Galactogogues

April 26, 2021

What is a galactogogue?

The Academy of Breastfeeding Medicine describes galactogogues as “medications or other substances believed to assist initiation, maintenance, or augmentation of the rate of maternal milk production.”1

Simply put, galactogogues are substances believed to increase human milk production.

The 2011 Academy of Breastfeeding Medicine Protocol begins with a discussion of lactation physiology and reminds the reader that good breastfeeding management is the first step in helping a mother with low milk supply. The protocol reviews that the rate of milk synthesis is controlled locally in the mammary gland by autocrine control. If the breasts are not drained regularly and thoroughly, milk production declines. Therefore, the mother needs to be reminded that even if she takes a galactogogue, she still needs to empty her breasts at least 8 times a day (8 or more in 24!) by nursing directly or pumping.

Pharmaceutical galactogogues

Several statements from the ABM protocol (reference 1):

  • “Currently available pharmaceutical galactogogues are all dopamine antagonists and will increase prolactin levels via this mechanism.”  

  • “However, while galactogogues do increase baseline serum prolactin, there is no direct correlation between baseline prolactin levels and rates of milk synthesis or measured volumes of milk production.”

  • “Because current research of all galactogogues is relatively inconclusive and all of the agents have potential adverse effects, ABM cannot recommend any specific pharmacologic or herbal galactogogues at this time.”

  • However, if used, the protocol goes on to recommend discussing known risks with the mother prior to use, documenting the discussion, and using the lowest possible doses, for the shortest period of time.

Having said that! ... Here is some information about two of the pharmaceutical galactogogues. Remember that these are dopamine antagonists and increase prolactin levels via this mechanism.

A dopamine antagonist has an effect that is opposite of what dopamine would do. Dopamine causes a decrease in milk production so a dopamine antagonist should cause an increase in milk production.

Metoclopramide (brands names Reglan and Maxeran)

  • Need a prescription

  • Dosage 10-15 mg three times a day

  • Side effect: depression. This is not the best choice for mothers who have a history of depression.

  • Other side effects: diarrhea, drowsiness, fatigue, gastric upset, nausea

Domperidone (brand name Motilium)

  • Need a prescription; not available in the United States

  • Dosage 10-20 mg 3-4 times a day

  • Side effects: dry mouth, headache, and abdominal cramps

  • Is used for the treatment of certain gastrointestinal disorders like gastroesophageal reflux and emesis

Herbal galactogogues

Herbal galactogogues come as capsules, liquids or teas. An herb that helps one mother may not work for another.

Do they work?

Here is what the Academy of Breastfeeding Medicine Protocol says, “Many of these herbal remedies have been used throughout history to enhance milk supply. Some herbs mentioned as galactogogues include fenugreek, goat’s rue, milk thistle, oats, dandelion, millet, seaweed, anise, basil, blessed thistle, fennel seeds, marshmallow, and many others. Although beer is used in some cultures, alcohol may actually reduce milk production. A barley component of beer (even nonalcoholic beer) can increase prolactin secretion, but there are ‘‘no systematic studies’’ and ‘‘there is no hard evidence for causal effect.’’ The mechanism(s) of action for most herbals are unknown. Most of them have not been scientifically evaluated, but traditional use suggests safety and possible efficacy. (Bolded by Lactation College author) The available studies for herbs, herbal medicines, or herbal galactogogues suffer from the same deficiencies as the studies for pharmacologic agents: Small numbers of subjects, lack of information regarding breastfeeding advice, and lack of randomization, controls, or blinding. The placebo effect may be the reason for widespread impressions (anecdotal experience) of a positive effect of fenugreek on increased milk volumes.” (reference 1)

I don’t know if beer is a galactogogue or not, but I do know I really enjoyed having a Guinness with my exact-producing, breastfeeding daughter sitting on the front steps of her condo in the South End of Boston on many a hot summer day.

Below is information about a few herbal galactogogues. (There are many!) They can be purchased in stores that sell herbal remedies or online. You do not need a prescription.

Fenugreek seed (Trigonella foenum-graecum)

  • Fenugreek is generally considered safe, but may have a hypoglycemic effect on the mother.

  • The major compounds in fenugreek are diosgenin, apigenin, and luteolin which stimulate the anterior pituitary to enhance human milk production.

  • Fenugreek is commonly used as a single herb.

  • However, in some places, like Thailand, fenugreek is combined with other galactogogue herbs like turmeric and ginger. A 2018 study in Breastfeeding Medicine reported that breastfeeding mothers receiving mixed herbal supplementation containing fenugreek, ginger and turmeric (3 capsules three times a day x 4 weeks) had a 49% increase in milk volume at week two and a 103% increase at week 4.2

  • Fenugreek can make the urine and sweat smell sweet, like maple syrup. It can lower blood sugar. A woman should not take fenugreek if she is on anticoagulants (blood thinners).

Goat’s rue (Galega officinalis)

  • The dried leaves of the goat's rue plant are thought to be a galactagogue. Goat’s rue is popular in France and other European countries.

  • Goat’s rue is also used to stimulate the growth of breast tissue, so it may be helpful for women who wish to breastfeed after breast surgery and those who plan to breastfeed an adopted child.

Milk thistle (Silybum marianum)

  • Milk thistle has been used historically throughout Europe, but there are no randomized controlled trials to validate its use. The plant is still commonly known as St. Mary’s thistle in honor of the Virgin Mary. Early Christians believed that the white colored veins in the leaves were symbolic of her milk.

  • In one study, taken as a tea, milk thistle significantly increased milk yield, compared with placebo.3

Other thoughts

  • It’s always a good idea to eat a well-balanced, healthy diet and drink plenty of water.

  • In online forums have a lot of chatter about eating grains to increase milk production (oatmeal, oats, barley, quinoa, rice, brewer’s yeast).

  • Who doesn’t like a cookie? Lactation cookies are also a nice treat to make. You can find recipes online. These often include oats, brewer’s yeast, flaxseed, and more. Again, no proof they work but lovely concept!

  • This website contains a wealth of information. Look under galactogogues. Low Milk Supply.org

Items that reduce milk supply

  • Sage, peppermint, spearmint, menthol

  • Pseudoephedrine (found in Sudafed) and antihistamines like Benadryl

  • Certain birth control preparations

  • Bromocriptine

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1

The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion (First Revision 2011). Breastfeed Med 2011;6(1):41-49

2

Bumrungpert A, Somboonpanyakul, Pavadhgul P, et al. Effects of fenugreek, ginger, and turmeric supplementation on human milk volume and nutrient content in breastfeeding mothers: A randomized double-blind controlled trial. Breastfeed Med 2018;13(10):645-650

3

Di Pierro F, Callegari A, Carotenuto D, et al. Clinical efficacy, safety and tolerability of BIO-C (micronized Silymarin) as a galactogogue. Acta Biomed 2008;79:205– 210