During the early weeks following birth a mum will often have more milk than her baby needs.

She may experience leaking and/or breast fullness/engorgement — this is simply a period of adjustment as the mum’s body adjusts to the amount of milk her baby actually needs.

In exclusively breastfed babies, milk intake increases rapidly during the first few weeks, then stays about the same between one and six months. Although it usually increases short term during a growth spurt. Sometime between 6-12 months (as solid foods are introduced and increased) baby’s milk intake may begin to decrease.

After the first 3 months the high baseline prolactin level gradually decreases to the lower level norm for later lactation. Subsequently the mum’s breasts may feel less full, leaking may decrease or stop, let-downs may become less noticeable, and pumping output may decrease. These are all normal changes and, on their own, do not mean that milk supply has decreased. 

How can you tell if your supply is low?

• Baby may be more fussy than usual following a feed
• They may not sleep as well or be difficult to settle
• There may be less wet nappies
• The baby weight is plateauing off on the centile chart
• They just don't seem as satiated as before
• Demanding more feeds

This may be a time you turn to using a herbal supplement and fenugreek is usually the go to. Fenugreek (Trigonella foenum-graecum L.) has been reported to be an excellent galactagogue (a milk inducing substance) for some mothers, and has been used as such for centuries. The few studies that have been done have had mixed results . 

Keep in mind that in almost all cases, natural products should be tried first, as there can be significant side effects from both herbal remedies and prescription medications used to increase milk supply. 

There are a few things you need to consider when using fenugreek.

• Does your baby have reflux - fenugreek can exacerbate reflux and digestive issues. Your baby may be more gassy and windy than usual, their poo may be frothy. Whatever digestive effects the fenugreek is having on you, the baby will experience the same effects
• Mothers generally notice an increase in production 24-72 hours after starting the herb, but it can take two weeks for others to see a change. Some mothers do not see a change in milk production when taking fenugreek.
• Fenugreek has been used either short-term to boost milk supply or long-term to augment supply and/or pumping yields. There are no studies indicating problems with long-term usage.
• Dosages generally used are -
• Powder and seeds - 1/2 – 1 teaspoon, 3 times per day;
• Tincture - 1-2 mL, 3 times per day (see package directions)
• Capsules (580-610mg) - 2-4 capsules, 3 times per day, 6-12 capsules (total) per day
• ~1200-2400 mg, 3 times per day (3.5-7.3 grams/day)
• Fenugreek is used to flavour artificial maple syrup, and is used as a common food ingredient (curries, chutneys, etc.) and traditional medicine in many parts of the world, including India, Greece, China, north Africa and the Middle East. It is a basic ingredient of curry powder (often used in Indian cooking) and the Five Spice mixtures (used in Asian cooking). It is also eaten as a salad and sprouted.
• Fenugreek is considered safe for nursing moms when used in moderation and is on the U.S. Food and Drug Administration’s GRAS list. As with most medications and herbs, various side effects have been noted; see the side effects and safety information below.

Possible side effects and cautions

• Sweat and urine smells like maple syrup; milk and/or breastfed baby may smell like maple syrup.
• Occasionally causes loose stools, which go away when fenugreek is discontinued.
• Use of more than 100 grams of fenugreek seeds daily can cause intestinal distress and nausea (recommended dose is less than 8 grams per day).
• Repeated external applications can result in undesirable skin reactions .
• Ingestion of fenugreek seeds or tea in infants or late-term pregnant women can lead to false diagnosis of maple syrup urine disease in the infant due to presence of sotolone in the urine. See and other studies on fenugreek and maple syrup urine smell.

Use with caution or avoid if you have a history of:

• Peanut or chickpea allergy: Fenugreek is in the same family with peanuts and chickpeas, and may cause an allergic reaction in mums who are allergic to these things. Two cases of fenugreek allergy have been reported in the literature.
• Diabetes or hypoglycemia: Fenugreek reduces blood glucose levels, and in the few studies using it as a hypoglycemic, also reduces blood cholesterol. Dosages higher than the recommended one (given above) may result in hypoglycemia in some mothers . If you’re diabetic (IDDM), use fenugreek only if you have good control of your blood glucose levels. While taking this, closely monitor your fasting levels and post-meal levels. Mothers with hypoglycemia should also use fenugreek with caution.
• Asthma: Fenugreek is often cited as a natural remedy for asthma. However, inhalation of the powder can cause asthma and allergic symptoms. Some mothers have reported that it worsened their asthma symptoms. .

