Breastfeeding and PCOS: Maximizing Success

I’ll never forget the moment when I first learned that women with PCOS may have a difficult time breastfeeding. I had just given birth after days of labor only to have an emergency c-section. As soon as I was transferred to a hospital room, Terri, the hospital lactation consultant burst through the door. With her were piles of handouts and a contraption I had never laid eyes on before: a hospital grade breast pump. Immediately, Terri started telling me that because I have PCOS, I may experience a problem with breastfeeding. One way to minimize any risk was to start pumping milk-NOW!

What?! This was my tired and surprised response. See, at the time I gave birth I was halfway done researching PCOS for my first book, PCOS: The Dietitian’s Guide. I had never encountered any information relating to PCOS and breastfeeding. That is until I met Terri. I knew that I wanted to breastfeed my baby even before I was pregnant and at that moment I faced the devastating thought of never being able to have that experience.

Why Do Women With PCOS Have More Difficulty Breastfeeding?

Truth is, there isn’t much published information about PCOS and breastfeeding (PCOS: The Dietitian’s Guide does have a chapter devoted to it) and many women with PCOS who failed at breastfeeding may be too embarrassed to talk about it.

No, not all women with PCOS have a difficult time breastfeeding their babies (some have reported making an overabundance of milk), but many do. Researchers have speculated that one reason why some women may have difficulty breast-feeding and producing an adequate milk supply for their infants is because of the many hormonal imbalances associated with PCOS. The hormonal aberrations in PCOS involve insulin, progesterone, prolactin, and estrogen, all of which are important to breast development and milk-secreting ability.

Lisa Marasco, MA, IBCLC, is a lactation consultant who began studying the connection between PCOS and low milk supply after seeing two patients with PCOS in one day who had problems with milk production. According to Marasco, 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 may contribute to lactation problems in women with PCOS.

Strategies to Maximize Successful Breastfeeding

Milk supply problems may be prevented or ameliorated by establishing early intervention strategies during pregnancy. This may include obtaining resources for local breast-feeding support groups and preparing to work with a board-certified lactation consultant soon after giving birth. You can find a lactation consultant near you by contacting the La Leche League.

After giving birth, let the nurses know you would like to consult with a lactation consultant while you are in the hospital. Good breast-feeding management, including proper latch and positioning, are imperative to successful milk production and proper infant growth and development. A lactation consultant can help you make sure your using the right positioning and that your baby is latched on correctly. In addition, the following strategies may help you to breastfeed successfully.

  • As a precaution, lactation consultants recommend that women with PCOS pump after feedings for at least 10 to 15 minutes on each breast to help establish an adequate milk supply in the first two weeks of initiating nursing.

  • Consume adequate amounts of food and fluid each day (enough to keep your urine color pale).

  • For mothers with a low milk supply, extra breast stimulation via frequent nursing or pumping sessions is crucial.

  • Skin-to-skin contact (often referred to as Kangaroo care) is also encouraged to boost milk production.

  • Herbal supplements such as goat’s rue, fennel, kale, verbena, chasteberry, milk thistle, and fenugreek may be used to increase milk supply.

  • Using progesterone supplements and metformin during pregnancy may also help support an adequate milk supply in women with PCOS and possibly support breast development during pregnancy.

  • Medications such as metoclopramide may be prescribed to boost milk supply.

  • If you struggle with low milk supply even with the interventions mentioned, don’t feel bad about having to use formula to supplement or replace some nursing sessions. Always remember that some breast milk is better than no breast milk because it provides unmatched immunity and protection against disease in you and your baby.

As for me, I feel so grateful that a lactation consultant was available to me after I delivered my son. With her help and using some of the strategies mentioned, I was able to successfully nurse him and, a few years later, his brother. I share this information in hopes it will be helpful to those who would like to successfully nurse their babies too.

Tell us! What were your experiences like breastfeeding your baby?

Sources
Marasco L, Marmet C, Shell E. Polycystic ovary syndrome: A connection to insufficient milk supply? J Hum Lact. 2000;16(2):143-148.

Grassi A. Pregnancy, Lactation, and the Postpartum Period. In, PCOS: The Dietitian’s Guide, 2nd edition. Luca Publishing 2013. Bryn Mawr, PA.

Waldoks DA. PCOS: Breastfeeding case study. Women’s Health Report. Summer 2008.
Vanky E, Isaksen H, Moen MH, Carlsen SM. Breastfeeding in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2008; 87(5):531-5.

