Five Things You Need to Know about PCOS and Breastfeeding

Guest post by guest author Suzanne Munson, MS, Director of Product Development for Fairhaven Health, LLC 

Over the past few decades, awareness about PCOS has increased dramatically. As a result, women and health care providers are now familiar with many of the tell-tale symptoms of this syndrome: acne, male-pattern hair loss, excess facial and body hair, irregular menstrual cycles, insulin resistance, and ovarian cysts. PCOS is now recognized as a leading cause of fertility issues in women, and, it is known that if left untreated, PCOS can cause type 2 diabetes, heart disease, and some types of cancer. And, thanks to the work of Amy Medling, founder of PCOS Diva, women with PCOS are learning that they can successfully manage PCOS with diet and lifestyle changes.

But, despite our growing understanding of PCOS, there is still very little discussion about how PCOS impacts breastfeeding. If you are trying-to-conceive or are already pregnant and planning to breastfeed your bundle of joy, here are 5 things you need to know about PCOS and breastfeeding.

1. PCOS might impact your breast milk supply

As early as the 1940s, researchers documented a lower than normal amount of glandular tissue in the breasts of women with PCOS, which impacts both the appearance and functionality of the breasts. Due to this lack of glandular tissue, the breasts of women with PCOS often have a characteristic appearance: small (almost pre-pubescent in size) and cone-shaped, with a wide space between the breasts. Alternatively, some women with PCOS have very large breasts, filled mostly with fatty tissue instead of glandular tissue.

But, while it is has been known for decades that PCOS negatively impacts breast development, we still don’t know exactly why this happens and how it impacts the ability of women with PCOS to breastfeed successfully. What we do know is that a lack of glandular tissue can result in insufficient breast milk production, and, consequently, some women with PCOS have difficulty initiating and/or maintaining breastfeeding.

Doctors have theorized that the abnormal breast development seen in women with PCOS is related to hormone imbalances, specifically involving progesterone, androgens, prolactin, and insulin. Progesterone is involved in breast development during puberty and pregnancy, and because progesterone deficiency is common in women with PCOS (due to the infrequency of ovulation) it makes some sense that breast development is incomplete. Prolactin is also essential to breast growth during pregnancy and milk synthesis after birth. Androgens (male hormones) are known to interfere with prolactin receptors, so even if prolactin levels are normal, breast growth or milk synthesis might be impacted if androgen levels are abnormally high – another common hormone disruption with PCOS.  Insulin also plays a role in milk synthesis. Because insulin resistance is common with PCOS, this might explain, at least in part, why some women with PCOS have trouble producing enough breast milk.

2. Many women with PCOS breastfeed successfully

Breastfeeding is the normal, natural way to feed your baby, and the health benefits of breastfeeding for both mother and baby are well-documented, which is why both the American Academy of Pediatrics and the World Health Organization strongly recommend exclusive breastfeeding for the first six months of life, and for as long after 6 months as is mutually desired by mother and baby.  All women, and especially those with PCOS, should be encouraged to breastfeed and given the support they need to do so successfully.

While it is important to be aware of the potential for PCOS to interfere with breastfeeding, it is equally important to know that many women with PCOS are able to reach their breastfeeding goals without trouble. Amy Medling, founder of PCOS Diva commented, that despite having PCOS, “I didn’t experience any issues with milk supply or breastfeeding my three children – which is saying a lot given that my boys were 10 pounds at birth, and very hungry babies.”

3. Managing your PCOS symptoms before, during, and after pregnancy can help ensure breastfeeding success.

We can’t simply chalk up Amy’s breastfeeding success to luck. Amy has been managing her PCOS naturally with diet, exercise and supplementation for many years, which, no doubt, helped her body to prepare for breastfeeding. With PCOS, breast milk supply issues are more likely to arise when hormones are out of balance. By staying on track with the lifestyle and dietary choices that help you manage your PCOS symptoms, you will help your body maintain hormone balance and allow your body to do the work necessary to make breast milk.

