EPISODE 53

Breastfeeding with a PCOS Diagnosis

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Episode Transcript

April 16, 2021

Do you have it and not know?

This is Maureen Farrell and Heather O’Neal. And this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus we laugh a little or a lot along the way.

So join us for another episode.

Welcome to another episode. Yes, we have a really big episode today about PCOS and breastfeeding. This was requested probably more often than any other topic this month. Yeah. I just really feel like we put it off a little bit just cause we really wanted to make sure that we had the research we needed to give you guys what you deserve.

Yeah. And polycystic ovarian syndrome is super complicated. At the best of times, like without throwing lactation in. So bear with us as we go through this episode and we’re going to try to give you all the information you need. But first I want to hop over to listener question. Yes, let’s get it.

Yeah. So this is kind of related. This is from Bethany and she asks, her question goes, PCOS and breastfeeding. Which breastfeeding friendly birth control options will be best for helping with PCOS symptoms? Hmm. I’m seriously missing how great I felt on the combo pill. Yeah, Bethany that’s not a surprise. So the reason you felt so good on the combo pill is because you had estrogen in that pill that was combating all of the androgens in your body.

And unfortunately, this is not going to be the answer you want to hear, but there’s not a lot of great options for people with PCOS and birth control during lactation because a lot of the ones that we use for lactation are progesterone only, and progesterone is what can actually make your cysts on your ovaries, which is poly cystic ovarian syndrome.

We’ll get into a little more. It makes it worse. So basically it’ll make it worse. There is one option though, that I can think of that will help that is also lactation friendly. And that is the copper IUD. That has no hormones in it at all so it’s not going to help with your symptoms, but it is breastfeeding friendly and it’s not going to make the cysts worse.

Yeah. And I think, unfortunately, that’s kind of where we’re at with birth control while breastfeeding with PCOS is that w we’re just kind of like in that holding pattern of maybe it not being worse until you can get back on estrogen. We’re just getting through a season. So we’re going to get into the conversation now, but don’t forget to stick around at the end. We always give an award in the alcove to one of our listeners who is just rocking the breastfeeding game right now. So stick around. Cause it might be you.

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So we are upside down and backwards today. Yeah. Yeah. Which you know is good for PCOS actually. Yeah. I feel like a lot of people feel upside down and backwards when they have PCOS. Exactly. Well, let’s talk about what it is. Oh yeah. So first of all, I’ve never heard anyone call it “Pee cos”. You’re super hip and I think that is such a cute way to say that something that’s so terrible.

So PCOS is polycystic ovarian syndrome and it’s a hormonal disorder, which is really common in women of reproductive age. So usually it kind of rears its ugly head during puberty and people tend to find out if it’s severe earlier on. However a lot of people don’t even know they have it until they try to conceive and they’re having issues conceiving, and then they don’t really know what’s going on.

So basically what happens is you are very high in androgens, which is like testosterone, and there’s just a bunch of androgens that can be in your body. And so all of these more masculine hormones are kind of getting in the way of that natural process of ovulation and your ovaries in essence, kind of get backed up.

So every month a follicle starts to mature and that hopefully one follicle explodes and travels down the fallopian tube. Okay, so just an aside, like in the textbooks, they always kind of mentioned the follicle, like erupting, but there was some like actual video of this and it is a fucking explosion out of your ovaries.

It’s crazy guys. Like, it really does like bust out of there. Yeah. And it creates a scab on your ovary, which actually ends up supporting the pregnancy until your placenta can. Yeah. It’s really weird. Yeah. So it truly is an explosion out of your ovary. Yeah. Okay. So ideally in the perfect world, one follicle matures, explodes, goes down the tube.

However, with PCOS you don’t have enough of that hormone to actually make the explosion occur. So you kind of always are in that getting ready phase and then it builds up month after month and we get more and more follicles that are getting more mature and more mature. And you’re developing these little cysts that never actually rupture or when they do, it’s really painful and you have breakthrough bleeding and you don’t know if you’ve actually ovulated.

So we call it an anovulatory cycles. So you might go a month or two or three or four without actually ovulating with breakthrough bleeding and all kinds of other things. In addition to the unhappy side effects of having high androgens in your body. So a lot of people with PCOS have issues with weight gain and hair growth, where they would not expect.

