Galactogogues: Do They Increase Milk Supply?

When milk production appears lower than expected, it is easy to start looking for something that might increase it. Galactogogues are medicines, herbs or other substances used with the intention of increasing milk production, but the evidence for their effectiveness is mixed.

For some families, a galactogogue may have a place within an individualised feeding plan. For others, it may add cost, side effects or complexity without addressing the reason milk production appears to be low.

Before considering one, it is useful to establish whether milk production is actually lower than expected and, if so, what may be contributing to this.

What are galactogogues?

Galactogogues are substances used with the intention of increasing milk production. They include prescription medicines as well as herbal and food-based products.

Medicines that have been studied in lactation include domperidone and metoclopramide. Herbal and food-based products marketed for milk production may contain ingredients such as fenugreek, fennel, milk thistle, moringa or shatavari, either individually or in combination.

The existence of a product marketed as a galactogogue does not establish that it works. The more useful questions are whether it has been shown to increase milk production, in which circumstances, by how much, and whether any potential benefit outweighs its risks (Brodribb, 2018; Foong et al., 2020).

Is milk production actually low?

One of the first questions is whether there is evidence of low milk production rather than a change in how the breasts feel or how feeding looks.

Milk production changes considerably during the early weeks after birth. Initially, lactation is largely under endocrine control, with hormonal changes following birth playing an important role in establishing milk production. As lactation becomes established, control becomes increasingly autocrine. Milk production is then more closely regulated within the breast according to milk removal and local mechanisms within the mammary gland (De Coopman, 1993; Knight, Peaker and Wilde, 1998; Wilde et al., 1998).

As this transition occurs, the initial fullness of the breasts commonly reduces and the breasts may feel much softer between feeds. This is an expected change in established lactation. Soft breasts at this stage do not, by themselves, mean that milk production has fallen or that there is not enough milk.

After the early weeks, an infant's growth, hydration and overall feeding picture are much more useful indicators of milk intake than breast fullness alone. NHS guidance identifies weight gain, wet nappies, swallowing during feeds and other aspects of feeding as useful indicators that an infant is receiving enough milk (NHS, 2026).

Frequent feeding, periods when an infant is unsettled or obtaining a small volume when expressing can also be interpreted as signs of low supply when they may have other explanations.

Expressed milk volume is not a direct measurement of total milk production. Pump fit and settings, timing, breast fullness, milk ejection and an individual's response to expressing can all affect the amount collected during a particular session.

My articles Increasing Breast Milk Production and How to Express Breastmilk look at milk production and expressing in more detail.

A proper assessment considers the wider feeding picture, including infant growth and hydration, feeding frequency, milk transfer, maternal health, birth and postpartum history and expressing practices where relevant (Brodribb, 2018; Foong et al., 2020).

Positioning and attachment can also affect how comfortably and effectively milk is removed. My articles Breastfeeding latch and positioning and How to Improve Infant Latch: Practical Breastfeeding Support explore these areas further.

If expressing is part of the feeding plan, pump fit can also be relevant. Breast Pump Flange Fitting: Finding What Works for You considers how flange fit can affect comfort and milk removal.

Infant oral function may also be relevant in some feeding situations, but an anatomical finding does not, by itself, establish that it is the cause of reduced milk transfer or milk production. Function needs to be considered alongside the whole feeding picture.

My article Breastfeeding problems caused by tongue-tie? explores why feeding difficulties need to be considered more broadly than the appearance of the lingual frenulum.

What does the evidence actually show?

The evidence for galactogogues is limited and does not support a universal recommendation for their use.

A Cochrane review of oral galactogogues in mothers of healthy term infants included 41 studies involving 3,005 mothers. The studies varied considerably in the interventions used, participant characteristics and outcome measures. There was low-certainty evidence that pharmacological galactogogues may increase milk volume, while evidence for natural galactogogues was very uncertain (Foong et al., 2020).

This does not mean that an individual cannot experience an increase in milk production after using a galactogogue. It means that the available evidence does not allow us to predict reliably who will benefit, how much benefit can be expected or whether an observed change was caused by the galactogogue itself.

