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
- 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.
Some parts of this article were helpful and informative but I was offended with the comment about “The more frequently you put baby to breast, the more milk your body will produce”. For a mother of a now 3 year old daughter and a PCOS diva I struggled with breast feeding no matter how hard I tried. When my daughter wasn’t latched on I tried and tired to keep the stimulation going but when you have no more than a golf ball (size of the amount of milk I had at my fullest) of milk it is very distressing to not be able to feed your starving baby. With the help of our local hospital and the lactation specialist we were given feeding tubes so after a while of sucking on the breast a feeding tube that had formula was inserted next to my nipple so my daughter could still get the few drips from me and get some food at the same time. Please don’t assume that women with PCOS will be able to breast feed either. I did my best bit it wasn’t enough. When you are nine months pregnant and your breast still haven’t developed don’t feel that you have to solely breastfeed, you may need help or bottle, it may not be the best but it may be the best for your child.
Thanks Victoria for your comment. The article was certainly not intended to offend anyone. I appreciate you sharing your experience.
Thanks so much for your comment. Yes, I completely understand that some women with PCOS are unable to breastfeed – regardless of how hard they try, how many experts they enlist to help, and how many breastfeeding support products they use. I so admire your effort – it sounds like you did everything humanly possible to get breastfeeding established, and I can only imagine how distressing and frustrating that experience was for you. I certainly did not intend to offend by making any of this sound easy, or by making it sound like all women with PCOS will be able to breastfeed successfully. Rather, the information presented in the article was intended to give women with PCOS hope that breastfeeding is definitely possible and to give them some tips (putting baby to breast frequently does help in some cases) and tools to lean on if challenges arise. In the end, I hope that others with PCOS have the determination to do exactly what you did – their very best! Best wishes to you and your family!
Thank you for this! I breastfed my first at 18 with no issues and him being a large baby at birth via C-section. It seemed like forever for my real milk to come in but once it did we were off and running. Victoria I didn’t take any part of this article to say that no one wouldn’t have issues so long as they did x,y, z. I read plenty that said some have it easy while some don’t. You are the one taking it personal and you are the only one to control your own thoughts and emotions. I’m sorry you had issues breastfeeding. That doesn’t mean every breastfeeding article you read is targeting you and wanting you to feel bad. It is true for the majority of breastfeeders the more you put baby to breast the more body will make. Supply-Demand. Several things cause cause supply issues unrelated to PCOS, Tongue or lip tie, shallow latch, insufficient glandular tissue, hormonal imbalance(non PCOS too) and loads of other things which is mentioned in this article. I’ve shared this with my PCOS support groups especially the Pregnant with PCOS ones. Thanks again!!
Even women without PCOS have trouble breastfeeding. Truth be told breastfeeding isn’t easy and it often doesn’t come naturally. But I disagree with you Victoria – the more you nurse – the more you will produce – BUT that doesn’t have any bearing on if the increase is enough. I went 16 months nursing my daughter with PCOS and it was a brutal battle. It was a blur of excessive pumping, pain, low supply, mothers milk tea, and other remedies. I do think my PCOS had something to do with it as well. I also went through a slew of lactation consultants.
Women just need to do what they can do – and supplement when they can’t – and that’s perfectly fine. Even a little bit of milk is beneficial.
Thank you for sharing this article. I have a 14 month old son and was unsuccessful at breastfeeding. I have Type 2 Diabetes and PCOS. He was in the NICU almost the first week and I was EP all the time. I would only get 2 ounces, if lucky total. At 6 weeks I finally stopped feeling defeated and sort of like a failure. What mom doesn’t want to be able to provide the best for her child. I found this super helpful and realize that its not my fault. We would like to have more babies, so hopefully getting the PCOS lined out better will help in the future. Thanks again!
Wow great article.