¬†Yeah, hirsutism. So facial hair, mustaches, that kind of deal. Right. Hair on the stomach and chest was pretty common. Severe acne on your face and back and chest, which is really, really hard to deal with. Yeah. Yeah. And, and it’s like hard enough also when you’re like in chronic pain and discomfort, but then you also have these physical manifestations that objectively, they are what they are, but within our cultural expectations, they’re not considered beautiful.

They’re considered outside of the norm. They are, you know, they kind of put you further outside of what should, you know, what you think should be normal, what you should look like. Right. It’s really, really difficult to deal with, on an emotional level. Especially because it does tend to show up, the more severe cases do tend to show up earlier when you’re in those like prime years of figuring out who you are and what your sexuality is and all of that.

You know, and then on top of that, also dealing with baldness on your head too. It’s like, it just feels like a kick while you’re down. Yup. It’s pretty rough to deal with, but you know what? The thing is, there’s suspicion that 50% of people that have PCOS don’t even know they have it. And I’m not really sure how they came up with that number, but I would probably believe it.

Especially like the amount of people that don’t notice it until they try to conceive. And then you think how many people don’t even try to conceive? Right? How many people never plan on having children? So they never know that they’re not ovulating? Right. That’s a lot. Yeah. Right. So as it stands right now the amount of people affected by PCOS is about 9 to 21% of reproductive age, biological women.

So, you know, on one hand I’m like, are we over-diagnosing this? Maybe? Maybe, and then on the other hand, I’m like, okay, so maybe we are all metabolically jacked up now? Definitely. That’s definitely true, but I do want to point out something else too, that makes diagnosis of these kinds of things hard is that this is a syndrome. It’s not considered a disease.

Right. And when we call something a syndrome, it basically means; here is a set of symptoms and if you check off enough of them, bam, you fit into the syndrome. Right. And it’s really, it makes it hard diagnostically. It makes it hard to treat because also, kind of once the medical community like coalesces into like, Oh, we’ve decided these symptoms are all caused by maybe one thing, probably, and we’re calling them a syndrome, sometimes that’s kind of the end of it, you know?

And then like, there’s not a whole lot of research further into it. Cause they’re like, Oh, we have a name now. So here’s, here’s a name. Yeah, stay in your little PCOS box and, you know, we’ll just treat your symptoms and yep.

21% of people. And you’re just one unlucky one, sorry. Have a great day. Right. And, and, you know, maybe in 30 years, this is going to be called PCOD right. Polycystic ovarian disease. And they’re going to figure out that this is caused by some metabolic issue or some bacteria in your gut or who knows, right?

Like maybe some shit we’re exposed to in the uterus? Yeah. It’s, it’s really hard to say, but basically we don’t, you know, if you’re like, wow, why do I have this? The answer is I don’t fucking know. Yeah. No one really knows what causes it. We know what can make it worse and some of what makes it better.

Right. Exactly. Yeah. But we just want to quickly tell you what the signs and symptoms are, because if you’re one of those possible 50% of people that don’t know you have it, and you’re struggling with fertility or, you know, any of these other things, then you might be in the shower right now going, Oh my gosh, that sounds like me.

So this list of symptoms, you have to check off at least two of these signs, which isn’t very many. It’s not that much, yeah, to be diagnosed with PCOS. So irregular periods, infrequent, irregular, or prolonged menstrual cycles are the most common sign of PCOS, obviously. Yes. You know, so that’s going to be like, you come into the clinic and you’re like, Hey, I haven’t had my period in three months and we take a pregnancy test and it’s negative.

And we’re like, Hmm. Okay. Now what? It can also look like excess androgen. So the things we were talking about before. Those elevated male hormones that result in the physical signs. So the excess facial and body hair, and occasionally severe acne and male pattern baldness, and then polycystic ovaries.

Which, to get this diagnosis, you actually have to get an ultrasound and they would see enlarged follicles that they call the string of pearls, which looks like a string of pearls. They’re just a bunch of cysts in a row that haven’t ever erupted and they just keep maturing. So those are failing to function normally. So two of those, and you’re in the box. Right.