The Academy of Breastfeeding Medicine advises that potentially modifiable causes of low milk production are assessed before considering a galactogogue, rather than using medication or supplements as the first response to the concern (Brodribb, 2018).

Does the preparation matter?

Yes.

A herb is not a single standardised dose simply because it has the same name on the packet.

A tea, capsule, powder, tincture, extract, cookie or other food containing an herb can provide very different amounts of its active constituents. A teabag and a concentrated extract are not necessarily equivalent.

This means that evidence from a study using one particular preparation cannot automatically be applied to a different commercial product containing the same herb.

The same applies to products containing several ingredients. If a study examines a particular combination, its findings cannot automatically be transferred to another tea, supplement or food containing some of the same ingredients.

This is one reason the evidence for commercial lactation products can be difficult to interpret. A product may contain an ingredient that has been studied without the product itself having been studied.

A randomised controlled trial of commercially available lactation cookies containing oatmeal, brewer's yeast, flaxseed and fenugreek found no significant difference in milk production between the intervention and control cookies. The study also found no significant difference in perceived insufficient milk or breastfeeding self-efficacy (Palacios et al., 2023).

The presence of ingredients traditionally or commercially described as galactagogues does not, by itself, establish that a particular food will increase milk production.

What about herbal galactogogues?

Herbal products are sometimes perceived as a gentler alternative to medicines because they are described as natural. Natural does not necessarily mean effective, free from side effects or suitable for everyone.

Fenugreek, fennel, milk thistle, moringa and shatavari are among the herbs that have been studied or used in relation to milk production, but the amount and quality of evidence varies considerably. The Cochrane review found substantial variation between studies and uncertainty around the effects of natural galactogogues (Foong et al., 2020).

Herbal products can also cause side effects or interact with medicines. Products may contain several ingredients, and the amount of an active constituent can vary between preparations.

There is also a difference between traditional use and evidence of clinical effectiveness. A herb may have been used for generations for a particular purpose without there being good-quality clinical evidence showing that it produces that effect.

That does not make traditional knowledge irrelevant. It does mean that it should not be presented as equivalent to evidence from well-designed clinical research.

Can herbs reduce milk production too?

This is another part of the discussion that is sometimes overlooked.

Some herbs and herbal preparations are traditionally used with the intention of reducing milk production, particularly during weaning or when someone is experiencing oversupply. Sage and peppermint are two commonly discussed examples.

The evidence for these effects is limited. LactMed reports that sage is traditionally used to reduce lactation and that peppermint has also been used to suppress milk production, but clinical evidence demonstrating these effects in breastfeeding women is lacking. For peppermint, milk-suppressing effects have been demonstrated in vitro and in animals with high doses, but it is not known whether typical human intake would have the same effect (National Library of Medicine, 2025a; 2025b).

The important point is that herbal preparations can have different intended effects depending on the herb, preparation and circumstances. “Herbal” does not automatically mean “milk increasing”.

If the aim is to reduce or stop breastfeeding, my article Stopping Breastfeeding looks at the gradual changes involved in reducing milk removal and managing the transition.

What about domperidone?

Domperidone is an anti-sickness medicine that can also increase prolactin and has been used off-label to support milk production. It is not licensed in the UK specifically for increasing milk supply.

The Specialist Pharmacy Service suggests that domperidone can be considered for low milk supply after a thorough assessment and once non-medical measures have been tried. Its guidance also notes that most of the evidence comes from mothers expressing milk for preterm infants, with less evidence in mothers feeding healthy term infants (Specialist Pharmacy Service, 2024).

Some specialist lactation guidance has described using doses higher than those generally used in current UK practice, including in circumstances such as delayed onset of lactogenesis. These approaches should not be interpreted as general dosing recommendations. Any use of domperidone should be discussed with the prescriber responsible for the individual (Newman, 2005).

Cardiac safety also needs to be considered in context. The evidence of increased cardiac risk comes largely from studies in older adults, rather than healthy lactating women. For example, one major study had a mean age of 79.4 years, while evidence in postpartum women remains limited (Johannes et al., 2010; Ou et al., 2021).

