Breastfeeding with Polycystic Ovary Syndrome (PCOS)
Photo: Belle Verdiglione
First published June 2016
PCOS is a leading cause of infertility in women.
Symptoms include:
- Raised levels of insulin (that can lead to excessive weight gain).
- Raised levels of male hormones (that can lead to acne and growth of unwanted hair).
- Irregular menses, ovarian cysts.
- Raised risk of diabetes.
- Underdevelopment of breast tissue.
Because PCOS is a syndrome and not a disease, the combination of symptoms is unique in each case, making identification more challenging for health providers. As a result, many women never receive a formal diagnosis. Mothers with PCOS may struggle to produce enough milk or some may make an overabundance of it.
Women with a diagnosis require careful monitoring by a health care provider before and after the birth of their baby.
Treatment
The drug metformin is the most common treatment prescribed by health care providers for PCOS and is used to help women who experience difficulty both getting pregnant and maintaining a pregnancy. It decreases hormonal disruption.
Thomas Hale PhD in Medications and Mothers’ Milk regards metformin as safe and compatible with breastfeeding (L1 rating) with little passing through the milk to the breastfeeding infant.
See our post Medications – A Quick Guide For Parents to find links to information in many countries.
Support
Learning all you can before the baby comes about “normal” breastfeeding will help you determine if there really is a problem, and whether the problem is related to your diagnosis of PCOS. Knowing the signs that baby is getting a good feed and enough milk is important. Talk to an LLL Leader or an IBCLC about positioning and breastfeeding management.
Not all mothers with PCOS experience trouble breastfeeding. But if you had problems with fertility and after giving birth are then struggling to breastfeed, even when you are doing all the “right” things, this can be heartbreaking. Some mothers blame themselves or feel judged for not “trying hard enough.”
If you do experience difficulties, finding a good network of knowledgeable breastfeeding support is important to defining your own breastfeeding goals. If you are struggling to make enough milk but want to breastfeed, then every drop you make counts. Likewise, if you are flooded with milk you will be looking for coping strategies.
LLL Leaders can help you explore ways to make breastfeeding work for you.
If you are trying to maximize your milk production this Global Health Media video may help: Increasing Your Milk Supply
You may also find these LLLI resources useful:
Building A Milk Supply
Pumping
Skin-to-Skin Care
La Leche League celebrates the mothering relationship as well as the product of human milk. Even if you can’t exclusively breastfeed or make milk at all, there are benefits to putting your baby to the breast. Skin-to-skin contact increases the physical, mental, emotional, and social stability and wellbeing of the baby. The release of the hormone oxytocin (the “love hormone”) in mother and baby relaxes both of you and aids bonding. Breastfeeding is “a connection as well as a food source” (The Womanly Art of Breastfeeding, 8th edition).
If you need to supplement
If you find that your milk supply is compromised and supplementing becomes necessary, here are some strategies to help you mother your baby at the breast.
At-Breast Supplementer Nursing
Some mothers with PCOS have oversupply If you have an oversupply of breastmilk have a look here:
Oversupply
Oversupply: Gift or Curse
My breastfeeding story
by Anna Earley, Bellport, New York, USA
When I was pregnant, I promised myself I would breastfeed my baby. I didn’t educate myself or build up a support system. I thought breastfeeding would come naturally… After about two weeks of supplementing my first child’s feedings with formula milk, he was no longer interested in breastfeeding, and we bottle-fed from then on. My well-intentioned husband urged me on with praise and told me that I had tried my best. My son needed to eat, he wasn’t gaining weight, and he was hungry. After many tearful days and nights, and a brief bout of postpartum depression, I found peace, vowing to educate myself and promising myself that my future children would be breastfed.
When my son was almost a year old, I became pregnant again. I called local La Leche League Leaders and started attending meetings. Even after a miscarriage, I continued attending. I wanted all the information I could get. The Womanly Art of Breastfeeding proved to be an invaluable resource. I got to educate my husband during this time as well, and two years later, armed with knowledge, resources, and an unfailing support system, I became pregnant again.