Something we also see, as you might think of like a comorbidity with this is issues with insulin sensitivity and developing type two diabetes. Yes. Yeah. Which again, I’m like, Oh, this is some metabolic shit. It really is. Yeah. So, I mean, this is going to shock all of you, but there are almost no studies on this.

You mean, nobody figured out how to make money off of studying this? Yeah. I mean, there’s studies on PCOS, but not PCOS and breastfeeding. Oh yeah. And even the ones on PCOS honestly, like they’re pretty lacking. You’re like, cool, here’s just the most basic stuff that doesn’t give us answers. Yeah. Because it’s symptom management.

Right. So like they don’t care. They’re making more money off of keeping you in a PCOS state. Yeah, and I mean, I hate to always be that person. And I don’t mean to sound like a conspiracy theorist, but in a 10 to 15 minute clinic visit, they’re not going to cure you. And I think they’ve kind of given up on people actually taking a hold of their health and taking it into their own hands and making the lifestyle changes needed.

So they just stopped telling people that lifestyle changes can help and they just throw medication at it and, you know, whatever, whatever. So anyways, what there is available is there’s a pilot study that I found, a case study and two other legitimate studies. And that’s it. And this always gets me fired up to do more research because I mean, come the hell on. If PCOS is affecting this many people and breastfeeding is something that affects everyone, then why don’t we care?

Yep. So as with everything, we put it on our list of shit to research. But before we get into the studies, let’s talk about what we notice as providers, when we see somebody come in for a visit. So like what, I want to hear this from you, because you’re in the community more and I’m more like hospital-based, but what does a typical PCOS person look like to you when they come in?

So, you know, I think a lot of these symptoms are not obvious except the hirsutism. So, you know, that’s what I was taught to look for. Right. This, you know, lots of drawings in a textbook of somebody who’s exhibiting this one particular body type and particular hair growth. And that’s kind of always in the back of my mind when I see that. Having those patterns of hair growth or baldness or that pattern of weight gain, and it is kind of like a specific place in your body that that weight gain is like right in the middle of the trunk.

You know, so when I see that I’m always like, okay, this might be PCOS, but I don’t jump to the conclusion that it is because also some people just have those attributes without having the polycystic ovaries. And it’s not like that’s a problem. Right. I’m not going to look at that and be like, Oh, you don’t look normal.

No, that’s not how that goes. For sure. So that’s like the obvious thing we see. And then the next thing is like somebody who’s struggling with fertility on top of that. That’s kind of when I’m like, okay, let’s look into this. And also like the more, I’ve seen a couple severe cases of, you know, my supply just hasn’t come in at all.

And a lot of times those breasts, the shape of them is more tubular and the nipples are a little bit more, how would you describe them? Like sausage shaped? Like elongated. Actually, you know, I’ve seen a lot of the same physical breast attributes that I see with insufficient glandular tissue.

And I actually meant to ask you, like, do we have kind of numbers on a co-morbidity of that? Or is that just like, Oh, maybe they’re kind of similar issues? Oh yes. Oh yes. We’re getting into it…

Okay, you’ll answer it when you’re ready. But also like, in addition to the tubular breast shape, there’s often a wider gap between the breasts on the chest. So like an inch and a half, plus. Which is interesting to assess as a professional cause most people wear bras that push their breasts together. Right? I mean, even just like the least supportive bras, still kind of smoosh things to the front.

So unless somebody is not wearing a bra, sometimes it’s really hard to see. Yeah. Yeah, yeah. A hundred percent. So early intervention is really important when we have somebody come into the office who is trying to get pregnant and we’re suspecting PCOS because there are some things you can do with lifestyle that are going to help them get on track.

And then also inevitably set themselves up for more success postpartum just with everything postpartum. Right? So, you know, like, are you doing talk about the lifestyle changes? I have a lot to say about that. Okay. Take the floor. Okay. I want to preface this with, just by saying that these lifestyle changes we’re going to talk about are actually very effective in symptom management for a lot of people.