Vanky E, Nordskar JJ, Leithe H, Jorth-Hansen AK, Martinussen M, Carlsen SM. Breast size increment during pregnancy and breastfeeding in mothers with polycystic ovary syndrome: a follow-up study of a randomized controlled trial on metformin versus placebo. BJOG. 2012 Oct;110(11):1403-9.

Foote J, Rengers B. Maternal use of herbal supplements. Nutrition in Complementary Care. 2000;1.

Cartwright M. Herbal use during pregnancy and lactation: A need for caution. The Digest. 2001;(Summer):1-3. American Dietetic Association Public Health/Community Nutrition Practice Group.

Briggs GG, Ambrose PJ, Nageotte MP, Padilla G, Wan S. Excretion of metformin into breast milk and the effect on nursing infants. Obstet Gynecol. 2005;105(6):1437-1441.

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Comments (16)
  • Kristen

    September 1, 2015 at 5:13 pm

    I had a similar situation. I had my heart set on breastfeed I discussed this with my dr but never heard anything from anyone about breastfeeding being a potential problem. I realized it was a problem when my son was loosing weight like crazy. I had a lactation consultant come in because of his latch and we started discussing how long he feeds and how he’s constantly hungry. We weighed him and he had lost a pound! I started pumping in between feedings. The part in upset about is the fact that no one mentioned it being an issue. Even after talking to the lactation consultant! She just kept saying it takes time for the milk to let down. I was pumping enough to give my son a 1oz bottle ONCE A DAY! He was feeding and having formula because of this. I spoke with my dr and tried the creek as well as stimulation, skin to skin and anything else the doctor recommended. I actually wound up in the hospital 3 weeks later due to an infected c section site that reopened. This time I spoke to a different lactation consultant who told me breast feeding would be almost impossible because a) my breasts were not big enough (not much tissue) b) I didn’t have many milk glands (and the ones I had were very small) C) my insulin resistance and high testosterone levels also hindered my development as a teen. After my hospitalization I realized I didn’t have the energy to pump every three hours. I was even starting to dry up! Needless to say, my baby is on formula and very happy. I wish I had this information when I was pregnant and considering breast feeding. It would have saved me from my depression when I felt like a horrible mother for not being able to feed my child! Once I found out the reason I was able to begin moving forward. Thank you for your story!!

  • Laura

    September 2, 2015 at 5:13 pm

    Well, this explains a lot! My boobs never grew while I was pregnant and haven’t in the 3 months I have been breastfeeding. I’ve tried everything to make more milk (lactation cookies, oatmeal, fenugreek, pumping/feeding more), but it seems that an ounce to an ounce and a half every three or four hours is all I’m going to get. I assumed that I’d just screwed something up in the early stages of postpartum life and was too dumb to fix it. Maybe it’s just my hormones! I feel a little better now.

  • Kara

    October 6, 2015 at 5:13 pm

    I was diagnosed with PCOS about a month before I became pregnant with my daughter. I had no information about the condition much less information about how it might effect pregnancy and breastfeeding. I tried for about a month and in that time I may have pumped/fed a TOTAL of 2 ounces. I had a lactation consultant but either she had no info about PCOS or didn’t know it might be an issue. I want every mother to know that if you can’t, it’s ok. Yes, most of us would prefer to breastfeed (especially if we’re on this site) but DO NOT blame yourself, fault yourself, or demean yourself because it couldn’t happen for you. My daughter is 4 and happy and healthy and she’s beautiful young lady. Be the best mother you can be and you will both be fine.

  • Kay

    April 24, 2016 at 7:25 pm

    I have had 2 children so far, working on number 3, 10 weeks to go! With both of my other children, I felt like there wasn’t enough milk, and I supplemented with formula, but never had a formal diagnosis. This time, I have more information, the last two times, I had no idea PCOS had anything to do with breast feeding… I am so thankful for this article!

  • alsector

    July 6, 2016 at 7:59 am

    I have PCOS and I did have low milk supply. This caused my daughter to fall asleep while breastfeeding as she wasn’t getting much milk. We were forced to supplement on day 3 as she lost 10% of her body weight. After one week, she no longer wanted to breastfeed as the milk in the bottle came out so much faster and easier. After about a week, I started pumping and was able to give her about half of her milk intake. All in all, this was a very difficult experience for me. No one at the hospital or my OBGYN provided any guidance or explanation for my low milk supply. I always wondered if it wasn’t related to my PCOS.

