What are some examples of galactagogues (substances that increase milk production) that can be consumed by lactating mothers?

Galactagogues for Lactating Mothers

Metoclopramide and domperidone are the most effective pharmaceutical galactagogues, while fenugreek, moringa, silymarin, and fennel are natural options that may increase milk production in lactating mothers. 1, 2

Pharmaceutical Galactagogues

Pharmaceutical options are typically used when natural approaches have failed to adequately increase milk supply:

• Metoclopramide is considered the galactagogue of choice due to its documented efficacy and safety profile for both mothers and infants 1

  • Acts by increasing prolactin levels through dopamine receptor antagonism 1
  • May increase milk supply when used as directed 3
  • Side effects can include tiredness, nausea, headache, and dry mouth 4

• Domperidone is another effective pharmaceutical option:

  • Used as a galactagogue that may increase milk supply 3
  • Has lower risk of crossing the blood-brain barrier compared to metoclopramide 1
  • Transfers into breast milk in low amounts due to first-pass hepatic metabolism 3
  • Women using domperidone should have access to a breast pump if there is any delay in feeding 3

Natural Galactagogues

Natural galactagogues are more commonly used than pharmaceuticals, with 55.4% of breastfeeding mothers reporting consumption of galactagogue foods or beverages compared to only 1.4% using pharmaceuticals 5:

• Fenugreek is one of the most commonly used herbal galactagogues:

  • May increase milk volume, though evidence is mixed 2, 4
  • Can cause urine and sweat to smell like maple syrup 4

• Moringa:

  • May increase both infant weight and maternal milk volume 4
  • Shows promising results in several studies 4

• Silymarin (milk thistle):

  • May increase milk volume in some studies 4
  • Results are inconsistent across research 2

• Other natural options with some evidence of efficacy:

  • Fennel may improve infant weight 4
  • Ginger has shown some benefit for milk volume in limited studies 4
  • Palm dates may help increase milk production 4

Factors Influencing Galactagogue Use

Understanding why women seek galactagogues is important for providing appropriate support:

• Perceived insufficient milk is the primary reason mothers turn to galactagogues 5, 6
• First-time breastfeeding mothers are more likely to use galactagogues (66.7% vs 49.3% for experienced mothers) 5
• Mothers who pump breast milk or supplement with formula are more likely to use galactagogues 5

Important Considerations

Before recommending galactagogues, healthcare providers should:

• Ensure proper latch and feeding frequency are established, as these are fundamental to milk production 4
• Address any underlying maternal or infant health issues that may affect breastfeeding 4
• Consider that the evidence for most galactagogues is of low to very low certainty 4
• Recognize that reported adverse effects are generally minor but monitoring is still important 4

Clinical Approach

When a mother expresses concern about milk supply:

1. First evaluate and optimize breastfeeding technique, frequency, and latch
2. Consider natural galactagogues as first-line options due to their widespread use and generally favorable safety profile
3. Reserve pharmaceutical options for cases where natural approaches have failed and there is documented insufficient milk production
4. Provide access to breastfeeding support resources, as inadequate support is a key factor in women seeking galactagogues 6

The decision to use galactagogues should be made with an understanding of the limited but promising evidence for their efficacy, balanced against their generally favorable safety profiles, particularly for the natural options that are most commonly used.