However, how they are represented to patients from providers often is in a way that’s almost like patient blaming. Right. So for example, one of the recommendations is weight loss. Okay. And when your midwife or doctor is like, Hey, if you lost some weight, your symptoms will be better. Wow. Does that feel shitty?

And wow. Have I had many doctors tell me that about random shit? You know, so when I approach this with clients, and actually I see this more with my herbal clients because they’ve obviously tried a bunch of medications and whatever, and it’s not working. They want to try some herbs. Great. But of course, I’m going to talk about lifestyle stuff first.

So the way I approach this is I’m like, Hey, we have really good evidence that these specific lifestyle changes might help. They are the lowest risk interventions that we can take. And they are the interventions where you have the most power to influence your own body. And when I mentioned weight loss, usually, you know, I mention it in really, really small amounts.

And I say, Hey, you know, weight gain is one of the symptoms of this and I understand that weight loss is really hard, but even losing five pounds can improve your symptoms. Right? So let’s start there. And if people are like, Nope, I don’t even want to talk about weight loss. I’m like, cool. Let’s not talk about it then.

Yeah. Yeah. So I mean all of that, for sure. And, you know, I think that again, when people are rushed in their visits, they’re like I don’t have time to motivationally interview this person and find out if they’re even willing to make the lifestyle changes. You know, you might not be able to. You might have 10 kids and you might not be able to cut out caffeine and alcohol.

Like, and those really can make a difference for some people. But if it’s not doable, then asking someone to do it just is detrimental. Yep. And it just, every time they have a worsening symptom, they just end up blaming and it just makes everything worse. So, you know, we’re really here to give you the information so you can do with it, what you like.

And that is all. That is all, but you know, when it comes to trying to get pregnant, so this is when it can really take a toll mentally. So like initially you get the diagnosis and you’re experiencing the initial symptoms and you take an emotional hit from that. And maybe you’re learning how to live with it in your life.

And then, you know, you hit 30 and you try to get pregnant and you can’t. And all of those old feelings come back up again because your body is failing you now. So in addition to not looking the way you wanted to look or, you know, understanding what your cycle actually is and, you know, getting the surprise bleeding, it’s so much deeper than that.

Now. It’s not just like, you know, Oh, I got my period when I was on my second date at the Greene Turtle with a hottie and it was super embarrassing. Damn my PCOS. It’s like, Oh my God, my body is broken. Why is this happening to me? Like, this is one thing that I’m supposed to be able to do naturally. So I like to use for ovulation, to figure out what’s going on because most people have no clue what’s going on with their cycle, just in general.

Like very few people actually understand their menstrual cycle. So, what I typically recommend is something like OvuSense, which is newer where you can actually insert it into your vagina and it tracks your cycles with your core body temperature. And it does this overnight, and then you can sync it with your phone and actually share it with your provider.

And so you and your provider can actually learn so much about your cycle together and figure out what PCOS camp you’re actually in because there’s varying degrees of it. And new research is showing that there might be actually different types.

Oh yeah. And this is something when I was taught about PCOS herbally, that was, my teacher kind of divided into a few different types, even though I’m sure at this point, like years later they might be a little bit different. But just because she noticed when she was treating them herbally, like different herbs worked with different people and Oh, like this might be the subset that experiences hirsutism.

And this is the subset that is what she would call like the skinny PCOS and like, you know, these couple. There are definitely different types. For sure. There are different types of PMS. There are different types of all this shit. Yeah.

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Well, there’s a lot of different hormones involved in maturing an egg, exploding it and sending it down the chute. And people have different surges at different times that can cause dysfunction, that all looks like PCOS. So basically we’re not going to get into those details in this podcast, but I just want to let you know that it’s really, really important for you to understand what’s going on with your cycle.

And I like the basal body temperature because when you pee on the ovulation sticks, that’s the other option, it can actually set you up for an aversion to doing that and disappointment when you go to actually pee on a pregnancy test. So yeah, that makes sense. So, you know, you’re trying to ovulate, trying to ovulate, you’re peeing on a stick every day for months and months and months, and then you think you’re pregnant and it’s like a constant let down and you kind of develop this negative feedback with your reproductive system and you just don’t need that amount of negative energy sent to that area.