With PCOS, improving insulin resistance is a key to restoring hormone balance. Insulin resistance causes blood levels of insulin to increase, which results in an increase in androgen hormones. Abnormally high levels of androgens cause many of the symptoms of PCOS, including other hormone deficiencies that impact breast development and milk synthesis. Doctors often prescribe metformin to improve insulin resistance.  Alternatively, taking myo-inositol, a B-complex vitamin found in dietary supplements such as Ovasitol, is a natural and effective way to increase insulin sensitivity.

4. Utilizing good breastfeeding practices is essential to maintaining your breast milk supply

Establishing breastfeeding in the early days after delivery can be challenging, even for moms who don’t have PCOS. Research shows that the earlier breastfeeding is initiated after delivery, the better the chances are that breastfeeding will be successful. So, for every mom-to-be, setting the stage for successful breastfeeding should begin well before delivery. During your pregnancy, be sure to talk to your doctor, midwife and/or doula about your intention to breastfeed and work together to develop a breastfeeding plan that clearly states your desire for:

• immediate skin to skin contact (and/or placing baby at the breast) following delivery
• breastfeeding on demand and rooming with your baby around the clock
• lactation support services to help with proper positioning and attachment if necessary
• avoiding supplemental formula unless medically necessary
• avoiding the use of pacifiers, as the use of pacifiers can cause nipple confusion, making it difficult to get breastfeeding established

Several days after delivery, your breast milk will come in. Once this happens, it is important to remember that breast milk production is based on supply and demand. The more frequently you put baby to breast, the more milk your body will produce. Skin to skin contact between feedings also helps maintain your supply, as it releases oxytocin, a hormone that stimulates breast milk production and the let-down reflex.  Staying well-hydrated and getting as much rest as possible (easier said than done with a new born!) also contributes to breastfeeding success.

If you do experience difficulty establishing or maintaining your breast milk supply, try pumping between feedings. Again, breast milk production is based on supply and demand, so the more you stimulate the breast (either through nursing or pumping), the more milk your body will try to produce. And, instead of moving to bottle feeding at the first sign of trouble, you might consider using a breastfeeding supplementer while nursing your baby. A breastfeeding supplementer consists of a container that is worn on a cord around your neck, with fine tubing that carries expressed breast milk or formula from the container to the nipple. When the baby sucks at the breast, milk is drawn through the tubing into the baby’s mouth, along with any milk from the breast.

Keep in mind that lactation support services are available at most hospitals and birthing centers, and peer support can be obtained from La Leche League International. For more information, see www.llli.org

  5.  Herbs are helpful for promoting breast milk production

For many centuries, women have been using herbs to effectively promote breast milk production. The herbs most frequently recommended for breast milk supply issues are fenugreek, goat’s rue, fennel, and blessed thistle. These herbs are available in dietary supplements and teas, such as Nursing Blend and Nursing Time Tea. You can begin using these herbs as soon as you start breastfeeding to help build your supply.

The bottom line is that having PCOS does not mean that you won’t be able to breastfeed. By taking a proactive approach to managing your PCOS before, during and after pregnancy and seeking out any necessary lactation support services after delivery, you have a great chance of meeting your breastfeeding goals.

Author’s addendum to the article

This topic has sparked a lively dialogue, and I am grateful to the numerous women that have shared their breastfeeding experiences via social media as a result of reading this article. An important takeaway from the comments that have been shared to this point: many women with PCOS are able to breastfeed (some with more challenges than others) and some women with PCOS, due to physiological complications resulting from their PCOS, are simply not able to breastfeed – no matter how hard they try and how many breastfeeding techniques and products they utilize. In providing information on this topic, I did not intend to minimize that reality or to simplify this issue. On the contrary, my hope is that in sharing this information with PCOS Divas we can continue to foster a dialogue about PCOS and breastfeeding that will serve the important purpose of helping women with PCOS understand how this condition impacts breastfeeding, provide them with resources to help, and to put their past difficulties with breastfeeding into a realistic perspective so that any resultant guilt and frustration are relieved to whatever extent possible.

