom Hale, a leading lactational pharmacology expert, found that the levels of Metformin transferred into breast milk are very low and are unlikely to impact an infant.
Besides Metformin, there are a number of herbal treatments that can be helpful for improving supply. Fenugreek is a popular one widely used by nursing mothers, but Marasco also mentions goat’s rue, which is an herbal galactagogue that contains some of the same chemicals as Metformin. Anecdotal evidence suggests that goat’s rue can help build breast tissue and could improve milk supply in PCOS patients, although she emphasizes that like many herbal treatments, no solid medical studies have thoroughly examined goat’s rue, and established guidelines for its use.
According to Sara Panning of Limestone, Maine, it’s important to be well informed and to choose a physician wisely. “I find that most doctors are still very ignorant about PCOS and its treatment,” she says, stressing that PCOS is not just a “female problem” that will be cured by weight loss and stress management. “Beginning a regimen for health and taking Metformin, if necessary, can prevent complications in the future. PCOS requires taking charge of your own treatment.”
Many women with low milk supplies are able to increase to a sufficient level, but it is not always possible. Denys, who is now pregnant with her second child, urges moms in her situation not to give up. Working with the child’s pediatrician and her OB–GYN, a mother should supplement as needed and work out a plan to make sure the baby is getting adequate nutrition while in the meantime doing what she can to boost supply.
“Remember that even if you are only able to supply your baby with a little bit of breast milk, it is better than none,” she says. “They will still benefit from what they get, and the bonding is wonderful.”