What you need is positivity, education and learning and appreciating to work with your cycle, not against it. So not a huge fan of that. If that’s all you have, it’s the cheaper way to go. But if you start to feel yourself getting really stressed out about it, I would probably back off on the pee sticks and get something a little bit more accurate.

This OvuSense is like 99% accurate in predicting ovulation up to 24 hours. So, I mean, we’re coming a long way with that kind of stuff. And that’s pretty badass. I love all of the ways that we’re using technology to help people understand their bodies. Yeah. Okay. So, like Maureen talked about before with obesity, we do know from plenty of other reliable studies that obesity is negatively associated with breastfeeding. Breastfeeding initiation, and duration actually.

 You know, I’ve really tried picking that apart before, and it’s like obesity doesn’t cause breastfeeding problems. I think the problem is that people who are larger, don’t get the kind of support that they need that’s tailored to their body. Do you know what I mean? Yes. And I mean, I think that this is multifaceted and we could actually, we probably need to do an obesity episode.

Okay. Yes, we do. Maybe we shouldn’t go more into that right now, but, but yes, let’s say right now, we’re here for our plus sized lactators and we want to support you. So if you’re listening right now and you’re like, Ooh, that’s me. I have questions. Please email them to us. Cause we want to do a whole episode on that [email protected]

Okay. So just as an aside, like we know that obesity is a big player in PCOS and actually worsens the PCOS as the obesity gets worse. So those are very strongly correlated and there’s this whole feedback cycle that you go through of weight gain, hormonal dysfunction, decrease insulin sensitivity, that can kind of go any direction in that triangle.

And it really sucks. Yeah. So it’s pretty complex. Yeah. Yeah. And I just wanted to direct you all to another podcast actually. If you are struggling with PCOS, there is a podcast called PCOS Diva and she goes into everything about PCOS. Diet, managing life with complications and you know, everything. Relationships and more resources.

So if you’re looking for a little bit more detail, I would definitely head over to PCOS Diva, and I will link that in the show notes for you. Okay. So one of the best studies that I found out of, you know, like two is from the Journal of Maternal Medicine, and this was done in 2012. And the purpose of this study was to figure out the significance of breast size increment in pregnancy and the impact of Metformin during pregnancy, on breastfeeding in women with PCOS.

So often we will give people with PCOS Metformin to help them ovulate. And so they were thinking, hm, let’s just keep giving them Metformin and see if that doesn’t help breastfeeding? Sure. So why not? Why not? Throw some meds at it? Yeah, so, I mean, I guess it was easy for them to do that because Metformin has already been approved for those specific, you know, pregnancy and lactation.

So they were like, Oh, we’ll just sneak this in here. So people with PCOS were randomized into a treatment with Metformin group or a placebo from the first trimester to delivery, and then they sent questionnaires to all of the 240 people one year postpartum and 186 responded. So it’s not a giant study and it is retrospective, but you know, it’s something. It’s, I’m just being honest.

It’s not the strongest evidence, but it’s definitely something. So the pre pregnancy and late pregnancy bra size and breastfeeding patterns were registered as well as androgen levels that were measured in the people. So the results were, I’m just going to skip ahead and tell you what happened and then we’ll discuss. Tell me. So they found that there was no difference in breast size increment and breastfeeding that was found between the placebo and the Metformin groups.

So the Metformin did not make your boobs bigger and it doesn’t make you breastfeed more. Oh, shoot. The one little easy pill fix didn’t work. Oh, everyone with PCOS is like, duh. Damn it, it didn’t work. The doctors are like foiled again. So the conclusion was that Metformin and androgens had no impact on breastfeeding. People with PCOS who had no breast size increment in pregnancy seemed to be more metabolically “disturbed” and less able to breastfeed. So, I mean, I get what they’re saying. It’s just a funny word choice. Yeah. So basically like the main takeaways from this was that people with no breast size increment, like your boobs never grew. They had higher blood pressure. They had more obesity.

They had higher fasting insulin and triglyceride levels already at the inclusion in the first trimester of pregnancy, compared with those who experienced breast size increases. Are we going to get to IGT yet? I feel like we’re inching towards it. We are. We’re inching. Yes, we’re inching. So I feel like, like we’re on like two different roads and I can see them converging.