If you are preparing to breastfeed or currently breastfeeding and looking for support or information, check out the following online resources and communities (Note: this is just a small sample of the resources available):

• La Leche League: www.llli.org
• Kelly Mom: www.kellymom.com and https://www.facebook.com/kellymomdotcom
• The Leaky Boob: www.theleakyboob.com and https://www.facebook.com/TheLeakyBoob
• Breastfeeding Mama Talk: www.breastfeedingmamatalk.com and https://www.facebook.com/bfmamatalk
• Best for Babes: www.bestforbabes.org and https://www.facebook.com/bestforbabes

Resources:

• Marasco L, Marmet C. Shell E. Polycystic ovary syndrome: a connection to insufficient milk supply? J Hum Lact 2000 May; 16(2): 143-8.
• 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.
• Neville MC, Webb P, Ramanathan P, Mannino MP, Pcorini C, Monks J, Anderson SM, MacLean P. The insulin receptor plays an important role in secretory differentiation in the mammary gland. Am J Physiol Endocrinol Metab 2013 Nov 1; 305(9): E1103-14
• Glueck CJ, Wang P. Metformin before and during pregnancy and lactation in polycystic ovary syndrome. Expert Opin Drug Saf. 2007 Mar;6(2);191-8.
• Sir-Petermann T, Devoto L, Maliqueo M, Periano P, Recabarren SE, Wildt L. Resumption of ovarian function during lactational amenorrhoea in breastfeeding women with polycystic ovarian syndrome: endocrine aspects. Hum Reprod 2001 Aug; 16(8):1603-10
• Maliqueo M, Sir-Pertermann T, Salazar G, Perez-Bravo F, Recabarren SE, Wildt L. Resumption of ovarian function during lactational amenorrhoea in breastfeeding women with polycystic ovarian syndrome: metabolic aspects. Hum Reprod 2001 Aug; 16(8):1598-602
• Sir-Petermann T, Recabarren SE, Lobos A, Maliqueo M, Widlt L. Secretory pattern of leptin and LH during lactational amenorrheoe in breastfeeding normal and polycystic ovarian syndrome women. Hum Reprod 2001 Feb; 16(2): 244-9.
• Bodley V and Powers D. Patient with insufficient glandular tissue experiences milk supply increase attributed to progesterone treatment for luteal phase defect. Journal of Human Lactation 1999; 15(4): 339-343.
• Kelly, Carolyn Griffith, PhD. PCOS and Breastfeeding. San Diego County Breastfeeding Coalition Newsletter. October 2003, volume 3, Issue 3, pp. 1, 3.
• Zuppa AA, Tornesello A, Papacci P, Tortorolo G, Segni G, Lafuenti G, Moneta E, Diodato A, Sorcinin M, Carta S. Relationship between maternal parity, basal prolactin levels and neonatal breast milk intake. Biology of the Neonate 1988; 53(3): 144-7.
• Polycystic ovarian syndrome and breastfeeding. Australian Breastfeeding Association. Appears online at https://www.breastfeeding.asn.au/bfinfo/polycystic-ovarian-syndrome-and-breastfeeding
• Cassar-Uhl, Diana. Supporting mothers with mammary hypoplaisa. Leaven, Vol. 45 (Nos 2-3), 2009: 4-14.
• Huggins K, Petok, E, Mireless, O. Markers of lactation insufficiency; a study of 34 mothers. Current Issues in Clinical lactation 2000: 25-35.

Suzanne Munson earned a MS degree Nutrition from Bastyr University and is Director of Product Development at Fairhaven Health. Fairhaven Health is a leading provider of natural products for fertility, pregnancy and nursing, and supports breastfeeding as the optimal feeding choice for mom and baby.