A galactagogue is a medication that increases your milk supply if you are having trouble producing enough milk for breastfeeding. For many years, two prescription medications and a host of herbal supplement medications have been used to start lactation or to maintain lactation.
There is no doubt that breastfeeding is the best way to feed your baby. There is no substitute for the antibodies, nutrients, and hormones in breast milk. Benefits for your baby include infection protection and a lower risk for obesity and diabetes. Breast milk may even make your baby smarter. But, even with best intentions, not all women are able to make enough milk to breastfeed. In fact, lack of milk production is the most common reason women give up breastfeeding.
Can Medications Help?
It would be great if they did, but the first thing you need to know is that there are no medications recommended or approved for milk production. That is because there are very few studies that show they work very well. Most of the studies show a modest improvement at best over a placebo, and the studies did not include large numbers of women.
The second thing you need to know is that using a lactation medication is a last resort. Before resorting to medication, you should try all the usual nonmedical remedies and work with a lactation consultant. These include getting help with latching, making sure you breastfeed frequently and long enough to empty your breasts, and having lots of skin-to-skin contact with your baby.
Women who could benefit most from a lactation medication are those who have given birth to a premature baby or have been separated from their baby by illness. Women who get a late start breastfeeding or who stop and want to start again could also benefit. Before starting a medication, your doctor should rule out other causes of low milk production that can be treated, like hypothyroid disease or polycystic ovary syndrome.
There are two prescription medications that have been used for many years. They both work by decreasing a chemical messenger in the brain called dopamine. High levels of dopamine inhibit secretion of the hormone prolactin, which is the hormone that stimulates breast milk production. Theoretically, reducing dopamine should increase prolactin, which should increase breast milk.
Both of these medications were developed for other purposes. Increased production of breast milk is just a side effect. One of the medications – domperidone – is no longer available in the United States because some studies found a small risk for increased heart arrhythmias. That leaves one option, metoclopramide (Reglan).
Metoclopramide is approved to treat migraine headache and nausea. As you probably know, dopamine is a brain messenger that stimulates pleasure centers of your brain. Therefore, it is not surprising that side effects of this medication can include depression, fatigue, and restlessness. Although this drug does not seem to cause side effects in babies, it does in moms. Four high quality studies tested metoclopramide against a placebo. None of them could show that metoclopramide provided any significant benefit for breast milk production.
In a recent study from Tulane University, 71 health care providers were asked if they ever prescribe or recommend galactagogues. Seventy percent of the providers said they did. The most common recommendation was the herbal supplement fenugreek. Other commonly recommended herbs were blessed thistle, milk thistle, and goat’s rue.
Unfortunately, the only evidence to support these herbal medicines is their long historical use. There have been no large studies done to support their use. They are also unregulated, so there is no way to know how they work, if they work, or even what is in the supplement. And, like the prescription drugs, they all have side effects.
Fenugreek has been linked to high blood pressure, diarrhea, and peanut allergy (the plant is part of the peanut family). It also makes you smell like maple syrup. Blessed thistle is part of the ragweed family and can cause allergy and stomach upset. Milk thistle can cause allergies and diarrhea. Goat’s rue can cause low blood pressure, and is toxic in high doses.
Be very cautious about using any medicine – prescription or herbal – to stimulate lactation. Try everything else first. If, as a last resort, you consider a galactagogue, make sure you go over all the side effects and weigh the risks and benefits very carefully with your health care provider. Although these medications continue to be used frequently, there is very little evidence that they will help.