  • Amy

    July 6, 2016 at 11:07 pm

    I have PCOS and my daughter is 3 months old. I have been able to successfully breastfeed her, mainly I think because I’ve continued taking metformin to help with my insulin level. I can relate to the part of the article on breast tissue though- I’m doing it all on one boob. I am really lopsided now, and one side barely makes an ounce in a day. It’s going to be interesting finding bras! One side is a C and the working side is an E.

  • Iryna

    August 4, 2016 at 10:18 am

    Wish I had this information when my daughter was born. I tried breastfeeding and could only breast feed for 3 months. My daughter would not always latch on, on top of me only pumping about 4 ounces all together, and having to supplement with formula. My doctor had even given me medicine to help, along with me drinking tea to help. I think if I had this information my whole situation could have been better.

  • Tristen Anderson

    March 1, 2017 at 5:29 pm

    I am a bf’ing mom with PCOS. This is my third baby and I am grateful to have had wonderful experiences bf’ing. One question I am trying to figure out is if there is any research yet about the milk composition of moms with PCOS. All my babies have been big from the start and gain a lot of weight their first year. We joke that my milk is super milk. All giggles aside, I wonder if this is just genetics or related to my milk composition. And does PCOS impact that? Does anyone know of any research about this?

  • Angela Grassi

    March 2, 2017 at 9:57 am

    Great question Tristen! I don’t think milk composition in breastfeeding women with PCOS has been researched but would be interesting to learn.

  • Stacy

    May 2, 2017 at 3:48 pm

    With my previous 2 babies, I have made lots of milk and after a month my milk supply would completely stop. I am now pregnant with my 3rd, What should I do or take? I want to breastfeed my baby longer than the previous 2. I’ve always set goals to exclusively breast feed for their 1st year of life. I’ve had PCOS since I was a teen.

  • Angela Grassi

    May 4, 2017 at 8:04 am

    In addition to the strategies we list in the article, I would recommend working with a lactation consultant so that you can have long-term success with nursing.

  • Ragni

    May 11, 2017 at 3:48 pm

    I had a hard time in the beginning, but in the rear view mirror that might be because of a long time exposure to pitocin during labor for both me and my kid. Keep in mind, that CS can also cause a delay in milk production, and a delay often (rightly so) means the kids get supplementatin with bank milk or formula. Which decreases the stimulation at an early stage and when bottle fed also often is followed by nipple confusion.

    I am really happy that my PCOS didn’t affect my overall breastfeeding duration. 24 months and still going.

    I also became a lactation consultant, so I could help others through the first confusing and hard times, And through later confusing and hard times, hehe,

  • Roxy Haynes

    September 21, 2017 at 12:21 am

    I have PCOS and my daughter is 12 months old now. I never had a problem breastfeeding her, and at the beginning I had a good supply. The issue became when my daughter stopped gaining the amount of weight she needed at 4 months old. Since 4 months old we have had weight gain issues, and now that she is 12 months old, her Doctor diagnosed her failure to thrive, I never knew that with PCOS and having hormonal imbalances, my milk would not be producing what my daughter needed. Now starting tomorrow we a working on weaning her off, and sadly it will be cold turkey. My daughter is set on wanting her milk and nursing, but I just can’t keep on doing it when I am hurting her health more than anything. My heart is broken and I feel like I failed her. I wish I would have known how PCOS was going to affect breastfeeding her. I remembered the day she was born and when I latched her for the first 4 days she was not peeing or even having any dirty diapers. She was dehydrated, and loosing weight really fast. I was never told how much havin PCOS would affect my breastfeeding journey. We saw many lactation consultants about her not gaining weight, and nobody told me. They just kept telling me she was ok and to keep on putting her to the breast. Now I has been 8 months of her having weight issues and I feel guilty. I am so upset nobody took the time to tell me about my PCOS and breastfeeding.

  • Tinisha

    December 14, 2017 at 12:20 am

    TY for this article. I just was diagnosed with PCOS. I had a baby 3 years ago but that was after 10 years of being told I couldn’t have kids. I did have issues breastfeeding. I used supplements, pumped & a consultant. Nothing would come out. I was so sad & didn’t feel like the best mom cuz we had to use formula. I now know my high testosterone & insulin resistance were a major factor. I wish I knew 3 years ago but now I feel more at ease.

  • Angela Grassi

    December 14, 2017 at 9:25 am

    Tinisha, you are a good mamma!

  • Caroline

    June 9, 2018 at 10:05 pm

    Hi, I’m wondering if inositol or bitter melon are helpful for women with PCOS with low milk supply?

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