Hello Medora,

I can share with you one case of a woman with PCOS who had (is having) 
a greatly enhanced lactation experience with her 2nd baby over what 
happened with her first, and one changed variable in her situation was 
the continuous use of metformin from pregnancy through the postpartum 
period and lactation.

During her first pregnancy (which was a shock to her), she resisted 
taking any kind of medication, including metformin.  She has breast 
hypoplasia -- one very well-developed breast and one much smaller, 
both somewhat tubular in shape and widely spaced.  She did notice 
breast changes during this first pregnancy.  Her baby was born and 
transferred to the NICU, there were several barriers to breastfeeding 
in the early days but these were barriers that most mother-baby dyads 
can overcome with support and assistance (such as baby being bottle-
fed, etc.).

After the baby was about a week old, they started attempting to 
breastfeed but the mother was making no milk.  Not even drops.  Major 
attempts to relactate were begun (and this was still within the first 
month postpartum) but even with medications, pumping, and 
galactagogues, she could make only drops of milk.  She was devastated.

During her 2nd pregnancy, she took metformin.  She also took 
progesterone at the end of her pregnancy (with the hope that extra 
progesterone might create a more precipitous drop in progesterone 
levels after the delivery, one hormonal factor in successful 
lactogenesis).  This 2nd birth was with a midwife, at home, and mother 
and baby were not separated.  There was extensive (sometimes twice 
daily) lactation support and baby was feeding well.

As it turns out, this mother is making just over half of what her baby 
needs and is supplementing at the breast with donated human milk from 
other mothers in our community.  She is also using a combined herbal 
tincture of fenugreek and goats' rue (with some other lactogenic 
herbs, I believe) and taking Domperidone.

The metformin may or may not have been a significant factor in this 
mother's increased lactation success with her 2nd baby.  Many studies 
show that mothers tend to make more milk after subsequent pregnancies 
anyway; her efforts to relactate after the first pregnancy likely 
influenced the readiness of her breast tissue, and the birth scnario 
and immediate postpartum circumstances worked to stack the deck in her 
favor.  The fact that there has been such a significant improvement in 
the lactation experience for this mother tells me that there were 
several factors at work for her, metformin being one of them.

I hope this helps you in your studies,
Diana in NY

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