Drug interactions

• Oral drugs or herbs taken at the same time as fenugreek may have delayed absorption due to the mucilage content of fenugreek.
• Glipizide and other antidiabetic drugs
  Fenugreek reduces blood glucose levels and may enhance the effects of these drugs.
• Insulin
  Fenugreek reduces blood glucose levels, so insulin dosage may need to be adjusted.
• Heparin, Warfarin and other anticoagulants
  Ticlopidine and other platelet inhibitors
  The fenugreek plant contains several coumarin compounds. Although studies have not shown any problems, it potentially could cause bleeding if combined with these types of drugs.
• MAOIs
  Fenugreek contains amine and has the potential to augment the effect of these drugs.

Fenugreek use during pregnancy

Medicinal doses of fenugreek are considered a uterine stimulant. Fenugreek has been used to aid and induce labor and is considered to be an emmenagogue . For this reason, fenugreek use is not recommended during pregnancy (particularly late pregnancy). However eating culinary fenugreek in the amounts used in a curry and cooking are considered to be safe.

• Fenugreek is used as a morning sickness remedy in Chinese medicine.
• “Use only in moderation during pregnancy. A uterine stimulant in high doses, but quite safe as a culinary herb or during labour.”
• Motherlove Herbal lists fenugreek as a cleansing herb which is “too strong or irritating” to be used during pregnancy.
• One study effectively used fenugreek as a source of fibre to control blood glucose and lipid levels of pregnant diabetic women.
• “A stimulant effect on the isolated uterus (guinea pig) has been reported and its use in late pregnancy may not be advisable.”
• “Water and alcohol extracts of fenugreek are oxytocic. They stimulate contraction of uterine smooth muscles during the last period of pregnancy according to studies on isolated guinea pig uterus tissue.”
• “Fenugreek exerts an oxytocic effect in guinea pigs. Its use in humans has not been sufficiently studied, but could potentially lead to SAB or preterm labor and prematurity secondary to its oxytocic effects. Its use in pregnancy is not recommended.”
• Not recommended during pregnancy.

Possible side effects for baby

Most of the time, baby is unaffected by mum’s use of fenugreek (except that more milk may be available for baby). Sometimes baby will smell like maple syrup, too (just like mom). However, some mums have noticed baby is fussy and/or has green, watery stools when mum is taking fenugreek and the symptoms go away when fenugreek is discontinued.

Fenugreek can cause GI symptoms in mum (upset stomach, diarrhoea), so it’s possible for it to cause GI symptoms in baby too. Also anyone can have an allergic reaction to anyherb, and fenugreek allergy, though rare, has been documented.

Another reason for these types of symptoms –and perhaps more likely than a reaction to the herb– may be that mum’s supply has increased due to the fenugreek and the symptoms are those of oversupply, where baby is getting too much fore-milk. Fussiness, gas and green watery stools are classic symptoms of an oversupply of breastmilk.

Some things to try:

• Stop the fenugreek (without switching to another herb). If you are taking fenugreek for low supply, and are having problems with oversupply when taking this herb, it may be questionable whether you needed to increase supply in the first place.If you are deliberately trying to maintain an oversupply (such as when you’re pumping part/all of the time rather than nursing directly), then you might also try the following things:
• Cut back on the fenugreek dosage to see if baby’s symptoms disappear.
• Take measures to remedy the oversupply (help baby get more hindmilk) by doing things such as keeping baby to only one breast for up to 2-3 hours.
• Try non-pharmaceutical methods of increasing supply (this is always the first thing to try), or talk to your health care provider and lactation consultant about trying a different herb. This should help if baby is reacting to the fenugreek in mum’s milk.

The main question in this instance, however, is whether the fenugreek is needed at all. Many mums feel their supply is low when it really isn’t.