Yes. Robert Frost just give me a minute.  So like specifically to breastfeeding after delivery, the people that didn’t have any breast size increases had shorter periods of exclusive and partial breastfeeding. And the reason given, this is important. The reason given for not breastfeeding at three months postpartum in the response, in the survey, was a shortage of milk in 86% of cases.

It was not a lack of motivation. Okay. So, you know, it was these people that were like, I really want to continue breastfeeding, but I just didn’t have enough milk. So, you know, we are saying now that the increase in bra size correlates positively with the duration of exclusive and partial breastfeeding.

And so what we have here though, is possibly a confounding variable. Which means we might have something that’s kind of throwing a little hitch in the giddy-up. Where some of these people might actually have IGT. Yeah. So insufficient glandular tissue, one of the, well, the biggest way to tell that you have it, is no breast changes in pregnancy.

Right. And when we say that, not everybody experiences an appreciable breast size difference, but most people feel breast soreness, tenderness, increased sensitivity, itching, maybe leaking, right. Something happens to your breasts in pregnancy.

And most of the time we see people with insufficient glandular tissue, they’re like, Oh yeah, my boobs haven’t really changed this whole time. Yeah. So basically this study is saying that there are levels of severity with PCOS, and there are many different ways that PCOS can present. And I think sneakily that there are some IGT people snuck in there as well, but we are seeing that the more severe cases of PCOS typically show very little breast size increases during pregnancy.

Yeah. I mean, I think these are hormonally pretty similar. They are, they are. And especially because if you are experiencing PCOS from the time of puberty and all of those prime growing years where you’re supposed to be developing that tissue and you’re not getting those estrogen levels. Yep. And that’s kind of how it plays out.

And so it’s a slippery slope. And then, you know, you’re 30 something and you’re trying to get pregnant and you can’t. Maybe you can. Most people with PCOS do, are actually able to get pregnant. Right? So we have seen that there are ways that we can get people with PCOS pregnant, or sometimes it just happens.

But Metformin apparently is not the way to go anymore. I’ve seen a lot more Clomid. Yeah. Yep. So Clomid is kind of the drug that makes it. I’ve heard good things about Clomid yeah. Yeah. Very little side effects and you know, it just kind of helps it pop, pop that egg out and get moving. So the other big thing that we got out of this study is the androgens.

So it, we know for sure that androgens actually do interfere with lactation. Okay. So it used to be back in the day that we would actually give people a shot of androgens, whether it was testosterone or DAGAS, to dry up their milk before they’d even leave the hospital. Oh, interesting. Yeah. You know how your grandma’s like, my milk never came in.

Grandma probably got a shot before she ever left the hospital. Here’s the thing, though, that was really important from this study. We saw that the people that had high androgen levels in the first trimester who still got pregnant, their pregnancy and all the estrogen in their pregnancy actually helped to resolve that and acted protectively for breastfeeding.

So even though you may have started out with a lot of androgens, you clearly had enough estrogen and enough other combos of hormones to get pregnant, to continue the pregnancy. And those pregnancy hormones actually kicked you over into a place where breastfeeding was not interrupted by your high androgen levels.

What you’re saying is that if you have PCOS, you got pregnant, you stayed pregnant, you had a baby, you’re probably not gonna have issues breastfeeding? Right. Cool. Yeah. So this is good news. Yeah, this is very good news. I’ve been like secretly waiting for you to tell me something like that. Yeah. So that’s what, it’s not a secret anymore, Maureen. You know now. Secrets out.

So, you know, a lot of people actually enjoy pregnancy when they’ve been struggling with PCOS for a long time, because they’re like, Holy shit, estrogen! Estrogen becomes your friend. Like everything that you ever got in the combo birth control pill is your uterus right now helping you. Oh, estrogen is not my friend right now.

Oh, it is. It’s just not agreeing with your gastrointestinal system. Yeah, that’s really interesting. So what about though, like the people who do have issues breastfeeding who have PCOS? So the people do have issues breastfeeding with PCOS often are the more severe cases that also started pregnancy with a high level BMI, high blood pressure and insulin sensitivity already.

