2. INTRODUCTION
• The process of secretion and production of milk in alveolus of breast after the
birth of child is called lactation.
• Low milk supply is a common concern among breastfeeding mothers.
• It is also called lactose insufficiency which can be caused due to several reasons.
• It may be due to maternal causes which include stress, anxiety, hypertension,
poor diet, smoking etc.
• The infant causes include CNS defect, small for gestational age, poor latch etc.
• The use of galactogogue helps to increase the prolactin levels and thereby
increasing the milk production.
3. What are Lactogogues?
• A lactogogue or galactogogue is a word derived from Greek language which
means milk leading substance.
• It is a food that increases the milk production in lactating mothers.
• This kind of food is used when there is an insufficiency of milk supply in
lactating mothers.
• Galactogogues are medications that aid in initiating and maintaining
adequate milk production.
• Most exert their pharmacologic effects through interactions with dopamine
receptors, resulting in increased prolactin levels and thereby augmenting milk
supply.
4. TYPES LACTOGOGUES
• There are many agents which are galactopoietic and cause increase in
prolactin levels.
• They may be synthetic or herbal.
• The synthetic medications include metoclopramide, domperidone,
thyrotropin releasing hormone, oxytocin etc.
• The herbal or natural lactogogues include fenugreek, goat’s rue, shatavari,
fennel, alfalfa etc.
5. METOCLOPRAMIDE
• Metoclopramide is the most commonly used synthetic galactogogue.
• Metoclopramide remains the galactogogue of choice due to its documented
record of efficacy and safety in women and infants.
• Most studies demonstrate an increase in basal prolactin levels and a 60% to
100% increase in milk volume.
• It antagonizes the release of dopamine and by inhibiting the effect of PIF,
increases the prolactin production
• Side effects may include headache, diarrhoea, nausea and severe
depression.
6. DOMPERIDONE
• Domperidone, an agent like metoclopramide, blocks dopamine receptors.
• It increases prolactin level and thereby acts as a galactogogue.
• The side effects maybe few and may include headache, skin rashes, GI
disturbances.
• The FDA issued a warning against importing and using domperidone which
was based on reports of cardiac arrhythmias and sudden death in patients
treated with intravenous domperidone.
7. FENUGREEK
• The best known of herbal galactogogue is FENUGREEK.
• It belongs to fabaceae family and is very commonly recommended as a
supplement to increase lactation.
• An increase in milk production occurs within 24-72 hours after using the herb
but it can take over two weeks for females in order to see a change.
• The active ingredient is found in the seed and should to used in small
amounts.
• It can be included in the diet as methi pulao, methi paratha or as fenugreek
tea.
• Side effects include maple syrup odor in urine, sweat, diarrhea and
flatulence.
8. ALFALFA
• Alfalfa is a common, mild galactogogue that is often used along with other
more powerful galactogogues like fenugreek.
• It is highly nutritive plant which is very high in essential vitamins and
minerals.
• It is perhaps, these nutrients that may boost milk supply in breastfeeding
mothers.
• Alfalfa leaves and sprouts contains saponins and isoflavonoids which causes
increase in milk yield.
• It is generally well tolerated and is Generally Recognized As Safe (GRAS) as
a food by the FDA.
9. SHATAVARI
• Shatavari is a well-known galactogogue.
• It has galactagogue properties that makes it a recommended herb
to increase milk production in breastfeeding mothers.
• It increases the production of corticoids and prolactin, which improve the
quality and the amount of breast milk produced by a lactating mother.
• Shatavari also stimulates the secretion of steroid hormones that improve
milk production and also increases breast weight.
• Shatavari or wild asparagus for lactation is thus very beneficial.
10. FENNEL
• The consumption of fennel during lactation is prevalent for its purported
lactogenic effects .
• The herb contains phytoestrogens that may increase milk supply.
• Fennel is commonly used in India and is a highly effective herbal lactogogue.
• It can be consumed as fennel tea or as fennel water.
11. GOAT’S RUE
• Goat’s Rue belongs to fabaceae family and is a traditionally used as a
galactologue for centuries.
• The main components responsible for lactogenesis is saponins.
• Goat’s Rue is considered as a lactogogue by increasing milk production by
30-50% within 24 hours.
• It stimulates the growth of breast tissue.
12. BLESSED THISTLE
• It belongs to Asteracea family.
• Blessed thistle is another herb which is used to enhance lactation.
• It has an unjustified reputation as a galactogogue, but is not known to be
toxic except for some reported gastrointestinal symptoms and allergic
reactions.
13. LACTOGOGUES
• There are many other lactogogues like fish, mutton and goat’s meat.
• Herbal lactogogues like garlic has been used for centuries as a beneficial
food to increase lactation.
• Cumin seeds, moringa powder, garden cress seeds, carrots, dark green leafy
vegetables, nuts and seeds and lactational cookies help in milk production.
14.
15. Survey in Experience and Use of Galactogogues-
• An online, cross-sectional survey was distributed between September and
December 2019 in Australia.
• Women were eligible to participate if they lived in Australia and were
currently/previously breastfeeding.
• Among 1876 respondents, 60% of women (n = 1120) reported taking one or
more galactagogues during breastfeeding.
• Women who had preterm births, saw a lactation consultants, had perceived
low milk supply, had a Caesarean section, or required supplemental feeding
with infant formula were more likely to use galactogogues.
• The most commonly used galactagogue included lactation cookies (47%),
brewer’s yeast (32%) and fenugreek (22%).
16. SIDE EFFECTS
• Domperidone had the highest proportion of women reporting one or more
side effects (45%), compared to less than 20% of women using herbal
galactagogues.
• For domperidone and metoclopramide, 9% and 19% of women respectively
stopped taking the medication due to side effects.
• Greater than 20% of domperidone users experienced two or more side
effects.
17.
18. EFFECTIVENESS
• The perceived effectiveness of galactagogues is reported for eight of nine
galactagogues was rated as being between ’slightly’ (2) and ’moderately’ (3)
effective except for domperidone which users reported as having the highest
perceived effectiveness.
19. REFERENCES
• Researchgate.net-role of lactogogues in milk production/January 2021.
• Sciencedirect.com/pharmacology/galactogogue/2015.
• Ncbi.nlm.nih.gov/pmc articles/plosone journal in use and experience of
galactogogues/July 2021.
