PCOS & Penyusuan

Sebelum berjaya mengandung, Mami pernah didiagnoskan mempunyai masalah hormon (PCOS) di mana salah satu petandanya ialah period yang tidak menentu (irregular period). Alhamdulillah setelah mencuba berbagai-bagai rawatan alternatif & berkat doa semua yang mendoakan, Mami berjaya mengandung pada tahun ke2 perkahwinan. Sepanjang kehamilan tiada masalah kesihatan yang serius selain daripada mengalami GDM (kencing manis).

Namun, selepas bersalin Mami mengalami masalah susu kurang @ low milk supply. Sehingga kini usia Haziq sudah pun hampir 14bulan, masalah susu kurang ini bagai tiada penghujungnya malah kini sudah semakin teruk. Puas Mami mencuba berbagai-bagai milk booster, mengepam susu bagai nak rak, berpower pumping etc tapi production masih tiada peningkatan.

Semasa umur Haziq 10bulan, Mami baru period. 2 bulan pertama period datang on time, tetapi sejak kali ke2 datang period, sehingga kini dah overdue hampir 3 minggu masih lagi tak period. Jadi, Mami syak penyakit PCOS lama berkemungkinan datang balik. Mungkin inilah juga faktor penyebabnya kenapa susu jadi makin berkurang.

Mami terus godek2 pakcik google & betullah jangkaaan Mami. PCOS & low milk supply memang ada kaitannya. Tak percaya??? sila scroll down..

Little research has been done on PCOS in relation to breastfeeding. A possible connection between PCOS and a low milk supply was initially presented in a case study in 2000 of 3 mothers with PCOS who also had low milk supply.² It is thought that PCOS may possibly interfere with the hormones required for the breast to develop milk-producing tissue.³

In 2008, a study⁴ of 36 mothers with PCOS and 99 mothers without PCOS concluded that mothers with PCOS appear to have a reduced breastfeeding rate in the early postnatal period as compared to mothers without PCOS. By 3 months however, breastfeeding rates were equal between mothers with and without PCOS. The researchers in this study also found a possible negative link between ‘pre-androgen’ hormone levels in PCOS mothers and breastfeeding rates. This may provide a possible reason why some mothers with PCOS have problems with low milk supply.

However, it is important to know that many mothers with PCOS have no problem with milk supply and breastfeed successfully, and some mothers with PCOS even make too much milk.² More studies are needed before any connection between PCOS and breastfeeding can be confidently stated.

sumber: https://www.breastfeeding.asn.au/bfinfo/polycystic-ovarian-syndrome-and-breastfeeding

Many moms with PCOS have no problems with breastfeeding, but recent research is showing that mothers with PCOS are at greater risk for insufficient milk supply. On the other hand, about one-third of women with PCOS report problems with oversupply (perhaps this is connected with the hyperprolactinemia – elevated prolactin levels – that occurs in about 20% of moms with PCOS).

sumber: http://kellymom.com/bf/concerns/mother/pcos/

Why is PCOS thought to have an effect on milk production?

According to Lisa Marasco 1, the IBCLC whose breakthrough research revealed the connection between PCOS and low milk supply, there are several different ways that PCOS could potentially interfere with breastfeeding.

1. Due to the hormonal imbalances which occur, there is the potential for poor breast tissue development during puberty and pregnancy. Fewer menstrual cycles in early puberty can translate into less estrogen to develop mammary tissue.
2. Prolactin and oxytocin are two of the main hormones involved in the onset of lactation. Women with PCOS have higher levels of androgen hormones that can interfere with prolactin reaching its receptors.
3. In addition, if too few prolactin receptors were formed during pregnancy, milk production will be limited.
4. Estrogen is known to inhibit lactation, particularly in the early days after delivery. Women with PCOS typically have an imbalance called “estrogen dominance.” If estrogen levels are not down-regulated after birth, circulating estrogen may interfere with lactation. This is why the contraceptive pill is not recommended for breastfeeding mothers.
5. Insulin resistance may affect breast growth and milk synthesis. Insulin is known to be an important factor in lactation in conjunction with prolactin and cortisol.

sumber: http://www.mobimotherhood.org/MM/article-pcos.aspx

Lisa Marasco, MA, IBCLC, is a lactation consultant in Santa Maria, California. She has studied the impact of PCOS on breastfeeding and first suspected the connection after seeing two patients within a week show up with low milk supply and similar symptoms. “I looked at their history and found out they both had infertility issues and a diagnosis of PCOS,” she says.

Building on her interest in low milk supply, Marasco decided to investigate the PCOS connection more thoroughly, making it the subject of her Master’s thesis. She studied a group of women with diagnosed lactation failure, and she found that PCOS was indeed a risk factor. Half of the women with lactation failure suffered from obesity, and 67 percent suffered from infertility—both of which are side effects of PCOS. Some women in her study group had never been diagnosed with PCOS but displayed symptoms and turned out to actually have the disorder.

“As it unfolded, I began to realize it was a great big huge spider web,” Marasco says.

Why?

With all the overlapping hormones involved in lactation, it makes sense that PCOS—which affects the balance of numerous hormones in a woman’s body—would impact breastfeeding. Marasco emphasizes, however, that PCOS affects all women differently. In a casual survey she conducted in an Internet PCOS support group, a quarter to a third of the respondents had supply troubles, and only a third of those had severe problems. “A whole lot of them do fine,” she says. In fact, in her Internet survey, Marasco found that a percentage of the respondents actually suffered from oversupply.

However, in those that do have low milk supply, the problem may be physical. Generally, the later the onset of PCOS, the better odds a woman has of being able to establish a milk supply. Women with early onset PCOS may have underdeveloped breast glands. In others, Marasco explains, the breasts may develop normally in puberty but fail to go through the required changes in pregnancy that make milk production possible. The breasts may also develop normally, but the milk simply never comes in

sumber: http://www.breastfeed.com/breastfeeding-problems/illness/breastfeeding-pcos

"....the fact that even successful pregnancy and delivery does not guarantee successful lactation in women with PCOS.1 Insulin, progesterone, and estrogen all are essential to breast development appropriate for lactation and all are imbalanced in women with PCOS. The heterogenous nature of PCOS, with different presentations and underlying pathologies in each woman, make it difficult to predict the lactation outcome. Some PCOS women easily breastfeed; some experience an oversupply of milk; some experience an undersupply.1 Insulin, progesterone, and estrogen all are essential to breast development appropriate for lactation and all are imbalanced in women with PCOS. The heterogenous nature of PCOS, with different presentations and underlying pathologies in each woman, make it difficult to predict the lactation outcome. Some PCOS women easily breastfeed; some experience an oversupply of milk; some experience an undersupply."

sumber: http://www.breastfeeding.org/uploaded_files/newsletters/newsletter11.pdf

Bagaimana untuk meneruskan penyusuan & mengembalikan susu yang hampir kering disamping berhadapan dengan masalah PCOS? Melalui pembacaan Mami ada beberapa cadangan yang boleh dilakukan, iaitu:-

1. Menggunakan SNS (Supplemental Nursing System).
2. Mengambil ubat 'metformin'
3. Mengamalkan Low-carb diet (diet makanan berkanji & manis)
4. Amalan pengambilan herba penggalak susu seperti Alfafa, Fenugreek (halba), goat’s rue, Shatavari etc
5. Mengambil ubat Domperidone (Motilium)

Alhamdulillah Mami dah jumpa jalan penyelesaian. Insya Allah Mami akan terus berusaha untuk kembali memperbanyakkan susu Mami untuk Haziq. Moga-moga Allah permudahkan..amin ya Rabb!!