PCOS - PMOS Breastfeeding Protocols

If you have been diagnosed with PCOS aka Polycystic Ovary Syndrome in the past, it is now been renamed to PMOS to encompass the endocrine and metabolic system.  As you may have experienced maintaining milk supply requires intensive milk extraction due to risks of delayed milk "coming in" and potential hormonal interference from insulin resistance and/or high androgens. To endeavor to get milk to come in and keep your milk supply, below are some protocols that may help.

Immediate Postpartum Protocols

Colostrum Collection: With the permission of your doctor or midwife, collect colostrum after 36-37 weeks.  Especially in high risk pregnancies, it is essential to be cleared prior to expression.

Early Initiation: Start nursing or hand expression within the first hour of birth.

Frequent Removal: Breastfeed on demand or use a hospital-grade pump at least 8–12 times every 24 hours (roughly every 2–3 hours).

Night Feedings:  Pitocin levels are the highest between 12pm-5am, so don't take advantage of nursing or pumping twice during those hours..

Antenatal Expression: Begin expressing colostrum at 38 weeks (with medical approval as it may cause contractions) to "wake up" breast tissue and build a supply before birth.

Avoid Early Supplementation: Unless medically necessary, avoid formula in the first few days to maximize biological stimulation of the breast. 

Skin to Skin Contact: Even if pumping, use skin to skin contact with baby to boost oxytocin which aids with let-down. 

 Advanced Extraction Techniques

Breast Pump & Flange Selection: Make sure to use a good double electric breast pump, not a wearable and measure for correct flange size to use.  A wearable breast pump should only be used on occasion.

Triple Feeding: If the baby cannot latch effectively, nursing is followed by 10–15 minutes of pumping on each breast to ensure thorough drainage.

Hands-On Pumping: Use a hands-free bra and perform breast massage while pumping to increase milk output by as much as 48%.

Power Pumping: Simulate cluster feeding once a day for several days by pumping for 20 minutes, resting for 10, pumping for 10, resting for 10, and pumping for 10.

Night Pumping: Prolactin levels are highest between midnight and 5 a.m.; ensure at least one extraction session occurs during this window. 

Metabolic & Hormonal Management

Insulin Sensitivity: High insulin can block milk synthesis. Manage this through a low-glycemic index diet and, if prescribed, continuing Metformin, which is considered safe during lactation.

Galactagogues: Certain herbs like Goat’s Rue (which supports insulin sensitivity) and Moringa may be more effective for PCOS-related supply issues than traditional herbs like Fenugreek.

Stress Management: High cortisol from stress can trigger androgen spikes that inhibit milk flow. Use skin-to-skin contact (Kangaroo care) to boost oxytocin and lower cortisol. 

Non-insulin Resistant PCOS

Following the immediate post-partum protocols and advanced extraction techniques is essential.  Poor prolactin response could be the culprit of low milk supply additional pumping especially between 12pm-1am and switch nursing (moving baby back and forth between breasts every 5 minutes) may be helpful.

Lifestyle, diet and weight management can help regulate hormones.  

Some find Myo-inositol and Vitamin D supplements helpful. Vitamin D dosage in prenatal vitamins is often 400-600IU/day which is insufficient.  Recommended dosage is 1000-2000IU/day to begin with upper level dosage at 4000IU/day.

Recommended Support

Prenatal Consultation: Meet with an IBCLC (International Board Certified Lactation Consultant) before birth to assess breast development (checking for Insufficient Glandular Tissue) and create a custom plan.

Weight Monitoring: Frequent weight checks for the infant in the first two weeks are critical to ensure they are transferring enough milk despite potential PCOS-related delays. 

Having PCOS does not mean you are unable to breastfeed, but it does pose challenges and milk supply may wain even with your best efforts.  The initial colostrum is your baby's first immunization and any breastmilk is liquid gold for you baby's health. Don't be discouraged if your milk supply is not like the next moms.  Your tenacity and effort to give your baby the best is what counts.

Every ounce counts,

Tanya