Galactagogues are herbal supplements, medications, or other substances that are taken by breastfeeding mothers in an effort to increase milk production. Some foods, including oats, barley, and certain vegetables, are rumored to have milk-boosting properties. Some herbal supplements (e.g., milk thistle, fenugreek) are also touted for boosting milk supply, and a couple of medications are recognized for their lactogenic (milk-producing) side effects.
Unfortunately, most of the studies showing the effectiveness of galactagogues are of poor quality, and the few randomized, controlled studies that have been done involved very few mothers.
The problem with pharmaceutical galactagogues
Prolactin is the hormone that causes the milk-producing cells in the breasts to make milk. Domperidone and metoclopramide (Reglan) are prescription medications that were developed for other health conditions but have one notable side effect—an increase in prolactin levels. Some small studies have shown an increase in milk production when domperidone and metoclopramide are taken by lactating women, but in 2018, the Academy of Breastfeeding Medicine (ABM) noted that while there have been some additional studies of domperidone and herbal galactagogues in recent years, current research is still relatively inconclusive and all have potential for adverse effects.
In cases where a mother and physician decide that the benefits of using a pharmaceutical galactagogue outweigh the risks, ABM recommends that the medication be given at the lowest possible dose for the shortest period of time. Currently, domperidone is unavailable in the U.S.; mothers who want to use the drug must obtain it through other sources, such as online vendors. (You can learn more about the domperidone dilemma here.)
Over-the-counter galactagogue products
Several over-the-counter herbal products are marketed as galactagogues, including milk thistle (silymarin), goat’s rue, dandelion, millet, blessed thistle, fennel seeds, and others. There tends to be a lack of evidence-based research in support of these products as well, but many have been used traditionally in various cultures around the world. ABM suggests that parents exercise caution in using such products.
Herbal supplements are not well-regulated in the U.S. and many have been shown to be contaminated with other products. In addition, some mothers have had unexpected allergic responses. For example, fenugreek, a popular choice among breastfeeding mothers that is readily available and on the Food and Drug Administration’s “Generally Recognized As Safe” list of food additives, can cause allergic symptoms (even anaphylaxis) in individuals with allergies to ragweed and similar plants as well as peanuts and other legumes, including chickpeas, soybeans, and green peas. Milk thistle can trigger a similar response in those allergic to ragweed and similar plants.
Other ways to boost milk supply
Before taking any herbal or medicinal product, breastfeeding mothers should first consider non-pharmacological methods for increasing milk supply. Too often, mothers think that their supply is insufficient, when in reality, less than 5 percent of women are truly unable to produce ample amounts of milk. More often, the perception of “not enough milk” reflects a lack of confidence on the part of the mother, due to a lack of knowledge or a lack of support from health care providers, family, and friends.
When babies experience a growth spurt, for example, nursing the baby at the first sign of hunger will usually boost a mother’s supply naturally. Similarly, mothers who think their milk supply has dropped when their breasts undergo normal physiological changes, need to know that they are not “losing their milk.” Rather, it is normal for breasts to feel uncomfortably full about 3–5 days after birth when abundant amounts of milk are being produced; and it is equally normal for those same breasts to soften as a mother’s milk supply responds to her baby’s demand. Oftentimes, mothers, especially those returning to work or school, worry about a lower-than-expected yield when pumping their milk, when in fact, the amount of milk a mother hand-expresses or pumps is not necessarily an indication of how much milk she is making. While some mothers pump quite successfully, others do not; in fact, babies are the most efficient pump. (For tips on how to increase the amount of milk expressed, read this.)
Whether galactagogues actually improve milk supply or simply act as a placebo (a substance with no therapeutic effect that the recipient believes is effective) is unknown. Foods that support breastfeeding pose little (if any) risk. But some medicinal galactagogues may interfere with other medications you are taking or have side effects (e.g., diarrhea, stomach discomfort). Before you consider taking an herbal supplement or medication—over-the-counter or prescription—talk to your health care provider about your milk supply concerns. More often than not, a mother’s perception of insufficient milk is actually a misperception.