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Your Quick Guide to PCOS and Breastfeeding

Woman holding PCOS sign

When I hear “PCOS and breastfeeding” in the same sentence, I immediately feel like I have more questions than answers. There’s very little information about the impact of PCOS on breastfeeding and lactation. And what little evidence we do have is often weak or conflicting, or difficult to explain. Let me try to provide some clarity.

What is PCOS?

PCOS stands for polycystic ovarian syndrome. The exact cause is unknown. First described in 1935, it is sometimes called Stein-Leventhal Syndrome.

Is PCOS a disease?

Strictly speaking, no. Polycystic ovarian syndrome (PCOS) is a metabolic disorder.

Syndrome comes from a Greek word meaning “concurrence.” Hence, Webster’s dictionary says that a syndrome is “a group of signs and symptoms that occur together and characterize a particular abnormality or condition.”

Individuals affected with a syndrome might have only a few of the signs or symptoms, and they might not feel ill at all. And, unlike a disease, a specific pathological process or exact treatment may not yet be identifiable or available. So it is with PCOS and breastfeeding.

What are the signs and symptoms of PCOS?

Often, the signs and symptoms in a syndrome depend on what expert you’re talking to. Remember? Syndromes are a little imprecise.

Most experts would likely agree that signs and symptoms of PCOS include:

  • irregular periods
  • enlarged ovaries with tiny cysts
  • evidence of excessive male hormones — such as facial hair — and a deficiency in female hormones — most notably, progesterone.  (This is a simplified explanation.)
  • altered insulin levels, which impact milk production, but its exact influence is unclear.

Some experts would say that PCOS also involves:

  • infertility and/or pregnancy losses
  • widely-spaced breasts
  • alterations in milk volume (in some cases).

Women with PCOS are also at increased risk for:

  • obesity
  • diabetes
  • heart disease
  • and more

What about insufficient glandular tissue?

It’s true that a small percentage of the population have insufficient glandular tissue. To be clear, I’m not talking about “small breasts.” (As I pointed out elsewhere, there’s a difference between “small breasts” and insufficient glandular tissue.) Here I’m talking about true insufficient glandular tissue.

Do women with PCOS typically have:

  • insufficient glandular tissue or a smaller volume of milk? Very possibly, yes.
  • unusually shaped or widely-spaced breasts? Very possibly, yes.
  • lower levels of progesterone or estrogen? Yes. Is that that the explanation for inadequate mammary growth? Possibly, but we don’t know.

Does PCOS affect milk production?

Yes, that’s possible. Without question, some women with PCOS do experience a low milk supply. PCOS is associated with low levels of prolactin, a hormone known for its role in milk volume.  

However, as astonishing as it may seem, some women with PCOS actually have an oversupply!

Some mothers with PCOS have about the same volume any other nursing mother.

Like all other syndromes, PCOS is a little quirky and not entirely predictable.

What about metformin, PCOS and breastfeeding?

Frequently, metformin is prescribed for women who have PCOS. When I think about adverse drug effects during breastfeeding and lactation, I consider four factors: safety, milk composition, milk volume, and initiation/continuation of breastfeeding.

Safety: Will the drug have a harmful effect on the infant? Read the information for yourself, but I cannot identify any serious safety issues reported in LactMed. That makes sense to me, because very little of the drug passes into the mother’s milk.

Volume: Will the mother’s milk volume be within normal limits? The explanation for altered milk volume is more likely related to the syndrome, rather than the metformin. Similarly, there are many other endocrine explanations for a low milk supply, and the most likely explanation is mismanagement.

Composition: Are the components of the milk altered? It seems logical that PCOS would affect the carbohydrate content of the mother’s milk, but as far as I can tell, there is no evidence to suggest that.

Initiation and continuation: Is the drug associated with a decreased likelihood of initiating or continuing breastfeeding? In this case, there is no evidence that it does.

What are the clinical implications for PCOS and breastfeeding?

If you are the pregnant or nursing mother in this situation, work with a qualified endocrinologist before, during, and after pregnancy. If you think you have an altered milk supply, get professional help from someone who truly understands how milk is made. Very often, the root of the problem is simple mismanagement.

Preparing for the IBLCE exam? Come to my Comprehensive Lactation Course. We’ll talk about this and other syndromes in more detail! I’d love to see you in Orlando in the spring!

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