PCOS is the most common hormonal condition to affect women of reproductive age. It can have a detrimental effect on fertility, as women with the condition struggle to conceive and are at greater risk of experiencing pregnancy complications, including miscarriage.
It is also thought that PCOS can affect a female’s ability to breastfeed, with some studies showing that women with clinically diagnosed PCOS are less likely to commence breastfeeding than those who do not have the condition. The issue seems to be with initiation of breastfeeding, as once it is successfully established, women with PCOS are no more likely to stop breastfeeding than their counterparts.
Reasons why PCOS might make breastfeeding more challenging
Women with PCOS often have lower levels of progesterone, particularly if they do not ovulate regularly. Anovulation is one of the main clinical symptoms of PCOS. Progesterone is required for normal breast development. It has been suggested that women with PCOS have insufficient glandular breast tissue, meaning that the breasts cannot undergo the normal physiological changes necessary during pregnancy.
Women with PCOS are often hyperandrogenic, meaning they produce high levels of androgens. Specifically, levels of Dehydroepiandrosterone‐sulphate (DHEAS) have been shown to be elevated in pregnant women with PCOS. DHEAS is a weak androgen, however, it can undergo intracellular conversion to more potent androgens, including testosterone. One of the sites for this conversion is the mammary glands, which suggests a potential build-up of testosterone in the breast tissue of women with PCOS during pregnancy. Androgens suppress prolactin receptors and inhibit lactation. Prolactin is essential for breast growth and milk synthesis.
Prolactin efficiency can also be compromised by high insulin levels. Insulin resistance is a common symptom of PCOS and many women with the condition have higher than normal levels of circulating insulin. Aside from having a direct effect on milk synthesis through the proliferation of mammary gland cells, insulin also contributes to the high androgen levels seen in women with PCOS.
One large cohort investigation looking at almost 5000 women, of whom 6.5% had PCOS, identified that there was a positive association between obesity and breastfeeding. Obese mothers were less likely to initiate and subsequently persevere with breastfeeding. Many of the women with PCOS were overweight, but any lactation issues were attributed to them having a high BMI, rather than their PCOS status.
Certainly there are explanations for why obesity may be linked to lower breastfeeding rates. Women who are obese are more likely to require interventions during labour and delivery, which lowers the likelihood of them breastfeeding. They may experience mechanical difficulties with the baby latching due to their increased size. Obesity is also a driving factor for hyperandrogenism and insulin resistance, and, as described above, these are two of the proposed causes of low breastfeeding rates and/or lactation difficulties. Thus, it remains unclear whether women with PCOS struggle to breastfeed because of their condition, or because of their associated symptoms.
Furthermore, it must be considered that for some women breastfeeding is challenging. This may be entirely irrespective of any coexisting medical conditions. Perhaps the reason why breastfeeding is difficult does not really matter and we should instead look for solutions to the problem.
Why it is important
The World Health Organisation recommends that all babies are exclusively breastfed for the first six months of life. Breastfeeding provides extensive health benefits to the nursing child. It is singularly the best way of satisfying all your baby’s nutritional needs and should be a resource that is freely available and accessible for all. It is for these reasons that all women who are struggling to breastfeed should be given sufficient help and support to overcome the barriers they face, whether they are medical, physical, emotional or a combination of the three.
- Joham, Anju E., et al. “Obesity, Polycystic Ovary Syndrome and Breastfeeding: an Observational Study.” Acta Obstetricia Et Gynecologica Scandinavica, vol. 95, no. 4, 18 Jan. 2016, pp. 458–466., doi:10.1111/aogs.12850.
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- Marasco, Lisa, et al. “Polycystic Ovary Syndrome: A Connection to Insufficient Milk Supply?” Journal of Human Lactation, vol. 16, no. 2, May 2000, pp. 143–148., doi:10.1177/089033440001600211.
- Sir-Petermann, T., et al. “Maternal Serum Androgens in Pregnant Women with Polycystic Ovarian Syndrome: Possible Implications in Prenatal Androgenization.” Human Reproduction, vol. 17, no. 10, Oct. 2002, pp. 2573–2579., doi:10.1093/humrep/17.10.2573.
- Vanky, E, et al. “Breastfeeding in Polycystic Ovary Syndrome.” Acta Obstetricia Et Gynecologica Scandinavica, vol. 87, no. 5, 2008, pp. 531–535., doi:10.1080/00016340802007676.