LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
Lisa Marasco IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 1 May 2006 08:42:53 -0700
Content-Type:
text/plain
Parts/Attachments:
text/plain (116 lines)
Margaret,

>>I'd like to provide her with some good references to discuss the possible
PCOS diagnosis with her doctor, and would like to hear suggestions on the
most effective literature to share.  How open have you found doctors to
prescribing metformin?  Would it have to be in response to tests revealing
certain blood sugar levels or some other specific marker, or would they be
willing to prescribe on the chance that it might help the milk supply?<<

You've asked some great questions and also later stated the greatest
problem- that there is no hard research data so far regarding PCOS and milk
supply. That means that everything we try is "experimental" and that we are
basically trying to figure things out as we go. Would metformin work for
your mother? I think it has a better chance in working in true PCOS women
(as opposed to merely insulin resistant) with decent breast tissue in place,
and of course will be limited to that amount of available breast tissue.
What I can tell you about metformin therapy in general as a treatment for
PCOS is that it really helps some women but does not help all women with
PCOS, and that it sometimes works best in conjunction with another
medication; thus there are a variety of drugs and approaches to the various
symptoms of PCOS. But another interesting aspect is that the subpopulation
of PCOS women who are non-obese and who often are not demonstrably insulin
resistant may also benefit from the drug; it can improve their overall
condition in many cases, so I personally don't think that requiring lab
confirmation of insulin resistance within this population is necessary. This
has been documented in research and seems to suggest that metformin works in
other ways as well that we do not yet understand, hence my hope that it may
help at least a few of these women who experience low milk production from
primary causes. 

(Note: a very recent research article discusses a theory that PCOS may be a
problem of *over*-sensitivity of the ovarian theca cells to insulin. The
researchers point out that if this is the case, it would explain the
conundrum of why insulin resistance (IR) does not automatically cause PCOS
in all IR women, and how non-obese, non IR women can still develop the
syndrome. I am fascinated by this, and it may help us to narrow down still
more what may be going wrong. The next question would be, where does
metformin therapy fit into this theory?

PCOS has been a great starting point for me in trying to understand
hormonal/infertility-related low milk production, but it should not be
limiting. Some of the same underlying hormonal problems could exist in women
who are not diagnostically PCOS but have suspicious backgrounds. Two
websites I often refer women to include that of researcher Charles Glueck MD
http://www.jewishhospitalcincinnati.com/cholesterol/polycyst.htm,
(http://www.jewishhospitalcincinnati.com/cholesterol/index.html#research is
a step above if you want to see the bigger picture first) and the lay
website http://www.pcosupport.org/, which has a short "test" a woman can
take to see if she has enough symptoms to go to her doctor for more
discussion (there can be other causes for these symptoms, which is important
to keep in mind but equally valid to pursue medically).
http://www.soulcysters.com/ is another excellent lay website that lays out
the issues in an easy-to-see manner and includes a short discussion of the
differences in approach of an endocrinologist vs a gynecologist, which can
affect diagnosis and treatment.

>>If that diagnosis was confirmed, would metformin be more likely to help
than Reglan/Domperidone?  Would a person take them both together? Should
fenugreek be discontinued, since it also has some potential for lowering
blood sugar?  Are there risks to taking metformin -- some of the Web drug
info on side effects is scary, but it's always hard to put that in
perspective.<,

I think this is individual. Women have definitely taken metformin and
reglan/domperidone together, and to my knowledge without any problems. They
have also taken fenugreek with metformin, and I have discussed the usage of
goat's rue and metformin with pharmacist Frank Nice, who feels that they are
probably compatible but that, like fenugreek, the mother should monitor
herself for low blood sugar symptoms just in case. It goes without saying
that a mother should be up front with her physician when considering these
options (adding herbs to her medications).  Regarding the safety profile for
metformin in lactation, there are two studies now, both small but strong and
consistent in results, and so Tom Hale has rated it L1. His study is
available on his website. 

>>How hard should she press to get someone to diagnose/rule-out PCOS, since
it seems to be a rather loosely defined set of symptoms, with very variable
effects on lactation.  Or is that a next-stage, to pursue if galactogogues
and ongoing milk-removal don't help?  It's always a question how far and
fast to move while waiting to see the response to each strategy.<<

I think the first and most important thing is to make sure that other issues
have truly been ruled out first, most especially poor management and delayed
lactation risk factors. If there are no answers and she is not responding to
the usual measures, it is my personal opinion that a work-up is deserved and
I often advocate for such, as lactation is NORMAL and primary lactation
insufficiency indicates that something in the body isn't working right,
something that could affect the mother's health in ways beyond lactation.
PCOS research is now pushing for long-term treatment as opposed to the
traditional band-aid or fertility/only approach because of the long term
health consequences of PCOS. I always ask about extended family members'
health, and quite often there is a history of heart disease or diabetes,
which has implications for the mother already. 

>>it's sometimes [difficult to] know how to proceed in these ambiguous
real-life cases.<<

Absolutely. Which is why I am appreciative of feedback from other LCs on any
of their own insights or something that really seemed to work for a
particular mother. The more such information we collect, the more we will
learn and start to narrow down some of this ambiguity.

~Lisa Marasco

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html

ATOM RSS1 RSS2