PCOS & Breastfeeding: Troubleshooting Milk Supply

Breastfeeding sounds deceptively simple, right? You have a breast, you offer it to your baby, your baby feeds. Easy enough. Unfortunately, the reality is not so simple. Even under the best circumstances (full-term baby, fully milk supply, etc.) challenges are common. And for the mom with PCOS, the likelihood is even higher that she will experience difficulty establishing and maintaining a full milk supply.

Let’s look at why this is and what you can do to help increase your likelihood of breastfeeding success.

It can be helpful to imagine your breasts as factories that will create and prepare food for your new baby. During pregnancy, your body is hard at work expanding the factory and even doing test runs for the eventual product. Under the influence of hormones like progesterone and prolactin, the alveoli, grape-like structures that are bunched together throughout your breast, grow and expand exponentially. Around week 20 of pregnancy, they cells within these alveoli, called lactocytes, begin to secrete small amounts of milk, also known as colostrum. Colostrum production continues throughout the pregnancy; while the factory is not operating at maximum capacity, the machines are primed and ready to launch when your baby arrives.

Immediately after your baby is born, the delivery of the placenta is not unlike the screeching factory whistle telling your breasts to “get to work!” Within 72-96 hours, your milk-making factory is operating full steam ahead, driven in large part by a complex interplay between three key hormones: prolactin, insulin, and thyroid.  Even if the breasts receive no stimulation, a woman’s body will produce milk automatically. As quickly as this factory revs its engines, however, it will shut down if the hormonal balance is disrupted or if there is not frequent milk removal and breast stimulation.

Despite their attempts to stimulate their breasts and remove milk, women who suffer from PCOS may not be able to maintain proper hormone levels or hormone sensitivity to ensure an adequate milk supply. Those same hormones I mentioned above, prolactin, insulin, and thyroid, are more likely to be disrupted in women with PCOS than in those without PCOS.

While many hormones play a role in the process of lactation, prolactin is undeniably the star of the show. Prolactin, which literally means “before lactation,” is the driver of milk production, relaying the signal necessary for the lactocytes (milk-making cells) to do their job. Recent studies have shown that obesity, which affects up to 85% of the PCOS population, can blunt the body’s response to prolactin. Effectively, the lactocytes of a woman who has PCOS may very well receive a muted version of what should be a loud and robust hormone signal.

In addition to obesity, many women with PCOS also experience varying degrees of insulin resistance. Insulin, or more specifically insulin sensitivity, is critical to the development and maintenance of a full milk supply. Recent research suggests that insulin resistance can potentially impede milk production within the lactocyte, even when prolactin sensitivity has not been affected. It is important to keep in mind that insulin resistance can occur even when your BMI is in a normal range. Therefore, a woman who is not obese but who experiences low milk supply should not discount the possibility that she might have some degree of insulin resistance.

While thyroid hormone’s role is less understood, we have enough research to know that it is invaluable to the process of lactation. It is not uncommon for women who suffer from thyroid hormone imbalance to experience challenges maintaining a full milk supply. Interesting new research links thyroid imbalances with PCOS, suggesting that as many as 25% of women with PCOS may also have a thyroid disorder. While women who first develop PCOS may go on to experience thyroid dysfunction, it is possible that an underlying thyroid problem can actually lead to PCOS. If you have PCOS, low milk supply and experience symptoms of thyroid imbalance (weight fluctuation, temperature sensitivity, dry skin/hair), you may want to ask your doctor to check your thyroid hormone levels.

Possible hormonal disruptions in women with PCOS can certainly add to the challenges of maintaining a full milk supply. Assuming you’ve already taken the first steps to increase your milk supply (stimulating and emptying your breasts regularly), you will want to consider your own possible hormonal milieu and how you can adjust those key lactation hormones: prolactin, insulin, and thyroid. Here are some suggestions:

1. Insist on a healthy diet and plenty of exercise. A PCOS diet (IR and anti-inflammatory) has no adverse effects and can even improve milk supply. In addition, an appropriate diet can increase prolactin sensitivity and lower insulin resistance. Exercise can reduce stress, which can lead to better hormone balance. Finally, remember to eat regular meals and small snacks, avoiding big dips and spikes in your blood sugar.

2. Consider herbal supplements. Herbal supplements have the potential to balance hormones, and some, such as fenugreek, torbangun, shatavari, may even improve your milk supply. Although consistent research is lacking about the effect of herbal supplements on lactation, both fenugreek and goat’s rue (a precursor to metformin) have been shown in studies to both lower glucose and increase insulin receptors. Be sure to talk with your doctor about the risks and benefits before taking any herbal supplements.

3. Consider pharmaceutical supplements: Ovasitol (over-the-counter) can improve insulin sensitivity and possibly milk production. Recent preliminary research suggests a relationship between vitamin D deficiency and insulin resistance; considering that many women may be deficient in vitamin D and vitamin D supplementation is recommended for breastfed babies, you may want to consider taking a vitamin D supplement. A 2015 study found that breastfeeding mothers who took 6400 IU of vitamin D were able to fulfill their infants’ entire requirement of vitamin D without the need for extra supplementation. New research also suggests that selenium may help to support insulin sensitivity and possibly decrease androgen levels and inflammation.

Beyond ensuring that your hormones are in proper balance, here are some general tips for keeping your milk supply as robust as possible:

• Frequent milk removal, either by baby, pump or hand expression. The more milk you remove, the more milk you will tell your body to make.
• Lots of skin to skin! Skin to skin is a highly effective way to increase your milk-making hormones. And it feels great, too—for both you and the baby!
• Keep stress low and manage your expectations appropriately. Trying to be superwoman will likely backfire. Task your partner with helping you to keep your goals in the realistic range. Trying to make more milk is not unlike trying to force yourself to fall asleep. The more you obsess about it, the less likely it is to happen.

Finally, and most important, accept any amount of milk, whether in drops or ounces, as a massive victory and a priceless gift for your child.

 

References

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Buonfiglio, D. C., Ramos-Lobo, A. M., Freitas, V. M., Zampieri, T. T., Nagaishi, V. S., Magalhães, M., … Donato Jr., J. (2016). Obesity impairs lactation performance in mice by inducing prolactin resistance. Scientific Reports, 6(March), 22421. http://doi.org/10.1038/srep22421

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Note: The views and recommendations shared by PCOS Diva LLC and pcosdiva.com, as well as the information contained in this email, if any, are for general health information only and do not constitute, and are not intended to be a substitute for professional medical advice regarding an individual’s specific health condition. The information is intended to provide accurate and helpful health information. The information is not intended as medical advice for individual problems or for making a diagnosis of a medical condition or an evaluation as to the risks and benefits of taking a particular drug or product.

 

Alex has been a lactation consultant in the Washington, DC area since 2010. In addition to running her private practice, Bethesda-Chevy Chase Lactation Consultants, Alex cares for breastfeeding moms and babies at Hirsch Pediatrics in Rockville, MD. After earning her master’s in English Literature and teaching for several years, Alex met two extraordinary people that inspired her to enter the field of lactation: her daughters. Alex has worked at Inova Fairfax Hospital and Sibley Memorial Hospital as an in-patient lactation consultant. In 2015, she graduated summa cum laude from the University of Maryland Baltimore School of Nursing with a Bachelors of Science in Nursing. Alex is committed to increasing awareness for impaired mammary organ development (IMOD) and impaired mammary organ function (IMOF).