Okay. So their bodies are compromised and actually this study said something really rude. Look at this. Oh God, are you going to read the really rude ass thing it said? I’m going to read this rude ass comment. This is not our opinion, everybody. It says “these findings support ours although we interpret them differently. Women who are not able to breastfeed are metabolically inferior compared with those who breastfeed easily.”

Ouch. Fuck you. Metabolically inferior? Ouch. Metabolically disturbed? Yeah. People do not understand how their language can impact patients. And it’s really like, providers read this and they’re like, Oh, metabolically inferior. And then like, they fucking parrot that to their patients and then their patients go home and they’re like, God, I’m inferior.

Yeah. That’s like the, “you have an incompetent cervix, failure to progress.” Oh God. Get your words off of me. Yeah. For real. Y’all you’re not inferior. Just FYI, no matter what’s going on. Your metabolites are going to be fine. We’ll figure it out. Regardless. They are not inferior. Yeah, Jesus. So the other study I found was an Australian study in 2016, and this showed high BMI being negatively associated with breastfeeding, which confirms the 2012 study.

So it said though, PCOS status per se, does not appear to be related to breastfeeding initiation and duration when you adjust for BMI. So basically that’s saying even if you’ve gained a hundred pounds in pregnancy, when they adjust for that, the people that had a high BMI to start with still had a harder time.

Interesting. Yes. Hmm. Yeah. I wonder like, is that, I have so many questions. I’m wondering like, okay, is that just because like, those people didn’t get the support to breastfeed in the right positions for their big boobs or is that because they have insulin sensitivity issues and the change in insulin sized sensitivity in order to make milk is like not happening in their bodies? I just now I’m like well, tell me why.

Yeah, that’s what we care about. It’s like, why? Let’s send out a survey to all of those people that, you know, in the category of, you know, obese to start with. And see what their journey was like. Did you experience support? What was your, you know, in your own words, please describe the positioning support that you received.

Yeah. Like I just, I look at that and I’m like, okay, basically you’ve told me people who are larger, have a harder time breastfeeding. Why? Why? Why? Yeah. Well, apparently it’s not for lack of trying based on that survey. Of course it’s not. It’s not like, I mean, honestly, if you were to say it’s for lack of trying, that would be like saying people who are fat are unmotivated, like, fuck that.

So not true. Fatphobia all over the place. Y’all like, yeah. I mean, I just think that really my takeaway is, you know, without saying “metabolically disturbed.” You know, when your body has been out of balance for so long that you are now compromised, you know, and you are doing all of these things maybe to try to fix it and nothing’s working and then you get down on yourself and you feel like nothing will work.

And then when one more thing goes wrong, like with lactation, you don’t bother asking maybe. Because you’re like, Oh, it’s just one more way my body’s failed me. Yeah. It’s definitely interesting. You know, cause it makes me think like, okay, you know, for a lot of people who are overweight, we have metabolic dysfunction. But honestly, like that’s not everybody who’s overweight and that’s not everybody who has issues with weight gain, you know?

And it’s not like everybody who with a high BMI is “unhealthy,” you know, it’s a piece of your body that is just so complex. Yeah. And it’s also a chicken or the egg scenario. Which came first?   Were you obese first? And then you got PCOS because of insulin sensitivity and your metabolism being thrown off?

Did you have this issue with high androgens and that set off that whole cascade? And that’s why I try to be so sensitive when talking to people with PCOS about weight loss and weight gain. Because you know, first of all, if you are a totally healthy person who is a little bit overweight, it’s still hard to lose that weight.

That’s like the hardest shit ever. So add on top of that, you have hormone imbalance, maybe you have metabolic dysfunction. Like losing five pounds might be the most you can do at all. And it might take you three months, like. That it’s just, it is fucking hard. It’s really hard. And especially hard postpartum.

Yeah. Oh God. When you’re already in this state where like so many people have trouble losing weight in the first place. Yeah. But I mean, I just want to remind you of the study that you pulled out in Episode 38 of The Milk Minute Podcast, where, you know, this research is showing that the time of lactation is actually a healing time from the damage that pregnancy did to your body.

