While many women with PCOS know that it can be difficult to conceive, not everyone knows that some women with PCOS also have difficulties with breastfeeding. The research is sadly lacking in this area with most of the work having been performed by Lisa Marasco, IBCLC. The good news is there are many resources for women with PCOS struggling with breastfeeding.

The statistics are not entirely clear, but some say that one third of women with PCOS have a normal milk supply, one third have an over-abundant milk supply, and one third have low milk supply. Of the group who have a low milk supply, one third of those produce hardly any at all. Overall, though, this is the good news for women with PCOS: the vast majority will be able to breastfeed at least to some extent.

The important thing to remember is that breastfeeding does not have to be all-or-nothing. For example, even if a woman only makes 50% of what her baby needs and the baby gets the remainder from formula or donated breast milk, the child will still reap the numerous benefits of the breastfeeding relationship. These include better orofacial development (the development of mouth and facial muscles), reduced allergic reactions, fewer infections, and improved lung capacity, not to mention the psychological benefits of intimate, physical maternal-infant bonding.

The mechanism by which milk supply is affected by PCOS is not entirely understood but there are several possible explanations. Some proposed mechanisms are described below.

In general, hormone imbalance is at the root of the lactation difficulties for women with PCOS. Estrogen dominance may play a role. If estrogen levels are too high, either by themselves or in relation to progesterone, it can inhibit milk production. Estrogen levels are normally fairly low in the post-partum period, but it is possible to have estrogen dominance both pre- and post-partum. This can be demonstrated by hormone testing.

Another possible mechanism is that if a woman has had PCOS for a long time, the hormone imbalance may have interfered with the development of mammary tissue during puberty as well as during pregnancy. Furthermore, high male hormones (e.g., testosterone and DHEA) interfere with prolactin receptors. Prolactin is one of the hormones that enable milk production. Finally, insulin resistance may impair a woman’s ability to breastfeed. It is noteworthy that sometimes women with uncontrolled diabetes have lactation problems as well as women with PCOS; insulin resistance is the common denominator. As Lisa Marasco says, “The breast is a sensitive target organ for insulin; if insulin cannot be taken in quickly and efficiently enough, this too can hypothetically cause lactation problems.”

Women with PCOS who are struggling with low milk supply should seek the assistance of a Lactation Consultant or La Leche League. There are many nursing techniques to look into, such as breast compressions or at-breast-supplementers, which can help optimize milk production and extraction and improve the breastfeeding experience for mother and baby. Two websites that are fantastic resources for nursing techniques are www.kellymom.com and www.drjacknewman.com.

In addition to strategies with nursing techniques, many nursing mothers with PCOS rely on herbs to assist their milk supplies. Herbs with a strong history of use as galactagogues (milk-producing herbs) and backed by sound research include fenugreek, blessed thistle, alfalfa, goat’s rue, and marshmallow, among others. Motherlove herbal company makes high quality herbal formulations that can help a woman with PCOS who is not making enough milk. Please discuss these herbal products and medications with a naturopathic doctor, herbalist, or your healthcare practitioner.

If you have PCOS and plan to breastfeed, don’t worry. Working to reverse your insulin resistance through a healthy low carb diet and exercise will certainly help. If you end up being one of the minority of women with PCOS who has low milk supply, with persistence and resourcefulness, you will be able to breastfeed your baby.

If you are interested in seeing what other women with PCOS are saying about these topics, visit http://pcos.insulitelabs.com/blog/index.php