If domperidone has been used for a period of time, stopping also needs consideration. Some lactation guidance describes gradual reduction rather than simply stopping, particularly after longer-term use. Any change in treatment should be planned with the prescriber rather than made independently (Newman, 2005; The Breastfeeding Network, 2026).

What about metoclopramide?

Metoclopramide has also been studied as a galactogogue, but evidence of benefit is inconsistent.

A systematic review and meta-analysis of eight trials involving 342 lactating women found that metoclopramide increased prolactin concentrations but did not increase milk volume compared with control treatment (Nik Hazlina Nik Hussain et al., 2021).

Metoclopramide can also cause adverse effects, including neurological effects and psychological side effects. The Academy of Breastfeeding Medicine therefore advises consideration of potential adverse effects, contraindications and interactions before a galactogogue is used (Brodribb, 2018).

The wider evidence does not establish that increasing prolactin will necessarily produce a clinically meaningful increase in milk production for everyone. Milk production is influenced by milk removal as well as hormonal responses, so a higher prolactin level is not, by itself, a guarantee of more milk (Specialist Pharmacy Service, 2024).

Why assessment comes before a galactogogue

A galactogogue cannot reliably compensate for milk that is not being removed effectively.

If milk removal is being limited by ineffective milk transfer, infrequent milk removal, pain, unsuitable expressing equipment or another modifiable factor, addressing that issue may be more important than adding a product (Brodribb, 2018; Foong et al., 2020).

For some feeding dyads, positioning and attachment may be relevant. For others, the issue may involve milk transfer, infant oral function, maternal health, breast surgery, medication, hormonal factors or the way expressing is being used.

My article When feeding doesn't feel right: Looking beyond tongue-tie considers some of the wider factors that can contribute to feeding difficulties.

If the concern is expressed milk volume, it is also worth considering whether the pump, flange fit, expressing frequency and reason for expressing have been assessed before assuming that milk production itself is low.

More expressing is not automatically better. If an infant is already removing milk effectively, repeatedly adding extra pumping sessions can sometimes create an oversupply rather than solve the original concern.

My article How to Express Breastmilk discusses the different reasons for expressing and why the approach needs to reflect what someone is trying to achieve.

How might a proportionate decision be made?

If a galactogogue is being considered, the starting point is not necessarily which product to choose. It is what the family is hoping to achieve.

The goal might be to increase direct feeding, increase expressed milk, make combination feeding more sustainable or reduce the need for supplementation.

It is then useful to consider:

• Is milk production actually lower than expected?

• Is milk being removed frequently and effectively?

• Are there maternal or infant factors affecting milk production or transfer?

• Are positioning, attachment or expressing practices contributing?

• Is there a medical reason for reduced production that needs assessment?

• What evidence supports the proposed galactogogue?

• What preparation is actually being considered?

• Could any other medicines, herbs or supplements be affecting milk production?

• How will any benefit be assessed?

• When will the plan be reviewed?

• What will happen if there is no meaningful benefit?

For some families, useful measures may include infant growth and hydration. For someone expressing, changes in milk volume over a defined period may be useful. For others, the most important outcome may be a feeding plan that is more comfortable or sustainable.

A defined review is particularly useful. If something is being used with the intention of increasing milk production, there should be a point at which its effect is considered rather than continuing indefinitely without evidence of benefit.

There is no single right response to concerns about milk supply

Concerns about milk production can be difficult, particularly when feeding has already involved pain, supplementation, expressing or previous challenges.

Using a galactogogue does not mean that someone has failed to feed their baby, and choosing not to use one does not mean that they have failed to try hard enough.

The evidence supports a measured approach: establish what is happening with milk production and milk transfer, consider modifiable factors, understand the evidence and potential risks associated with any proposed galactogogue, and agree how the outcome will be reviewed.

If there are concerns about milk production, feeding or milk transfer, an individual assessment can help identify what may be contributing. This may include support from an appropriately qualified infant feeding specialist, such as an IBCLC, alongside medical assessment where indicated.

My article When feeding doesn't feel right: Looking beyond tongue-tie considers the wider feeding picture, while Breastfeeding latch and positioning, How to Improve Infant Latch: Practical Breastfeeding Support, How to Express Breastmilk and Breast Pump Flange Fitting: Finding What Works for You explore specific areas in more detail.

