For breast/chest-feeding folks with a breast/chest-fed baby, the ability and opportunity to maintain a healthy milk supply may not be easy. Proper nutrition, adequate hydration, feeding/pumping frequently, and sleep are all the most important aspects of being able to lactate successfully. Though some may even take galactagogues to help them develop and maintain some supply. But what are galactagogues? How do they work?
This article offers insight into what galactagogues are and how they help, types of galactagogues, effectiveness of galactagogues, and considerations when using galactagogues.
What Are Galactagogues?
Galactagogues refer to substances (natural or pharmaceutical) that facilitate or increase breast milk production. The term comes from the Greek words galacto-, which means milk, and agogos, which means leading to or promoting. Various cultures have used galactagogues for hundreds of years, but scientific study and examination of them as a group have only recently taken place.
When considering the use of galactagogues as effective lactation supplements, it is important to note that these substances are designed to help, not fix issues with breastfeeding, and will work best when used in conjunction with the proper breastfeeding strategies when a parent has low milk supply due to lactation not being established in a timely manner (for example, a premature birth or illness that is delaying the onset of lactation or stress).
How Do Galactagogues Work?
Galactagogues stimulate milk production in different ways depending on the type of galactagogue. Broadly, galactagogues will act on the hormonal pathways that regulate lactation, which typically include prolactin and oxytocin.
- Prolactin is the hormone that causes the mammary glands to produce milk. Some galactagogues are understood to raise blood levels of prolactin, leading the mammary glands to produce milk excretion.
- Oxytocin is the hormone that triggers the let-down reflex to release milk from the expanding milk ducts. Some galactagogues are thought to promote this hormone as well to promote milk ejection during nursing or pumping.
Whether they are herbal products or pharmaceuticals, all galactagogues should support these hormonal pathways; the response will vary by person.
Types of Galactagogues
Galactagogues can be divided into two categories: herbal (natural) and pharmaceutical (prescription).
Herbal Galactagogues
Herbal galactagogues are commonly used herbs that can come in various forms, such as tea, capsules, or tinctures. Some of the most popular herbal galactagogues are:
- Fenugreek: This is probably the most popular herbal galactagogue for lactating people’s use. Fenugreek is thought to increase milk supply within 24–72 hours. This herb may also lead to other side effects such as gastrointestinal upset or a maple-syrup body odor.
- Blessed Thistle: Usually taken with fenugreek, blessed thistle seems to promote prolactin production.
- Fennel: This herb has estrogen-like properties when lactating; fennel may assist milk flow and aid in the digestive process for both parent and infant.
- Goat’s Rue: This herb is not as well-known but is potent, especially for people with glandular issues.
- Alfalfa, Anise, and Milk Thistle: These herbs are also thought to support lactation but are usually considered secondary to the main galactagogue.
Although herbal galactagogues are available over the counter, the safety and efficacy of these plants are not supported by sound, evidence-based clinical information. If you are considering starting with galactagogues, it is prudent to check with your healthcare provider or lactation consultant before starting any herbal regimen.
Pharmaceutical Galactagogues
Sometimes, patients with persistent low supply or other medical complications may be recommended pharmaceutical options. The most common pharmaceutical galactagogues include
- Domperidone: This medication increases prolactin levels by blocking dopamine (dopamine generally suppresses prolactin). In many countries, domperidone is commonly used off-label to help with lactation. This medication has shown consistent efficacy, but as with all medications, domperidone does have potential side effects, which could include headache and dry mouth.
- Metoclopramide: Metoclopramide also increases prolactin levels; however, because of its potential side effects (for example, fatigue, depression), it is used less often.
Pharmaceutical galactagogues should only be used under the supervision of a medical professional. Generally speaking, pharmaceutical galactagogues are recommended for patients if other, non-pharmaceutical, options have not been successful.
Effectiveness and Limitations
Although many parents notice an improvement in the milk supply after they start using galactagogues, their effects vary considerably from one mom to the next, as some notice a substantial improvement while others note very little or no change at all. There are many factors involved, such as what caused the low supply, mom’s underlying health, and how frequently milk removal was taking place (whether through nursing or pumping).
That said, galactagogues should not be the first approach. The most effective way to increase milk supply is to remove milk more frequently. The galactagogues may help in supporting that process but cannot substitute it.
In addition, galactagogues are not miracle drugs. If mothers overuse these products or rely completely on them to help increase their milk supply while not addressing the underlying breastfeeding issues (such as delayed latch, errors in positioning, or infrequent nursing), the mother may feel frustrated and disappointed.
Things to Consider Before Using Galactagogues
Before you leap to start using galactagogues, think about the following:
- Identify the Cause: You should consider working with a lactation consultant to determine if the cause of your low supply is due to latch issues, infrequent feeds, or some other reason.
- Be Aware of Potential Side Effects: Herbal supplements are still herbs, and while they are “natural,” they can still cause side effects or interact with medications.
- Try Only One at a Time: To monitor for effectiveness and for tolerability, it’s best to follow only one galactagogue, under supervision.
- Document Changes: Keep a journal of feedings, pumping sessions, and total milk output to assess for changes.
- Have Patience: Changes may take a couple of days to realize, and changes will not always be dramatic.
Final Thoughts
Galactagogues can be a useful resource for breastfeeding parents who are having challenges with their milk supply, but they are most effective when combined with ongoing nursing on demand, a good latch, and responsive feeding. If you are considering herbal galactagogues or are considering prescription support, it is prudent to involve a health care professional.
Understanding how galactagogues function allows parents to make informed decisions— and ultimately, support their breastfeeding experience with knowledge and care.
Photo by Adonyi Gábor:
