Promising Treatments
Progesterone supplementation and metformin have been used to maintain a healthy pregnancy in PCOS women, and also may have the added benefit of an increase in milk supply. Progesterone treatment, prior to conception and through the first trimester of pregnancy, improved breast morphology and yielded successful lactation in one infertile (though non-PCOS) patient. (3) Metformin may be the best treatment to consider for women with PCOS-related milk supply problems. Though originally used for improving insulin sensitivity, metformin often ameliorates many other PCOS symptoms. (4) Several women treated with metformin postpartum gained full milk supplies after initial milk supply problems. (5) Recent studies have shown that metformin levels are relatively insignificant in the breastmilk. (6) Even the optimal scenario of metformin use before, during and after pregnancy may not correct the most serious breast tissue deficits in women with PCOS. One mother with very little breast tissue started metformin treatment before pregnancy, was supplemented with progesterone during the first trimester, and continued metformin through the pregnancy and lactation. (7) Unfortunately, her small breasts still did not grow and she produced only drops of milk.

Herbal Galactogogues
Two herbal galactogogues of particular interest for use during lactation are goat's rue and fenugreek. Both goat's rue and fenugreek are reputed to increase milk supply and possibly even stimulate breast growth. They are also considered to have potential hypoglycemic properties, though they are not commonly used for this purpose. (8,9) Dosing should be discussed with an experienced medical professional since optimal doses for stimulating breast growth in women with PCOS are unknown. I took the recommended dose of More Milk Plus for about a week and experienced no milk output changes. Because women with PCOS sometimes complain of hypoglycemia, PCOS mothers taking either goat's rue or fenugreek should be encouraged to eat regularly to maintain consistent blood sugar levels.

Traditional Galactogogues
Domperidone (Motilium) and metoclopramide (ReglanO) are medications used for gastrointestinal distress that, as a byproduct, act as galactagogues by stimulating prolactin production. (10) Both have been used successfully to help mothers with previous full supplies to regain them, but not as successfully with primary failure. Domperidone may be a better choice since women with PCOS may be more vulnerable to depression, and metoclopramide can induce depression in some postpartum women.

Hope for the Future
We can approach moms who had a low milk supply in the past and are nearing the birth of a new infant with cautious optimism. The amount of milk available (at least initially) is higher in multiparous women from a normal population. (11) Zuppa et al. hypothesize that this difference might be attributed to higher prolactin receptor number. (11) I dreaded experiencing low milk supply with my second child. After consulting a number of experts, I decided to postpone any herbal or medicinal interventions until after focusing fully on the initial establishment of my milk supply. I rested in bed for one week with my newborn, nursing on demand. Perhaps I can thank the higher number of prolactin receptors (and God!) for my full milk supply.

References:

1. Marasco L, Marmet C, Shell E. Polycystic Ovary Syndrome: A connection to insufficient milk supply? Journal of Human Lactation 2000;16(2):143-148.
2. Kidson W. Polycystic ovary syndrome: a new direction in treatment. Medical Journal of Australia 1998;169:537-540; Solomon C. The epidemiology of polycystic ovary syndrome. Endocrinology and Metabolism Clinics of North America 1999; 28(2):247-63.
3. Bodley V and Powers D. Patient with insufficient glandular tissue experiences milk supply increase attributed to progesterone treatment for luteal phase defect. Journal of Human Lactation 1999;15(4):339-343.
4. Glueck CJ, Streicher P, Wang P. Treatment of polycystic ovary syndrome with insulin lowering agents. Expert Opinion on Pharmacotherapeutics 2002;3:1177-89.
5. Charles Glueck, M.D., personal communication, August 2003; Mona Gabbay, M.D., personal communication, August 2003.
6. Hale TW, Kristensen JH, Hackett LP, Kohan R, Ilett KF. Transfer of metformin into human milk. Diabetologia 2002;45:1509-1514.
7. Lisa Marasco, MA, IBCLC, personal communication, August 2003.
8. Nice F, Coghlan RJ, Birmingham BT. Herbals and Breastfeeding. US Pharmacist, http://www.uspharmacist.com/, retrieved August 2003.
9. http://www.motherlove.com/plants_goatsrue.html, retrieved August 2003.
10. http://www.breastfeedingonline.com/domperidone.shtml, retrieved August 2003.
11. Zuppa AA, Tornesello A, Papacci P, Tortorolo G, Segni G, Lafuenti G, Moneta E, Diodato A, Sorcinin M, Carta S. Relationship between maternal parity, basal prolactin levels and neonatal breast milk intake. Biology of the Neonate 1988;53(3):144-7.