Polycystic ovarian syndrome and breastfeeding

What is polycystic ovarian syndrome?

Polycystic ovarian syndrome (PCOS) is a complex hormonal condition that affects 5% to 10% of women of reproductive age. Features of PCOS can include fertility problems, acne, obesity, excess body hair growth and an increased risk of developing type 2 diabetes.1

PCOS and milk supply

Little research has been done on PCOS in relation to breastfeeding. A possible connection between PCOS and a low milk supply was initially presented in a case study in 2000 of 3 mothers with PCOS who also had low milk supply.2 It is thought that PCOS may possibly interfere with the hormones required for the breast to develop milk-producing tissue.3

In 2008, a study4 of 36 mothers with PCOS and 99 mothers without PCOS concluded that mothers with PCOS appear to have a reduced breastfeeding rate in the early postnatal period as compared to mothers without PCOS. By 3 months however, breastfeeding rates were equal between mothers with and without PCOS. The researchers in this study also found a possible negative link between ‘pre-androgen’ hormone levels in PCOS mothers and breastfeeding rates. This may provide a possible reason why some mothers with PCOS have problems with low milk supply.

However, it is important to know that many mothers with PCOS have no problem with milk supply and breastfeed successfully, and some mothers with PCOS even make too much milk.2 More studies are needed before any connection between PCOS and breastfeeding can be confidently stated.

Importance of breastfeeding for mothers with PCOS

Women with PCOS have an increased risk of developing type 2 diabetes later in life. As well, babies born to mothers with PCOS have an increased genetic risk of developing type 2 diabetes. Since breastfeeding helps to protect a mother and her baby from developing type 2 diabetes later in life, this makes breastfeeding for a mother with PCOS of particular importance.3

Breast changes during pregnancy

Many mothers notice that their breasts change in the following ways during pregnancy to prepare for breastfeeding:

  • Early breast tenderness is common and is often the first sign of pregnancy for many women.
  • Some mothers notice darkening in colour of their areola/nipple.
  • ‘Bumps’ around the areola (calledMontgomery’s glands) typically get bigger. These glands make a fluid which helps to keep the areola and nipple supple and also helps to get rid of germs.
  • Breasts increase in size.5 When this occurs varies from woman to woman, but most women by the end of their pregnancy have noticed some breast growth.
  • Breasts start producing colostrum (the first milk that the breasts make). Some women can express tiny amounts of this anywhere from 16 weeks of pregnancy, while others don’t notice it at all until after their baby is born.

These changes indicate that your breasts are developing well for breastfeeding. If you haven’t noticed any of these changes you may wish to consult your medical adviser or lactation consultant.

What can be done to maximise breastfeeding success?

In the beginning:

Understanding the possible effect of PCOS on milk supply can enable women with PCOS to maximise their potential to breastfeed. This could include things such as seeking guidance from a lactation consultant or medical adviser. Part of this guidance may include taking steps to use non-medical options for pain relief during labour (eg TENS, hypnotherapy, water, massage, heat packs, focused breathing); being in skin-to-skin contact with your baby without delay after birth, followed by 24-hour rooming in with your baby; feeding your baby according to need; ensuring optimal positioning and attachment; avoiding supplementation unless medically indicated; and avoiding artificial teats and dummies. For further information see the My breastfeeding plan article on this website.

Medications:

Mothers with PCOS who have problems with low supply may find it helpful to speak with their medical adviser about the use of certain medications which may help to maximise milk supply. Metformin is one medication that has been studied to improve a woman’s symptoms of PCOS. Depending on the individual situation, some medical advisers use metformin and a galactagogue to help maximise the supply of a mother with PCOS.6

Breastfeeding supplementer:

Mothers with PCOS who have problems with low milk supply may find it helpful to use a breastfeeding supplementer, which allows a baby to receive any necessary supplementary milk while still feeding at the breast. For further information see the website article Using a breastfeeding supplementer article on this website.

© Australian Breastfeeding Association August 2012

The information on this website does not replace advice from your health care providers.

References

  1. Shannon M, Wang Y 2012, Polycystic ovary syndrome: a common but often unrecognized condition. J Midwifery Womens Health 57(3):221-30.
  2. Marasco L, Marmet C, Shell E 2000, Polycystic ovary syndrome: a connection to insufficient milk supply? J Hum Lact 16(2):143-8.
  3. Nesmith H 2006 (November), Polycystic Ovarian Syndrome (PCOS) and Lactation. Topics In Breastfeeding Set XVIII, Lactation Resource Centre.
  4. Vanky E, IsaksenH, Moen MH, Carlsen SM 2008, Breastfeeding in polycystic ovary syndrome. Acta Obstet Gynecol Scand 87(5):531-5.
  5. Vanky E, Nordskar J, Leithe H, Hjorth-Hansen A, Martinussen M, Carlsen S 2012, Breast size increment during pregnancy and breastfeeding in mothers with polycystic ovary syndrome: a follow-up study of a randomised controlled trial on metformin versus placebo. BJOG doi:10.1111/j.1471-0528.2012.03449.x. [Epub ahead of print]
  6. Baillargeon J, Jakubowicz D, Iuorno M, Jukubowicz S, Nestler J 2004, Effects of metformin and rosiglitazone, along and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil Steril 82(4):893-902.