>>I spoke with her today and her milk isn't in yet. Do those of you working with these women wait and see what happens with milk supply? Would she respond to either Reglan or Domperidone (available locally)? Or is Metformin the better choice and if so, what dose is recommended? My collaborating physician says they usually start at 500 BID or 850 qd and then increase up to 2000 a day to get them pregnant but I can't find anything about treatment for low milk supply. Resources for using Metformin for treatment for low milk supply?<< Patty, there isn't any info on treating with metformin for low milk supply because it's just barely starting to be tried for that purpose. In assessing the newly postpartum PCOS mom, take a look at her breasts first and take a history. Did her breasts grow during pregnancy? Did the areola darken and/or enlarge, and did her veining become more prominent? Do her breasts *look* like they've gone through a pregnancy? If so, I'd watch her another day or two before hitting the alarm button. Other things to consider are if she experienced any pregnancy complications- hypertension, pre-eclampsia, etc., things that may cause delayed lactogenesis. Metformin is definitely being used to get women pregnant-- sometimes they are left on it during the pregnancy, sometimes they are taken off as soon as pregnancy is achieved. Research by Charles Glueck MD and colleagues suggests that metformin treatment during pregnancy helps to significantly decrease pregnancy complications. I personally favor its use during pregnancy with the further hope that the hormones necessary for lactation will be normalized to allow for normal breast development and lactogenesis. If a mom has been taken off of Metformin, Tom Hale's research suggests that it is safe to take while lactating. Given that a number of PCOS women will experience rebound PCOS symptoms after childbirth, I think that it is worth mom going back on met just for that reason. In addition, as Kathy Leeper mentioned, we have had several reports now of moms being put on or back on metformin and experiencing increase in milk supply. I would like to emphasize here that these women generally had decently developed breasts and partial milk supplies to begin with; I have two other moms now who "did everything right," but their breasts were severely underdeveloped and did not improve with pregnancy, and they have made only drops of milk regardless of meds and optimum care. If a PCOS mom's milk does not come in well, I would encourage the metformin plus galactogogues. On the prescriptive side, domperidone would be my first choice. On the herbal side, I am strongly favoring goat's rue because of its reputation of increasing breast tissue (my concern for these moms is underdeveloped glandular tissue) along with milk supply; I may pair this with another galactogogue or combo tincture. We have no real information on appropriate dosages for herbs, but I am now leaning towards a more aggressive amount than is usually recommended. Pumping as is possible is always helpful as well. Hope this helps. Lisa Marasco MA IBCLC *********************************************** 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(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html