Sometimes a galactogogue may have a place. In other circumstances, the more useful intervention may be addressing milk removal, feeding technique, expressing equipment or an underlying maternal or infant factor — or establishing that milk production is not actually lower than expected.

References

Brodribb, W. (2018) ‘ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018’, Breastfeeding Medicine, 13(5), pp. 307–314. doi: 10.1089/bfm.2018.29092.wjb.

De Coopman, J. (1993) ‘Breastfeeding after pituitary resection: support for a theory of autocrine control of milk supply?’, Journal of Human Lactation, 9(1), pp. 35–40. doi: 10.1177/089033449300900129.

Foong, S.C., Tan, M.L., Foong, W.C., Marasco, L.A., Ho, J.J. and Ong, J.H. (2020) ‘Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants’, Cochrane Database of Systematic Reviews, 2020(5), CD011505. doi: 10.1002/14651858.CD011505.pub2.

Johannes, C.B., Varas-Lorenzo, C., McQuay, L.J., Midkiff, K.D. and Fife, D. (2010) ‘Risk of serious ventricular arrhythmia and sudden cardiac death in a cohort of users of domperidone: a nested case-control study’, Pharmacoepidemiology and Drug Safety, 19(9), pp. 881–888. doi: 10.1002/pds.2016.

Knight, C.H., Peaker, M. and Wilde, C.J. (1998) ‘Local control of mammary development and function’, Reviews of Reproduction, 3(2), pp. 104–112. doi: 10.1530/ror.0.0030104.

National Library of Medicine (2025a) ‘Peppermint’, Drugs and Lactation Database (LactMed®). Bethesda, MD: National Institute of Child Health and Human Development. Last revision 15 June 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK501851/

National Library of Medicine (2025b) ‘Sage’, Drugs and Lactation Database (LactMed®). Bethesda, MD: National Institute of Child Health and Human Development. Last revision 15 July 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK501816/

Newman, J. (2005) ‘Domperidone’, Handout #19a, January 2005. Available at: https://breastfeedingmadesimple.com/wp-content/uploads/2016/02/newman_Domperidone1-January2005.pdf

Nik Hazlina Nik Hussain, N.H., Mohd Noor, N., Ismail, S.B., Zainuddin, N.A. and Sulaiman, Z. (2021) ‘Metoclopramide for milk production in lactating women: a systematic review and meta-analysis’, Korean Journal of Family Medicine, 42(6), pp. 453–463. doi: 10.4082/kjfm.20.0238.

NHS (2026) ‘Breastfeeding: is my baby getting enough milk?’, NHS. Page last reviewed 30 April 2026. Available at: https://www.nhs.uk/baby/breastfeeding-and-bottle-feeding/breastfeeding-problems/enough-milk/

Ou, L.B., Moriello, C., Douros, A. and Filion, K.B. (2021) ‘Domperidone and the risks of sudden cardiac death and ventricular arrhythmia: a systematic review and meta-analysis of observational studies’, British Journal of Clinical Pharmacology, 87(10), pp. 3649–3658. doi: 10.1111/bcp.14737.

Palacios, A.M., Cardel, M.I., Parker, E., Dickinson, S., Houin, V.R., Young, B. and Allison, D.B. (2023) ‘Effectiveness of lactation cookies on human milk production rates: a randomized controlled trial’, The American Journal of Clinical Nutrition, 117(5), pp. 1035–1042. doi: 10.1016/j.ajcnut.2023.03.010.

Specialist Pharmacy Service (2024) ‘Using domperidone for low milk supply’. Published 21 June 2024. Available at: https://www.sps.nhs.uk/articles/using-domperidone-for-low-milk-supply/

The Breastfeeding Network (2026) ‘Domperidone and breastfeeding’, Drugs in Breastmilk Information. Last full review September 2019; last amended May 2026. Available at: https://www.breastfeedingnetwork.org.uk/factsheet/domperidone/

Wilde, C.J., Addey, C.V., Bryson, J.M., Finch, L.M., Knight, C.H. and Peaker, M. (1998) ‘Autocrine regulation of milk secretion’, Biochemical Society Symposium, 63, pp. 81–90.