Medora, I have tracked several anecdotal cases of PCOS low supply mothers (internet, other LC clients) who have tried metformin, and it seems to have varying levels of effect, from zero to significant. Tom Hale has also received some anecdotal reports. Of my clients who try metformin, for some it makes a difference, and for others it doesn't. I think that available lactation tissue makes a difference, for starters. In women who have poorly developed mammary gland tissue, there is little to act on and therefore limited or no change. Mona Gabbay MD and Heather Kelly IBCLC presented a case series study of 9 women to the Academy of Breastfeeding Medicine in 2003; here is their results and conclusion: Results: Nine women between 2 and 9 weeks postpartum began treatment with metformin from December 2002 to June 2003. Duration of therapy ranged from 3 to 10 weeks and four women remain on the medication at the time of this analysis. Other interventions used by this cohort to augment milk production include one or more of the following: pumping >5 times/day (n=9), domperidone (n=8), fenugreek (n=3), supplemental nursing system (n=2), and acupuncture (n=1). Two women discontinued metformin due to side effects of the medication: diarrhea in one, parasthesias in the other. Of the remaining 7 women, all had increases in milk supply of variable amounts. One patient, exclusively pumping 6 ounces per day at 2 weeks postpartum, started metformin alone (without domperidone) and was exclusively breastfeeding after 6 weeks. Another patient, supplementing 25 ounces of formula per day at 4 weeks postpartum, took metformin for 10 weeks, and was breastfeeding with a decrease in formula supplementation to 5-10 ounces per day. This patient experienced engorgement for the first time on the night she increased the dose from 1gm to 1.5 gm per day. Three other patients also developed notable engorgement at dose escalations of metformin: one had to stop due to intolerable diarrhea at the higher dose, one mother of twins pumped 10 ounces during that engorged state compared with a previous maximum of 5 ounces but had minimal improvement thereafter, and a third is on her fourth week of therapy, with minimal increases in production thus far. The remaining three patients have had variable increases to date and all three remain on therapy. Conclusion: It remains unclear whether metformin improves milk production in this population of breastfeeding women. The episodes of engorgement experienced by 4 of the 9 patients at the time of dosage increases suggest that improving insulin resistance with metformin may be helpful in increasing milk production. Treating these women during the last stage of lactogenesis may be too late; we speculate whether earlier therapy, perhaps during pregnancy, may improve outcomes. ***The assumption has been that metformin may help milk production via insulin resistance, but I am not convinced that its potential beneficial effects are limited to insulin-related issues. For one thing, metformin has been found helpful in improving PCOS related pathology among PCOS women who DON'T have insulin resistance. This seems to imply other modes of action that simply haven't been identified yet. We have much more to learn. As a side note: goat's rue and its constituent galegin is the herb that metformin was original derived from. Phenformin was the first drug, but had some toxicity concerns so metformin was then developed from that. Kathryn at MotherLove Herbal tells me that she has been receiving positive feedback from PCOS low supply mothers who try More Milk Special Blend, which includes goat's rue. We don't know how many *don't* respond, but I find it notable that some of the mothers feel that it makes a difference. One of the difficult aspects of low supply among PCOS moms is that there are multiple possible interferences. I would not expect one drug or herb to address all of them. Lisa Marasco MA IBCLC *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]