Wow great article. I was diagnosed with PCOS at the age of 15 (now 38) After having my daughter (in the UK), I had great difficulty in breast feeding, producing very little milk. I argued with the midwife that I thought it likely my PCOS was causing it but I was ignored. I was left feeling totally useless. One midwife even suggested Post Natal Depression. Two years later my son was born and the same thing happened. So much more is needed to support those with PCOS.
I wish I had this information 10 years ago when I had my first baby and felt that I was a failure – then again 6 years ago and 4 years ago when my supply diminished and seemed to disappear overnight – now successfully breast feeding number 4 who is now a little over 3 months. I only discovered the link to breast feeding issues and PCOS when I was pregnant with this baby and I am so thankful I did. Great information to help women understand why they might be struggling.
I can personally attest to this. I had difficulty getting pregnant with both of my children and never could establish a good milk supply. The only evidence I had that my milk came in was the change in color. No waking up hard achy huge breasts for me. I hope this new information will help the next generation of mothers out there to be more successful than I was.
Great article! I am glad that I read this while being 20 weeks pregnant. Amy, can you please write more articles on managing PCOS DURING and AFTER pregnancy? Afterall, for many Pcos women who dream to be a mum, getting pregnant is only the first step. Thank you!
I found a lot of this really awesome but the whole the more you do it the more you produce. That is not completely true. I was just hurting both me and baby both times I tried. I tried for a month and half and all that was happening was baby was losing weight and I wasn’t happy in fact I was getting depressed. Finally after coaxing from both the pedi and my husband we started giving bottle to both of my boys. Please be aware that some of us do fail who have PCOS, no matter how hard we try. I’m not trying to be mean but I’m just giving my experience with the issue.
Another reason why I am not so sure I have PCOS. My diagnosis really only includes amenorrhea and cysts on my ovaries. After 22 years of infertility, I have had 3 pregnancies (2 resulting in live births 10 years apart). With both births, I could have fed twins and supplemented a triplet. I have an oversupply. I only pump 3 times per day so it has nothing to do with stimulation. Either this is also written on old, anecdotal evidence that PCOS may cause breastmilk production issues, or I don’t have PCOS.
I know many women that also fall into this category of having an oversupply and having PCOS. I wonder if there are “degrees” of PCOS or that we might be misdiagnosed. I would like to see a study on that. Study these women who have PCOS and have an oversupply. What is different? What can we learn from people like me who were diagnosed with PCOS yet have so much milk it is donated or worse…tossed. Is there something the women can do who are struggling and trying with all their might? There has to be an answer other than…put baby to breast more and take herbs.
I also despise the words “nipple confusion.” It’s not confusion…it’s preference. I don’t use that word in my classes with my parents-to-be. It implies their baby is dumb (plainly not true). Babies are just like us…who chooses the hard way over the easy way? It’s a preference.
There is SOME information I can take from this article so I appreciate you taking the time to write it.
I wonder if there are different disorders that are getting lumped together as PCOS?
I had no trouble with becoming pregnant with any of my three children, and had an oversupply of milk too…to the point that my babies had to learn to latch properly to control the amount of milk they received (leading to painful nipples in the first month.) However, I do have hormone imbalance issues and insulin resistance, as well as many other signs that point to “PCOS”. The symptoms had become worse and worse in the 10 years after my last baby was born and before I was finally “diagnosed”.
I have found that dietary changes, including being gluten free, have helped a lot with improving my symptoms and regaining better health.
I wish I had been given this information while pregnant. After fertility treatment I finally got pregnant and delivered last week. I able to produce about 12 ML every 3 hours while my baby needs close to 60 ML. While in the hospital the lactation consultant never said anything About PCOS being an issue. I’ve been going crazy trying to figure out what I’m doing wrong. This article helped shed a lot of light on the issue. For that, I thank you. 🙂
I also wish I had ready this earlier….I read about possible problems with breastfeeding before I had my daughter but when my feeding problems started I never put two and two together and now I’m not producing anything, very disappointing. But I am happy that I was able to feed for almost 3 months