This is part one of a 2 part series on breastfeeding and PCOS by Alex Walker.
Breastfeeding is best. We hear it all the time and for good reason. Breast milk provides babies with the perfect balance of nutrition and immune protection that ensure a healthy start to life. But for women diagnosed with PCOS, exclusive breastfeeding for the first six months of their baby’s life (the recommendation of the American Academy of Pediatrics) may not be possible. Many of you know all too well that PCOS can wreak havoc on a woman’s body, potentially causing obesity, insulin-resistance and even infertility. What you may not be aware of, and what your physician may not be telling you, is that PCOS can also lead to insufficient milk supply, or what I prefer to call impaired mammary organ function (IMOF).
Before we address IMOF, we ought to start with its predecessor: impaired mammary organ development (IMOD).
While almost all vital organs in the human body develop in utero, the mammary organ is different. Not until a girl begins puberty does the breast start its journey toward becoming a fully functioning organ. At the onset of puberty, continuous pulses of estrogen from a girl’s ovaries during each menstrual cycle will stimulate mammary organ growth. Estrogen, in concert with growth hormone (GH) and insulin-like growth factor (IGF-1), will initiate and maintain the development of the ductal network that forms the foundation for future lactating breasts. These ducts will function as canals that will carry breast milk from the milk-making cells, called lactocytes, within the breast to the nipple.
PCOS, which often begins in adolescence, can potentially disrupt the creation of this ductal network in two important ways. First, abnormally high androgen levels, which are common in PCOS, can potentially stunt estrogen-driven ductal growth and proliferation. Second, obesity, another common occurrence in PCOS, can inhibit normal development of the mammary organ by decreasing estrogen sensitivity.
In order to promote optimal mammary development in the face of high androgen levels and/or obesity, we can encourage adolescents to do the following:
- Receive timely screening and diagnosis for PCOS, ideally within the first two years of the first menstrual period
- Maintain a healthy BMI through a PCOS-friendly diet (IR or anti-inflammatory), regular exercise, avoiding inflammatory food, etc.
- Control high levels of androgens with dietary changes, exercises or natural supplements such as Ovasitol.
Pregnancy is the second stage of exponential mammary development. Under the influence of insulin, progesterone and prolactin, the milk-making cells of the breast (lactocytes) undergo substantial growth and proliferation. If you suffer from PCOS then it is likely that your cells, including the lactocytes, have become insulin and possibly progesterone resistant, making it difficult for these key hormones to initiate growth. Decreasing circulating androgens and restoring insulin sensitivity through diet, exercise and natural supplements are simple yet critical steps to support mammary development during this period.
In addition to progesterone and insulin, your breasts depend on the hormone prolactin to make milk. Although prolactin activity is muted during pregnancy, prolactin levels should be high enough for the lactocytes to start producing colostrum toward the end of the second trimester. Numerous studies have shown that obesity, a common comorbidity of PCOS, can blunt the prolactin response, causing the lactocytes to lose some of their necessary sensitivity to this vital hormone.
Given the possible barriers that PCOS women face for mammary organ development during pregnancy, we can encourage expectant moms to do the following:
- Increase insulin sensitivity (IR or anti-inflammatory diet, medication, supplements)
- Decrease free testosterone levels and thereby increase progesterone sensitivity (medication, supplement such as Ovasitol or vitamin D)
- Increase prolactin sensitivity through weight loss
We have covered methods for decreasing the risk of IMOD and increasing breastfeeding success before and during pregnancy. But now you may be wondering if there is anything you can do to decrease the chances of impaired mammary organ function (IMOF) once your baby is born? Fortunately, the answer yes!
Once your baby arrives, we want to make sure that two vital hormones during this stage, prolactin and insulin, can function optimally. Insulin and prolactin sensitivity are key and can be maximized by maintaining a normal BMI and nourishing your body with healthy foods, including whole grains, fresh fruits and vegetables and lean proteins. And if you haven’t already started a supplement such as ovasitol or vitamin D, it’s never too late to start.
Another way to maximize production is to make your breasts think you are having twins or even triplets by expressing your breasts twice: once with the baby, and again with a pump. While you can certainly request a breast pump right after delivery, another option is hand expression. Studies have shown that early colostrum expression (within the first few hours after delivery) can possibly stimulate your milk supply better than pumping.
Some final tips:
- Stay hydrated and relaxed; stress and ensuing elevated cortisol levels can lower milk supply
- Take your baby on walks to keep your body moving; fresh air and nature can do a lot to recharge the body and lower cortisol levels
- Skin to skin contact with your baby can help spike your lactation hormones—enjoy it often!
While there is no way to tell whether or not PCOS will affect your ability to produce milk, the key to success is starting as early as you can to remove potential barriers. With a little bit of planning, you can do a lot to help minimize the risk of IMOD and IMOF and ensure the best start to your breastfeeding relationship with your new baby.
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