So it’s actually able to bring you back to center and recalibrate you in a lot of ways by breastfeeding. Right. So as far as your metabolic function, insulin sensitivity. Yeah. That was a cool one. Yeah. Yes. So, you know, there’s hope for you and incentive for you to move forward and get the help that you need, because you might actually be able to use this time to heal and recalibrate.

Whereas, you know, losing five pounds pre pregnancy might have adjusted your PCOS symptoms by 10%. Whereas now, when you are actually already in flux and your body isn’t moving in a natural trajectory of healing, you might get more bang for your buck by losing that five bucks. Or don’t lose your five bucks, lose five pounds.

Yeah. And you know what, like I would really like to do an episode about weight loss in the post-partum sometime just all on its own. But I do always try to remind people, it took a whole, you know, nine ish months for you to gain all of that weight that you gained in pregnancy. And it is more than reasonable to take that much time or longer to lose it.

That’s great. So I just want to end on a positive summary. So we did, even though we got a little fired up in this episode, there were some really positive things that came out of this. Yeah, actually. So first of all, we know that most people with PCOS are able to conceive and breastfeed. And number two, most people that have PCOS, even pretty severe PCOS, are able to breastfeed without their androgen levels interfering.

Which is also cool. And also we know that postpartum lactation is healing for your body. And we have the resources that you need, if you need anything. So you can join and be a patron of ours and you can come. Third Tuesday of every month, we meet and have a live Q and A with our patrons. Yeah. And you know what? We know about plus sized breastfeeding.

Yeah. I have done it myself personally. And we’re happy to learn more and research for you. Yeah. So if you are not comfortable going to your provider, for whatever reason, I don’t blame you. You know, lactation can be a really tricky thing to try to seek help for. So we are totally here for all of that, and we are very comfortable with all of those things.

And we just want to invite you to join us. You can find us at www.Patreon.com/MilkMinutePodcast Good job remembering. Wow that was really tough. It’s the end of the day folks. It is. You know,  maybe it’s the end of your day too. You’re like driving home from your commute to work. You know, you took off your mask. You’re just like, taking your hair down, listening to us in the car. We appreciate you.

Hey guys, it’s Maureen here. And I wanted to let you know about my Etsy shop. I am an artist and a designer, and I have a shop where I make educational breastfeeding posters, shirts for birth workers. Like for your favorite nurse or midwife. Shirts for people who are lactating, mugs, stickers, all kinds of stuff.

Some of my birth paintings are on there. It’s an eclectic collection and it’s really beautiful. So if you want to find that you’re going to go to etsy.com/shop/thewanderingwom6, except instead of a B it’s a 6. So that’s The Wandering Wom6 with a six instead of a B.

 It’s time for awards in the alcove. Yeah. We like to give awards in the alcove just to let you guys know that you’re all fucking rock stars and you all deserve an award every day. Oh my gosh. I love this one. So this is, this is from Renee F. She actually sent us a picture. She’s so cute. She is 35 weeks pregnant and she is chopping up deer meat.

And she says, we spent four hours cutting up deer meat, listening to The Milk Minute tonight. My husband and I laugh so much and learn so much at the same time. Thought you would think it’s funny to know what your audience is doing while listening. I love it. I love Renee, that you listened with your partner.

That’s like, that’s like our goal guys. Yeah, that’s amazing. And I just love you Renee. And thank you. This is such a West Virginia thing. If you forgot, we, we live in West Virginia. I know cutting up deer meat is like a very thing we do. What award do we give her?  Do we give her the sustainability award or the preparation?

Oh, She’s prepping. Yes, she is prepping so many ways. I love it. Prepping to Feed Award. That’s great. That’s great. We’re great. PTF prepared to feed. Yes, Renee. You get the PTF award and we couldn’t be more pleased with it. So thank you so much for reaching out to us. If you want to send us your wins or ask us a question, you can reach us by email [email protected]

Bye-bye. Goodbye. Thanks for listening to the milk minute. If you haven’t already please like, subscribe, and review our podcast wherever you listen. If you’d like to support our podcast, you can find us on Patreon at Patreon.com/MilkMinutePodcast. To send us feedback, personal stories, or just to chat, you can send us an email [email protected]

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