I was incredibly frightened of miscarrying again. But the pregnancy lasted and the only obstacle was my gestational diabetes.
The members of hospital staff were helpful and supportive in my decision to breastfeed and room in. They did not supplement my daughter with any formula. And though we were separated for four hours after the birth, my daughter and I shared a 40-minute, blissful first nursing session. The memory is foggy because of the medications I received, but I will remember it forever. She latched on like a pro and I marveled at her perfection.
We nursed round the clock, on demand, and exclusively from that moment forward. And though my baby lost a bit of weight, the hospital staff seemed unconcerned as she was passing urine and stools. Three days later we went home. I felt my milk come in on day four. My baby nursed herself to sleep and she seemed content. On the sixth day, my breasts felt empty and on the seventh day the crying started. She was attached to me every minute. Thank goodness for my husband taking some time off to stay home and care for our four-year-old, because I did not have one moment when my baby was not latched on. She was hungry, she was nursing to sleep, but she was not happy.
A local LLL Leader observed us. The latch was still perfect, but little to no milk was being transferred. She’d lost close to 14 percent of her birth weight. I couldn’t pump a drop, and the fullness I had experienced shortly after birth was gone. Tearfully, reality set in that supplementation was inevitable.
Rule No. 1: feed the baby, by any means necessary.
Goat’s rue, fenugreek, supplements, lots of water, quinoa—nothing seemed to help me produce more milk. I went to an endocrinologist to check my hormone levels. I received a diagnosis of the hormonal disorder polycystic ovary syndrome (PCOS). I continued with the galactagogues, added shatavari (asparagus racemosus), and was given a prescription for domperidone [domperidone (motilium) is not currently available on prescription in the U.S.A. Canadian pediatrician Jack Newman has information about the drug on his website.] I drank special teas as well. I got a good pump and began working. My supply has gone up, but only slightly. It’s minimal, but still more than before.
At 12 weeks old, my baby still latches on like a pro. She refuses the breast in the late evening, almost knowing intuitively that is when my breasts have the least amount of milk in them. I pump instead. Nearly every feeding is followed by a bottle. Nursing is her appetizer and her bottle is her main course—except for the first feeding of the day.
Already sleeping through the night, she wakes to find my breasts full and leaking. She nurses calmly, happily, on both sides, and it’s enough. She nurses herself back to sleep. If she doesn’t empty my breasts, I pump but that’s not often. I know as she grows, my morning supply may have to be supplemented as well but for now, it’s enough.
I’ve redefined what breastfeeding means to me. It’s personally tailored to each unique baby. Every nursing relationship is different—no two are alike. Many are cut short, accompanied by tears, while others go on for years without a hitch. Ours, though supplemented, is continuing. I’m fortunate enough not to have experienced a clogged duct, mastitis, sore or bleeding nipples. My baby’s latch is still as beautiful as it was on day one.
She prefers a bottle at night, but her very last nibble is at the breast. Whether there’s any milk there or not, it brings her the peace she needs to sleep. I’m so grateful for the gift I’m able to give, however small it may be. And even more grateful for the gift it’s given me. This is mothering—doing everything I can to give her what’s best, no matter what.
She’s getting more breast milk than many babies do at her age. And there’s no end in sight. Until that day, I will keep on taking the extracts, the teas, and the herbs. I will continue to pump after every nursing session until the day that signals the end. What that signal will be we have yet to find out. But for now, this is how it is. It’s bittersweet and far from perfect, a little sad, but also wonderful.
Thank you La Leche League. I could not have done it without you.
Further Resources
Breastfeeding with Hypoplasia. Insufficient Glandular Tissue
Breastfeeding and Thyroidsm
Galactogogues
Milk Donation and Sharing
Breastfeeding is Love – a mother’s story about her atypical breastfeeding journey