Photo Credit: UfaBizPhoto/Shutterstock.com
By Marc Sklar, LAc, DACM, FABORM
Reviewed by Deanna Minich, PhD and Kim Ross, DCN
August 23, 2023
While melatonin is most commonly associated with sleep concerns, it has many additional benefits due to its anti-inflammatory and antioxidant effects. Additionally, oral melatonin is considered a safe product that is well-tolerated for general use in adults, with adverse effects rarely reported in the literature (1–3). There are also benefits of melatonin related to fertility and breastfeeding.
Fertility
Infertility is a growing concern, with approximately 16% of couples being impacted worldwide (4). While multiple factors can affect fertility, melatonin has become an area of interest for researchers, clinicians, and couples due to its function as an antioxidant.
Melatonin is a potent free radical scavenger and multiple studies have shown it to enhance both male and female fertility and sperm and egg quality, resulting in increased fertilization (4,6–9). Conversely, one study found that melatonin did not increase the odds of pregnancy but did reduce the number of low-quality embryos (10) . Furthermore, melatonin demonstrates promise for advanced-age infertility and improves in-vitro fertilization (IVF) outcomes (11–15).
Melatonin has been noted to play a role in sperm function, the development and increase of ovarian follicles, ovulation, placenta cell survival, and it increases in the luteal phase of the menstrual cycles, helping to stimulate progesterone. Further, studies demonstrate varying doses of melatonin to benefit reproductive health conditions that may impact fertility, such as PCOS and endometriosis (4).
For more information on optimizing fertility, download
Conceive and Deliver a Truly Healthy Baby
by Jan Roberts, B.Pharm (Hons), Diploma Clinical Nutrition
Pregnancy
Melatonin’s use in pregnancy and lactation has been less studied in humans than other health topics, though research is emerging for this population. Some clinical trials report safety without adverse effects for daily doses of 8-30 mg (16). These doses are much higher than the recommended physiological dose of 0.3-1.0 mg, especially for sleep concerns, which are commonly reported in pregnant women (16).
Historically, melatonin was contraindicated in pregnancy because of its role in uterine contractions; however, more recent literature suggests many positive aspects of melatonin, likely due to its antioxidant and anti-inflammatory properties. Some benefits include reducing preeclampsia risk (a pregnancy complication characterized by high blood pressure, swelling of feet and hands, and protein in the urine that is potentially dangerous for both the expectant mother and baby), hyperglycemia (high blood glucose), uterine growth retardation, and neonatal complications (16,17).
In a comprehensive review of the available literature, obstetric researchers found that because of the increased oxygen demands on the body during pregnancy, there is more free radical damage. Due to melatonin’s natural antioxidant properties, when used within proper doses, it may be beneficial as a supplement for both complicated and normal pregnancies, counter to the traditional stance of avoiding it during pregnancy. The use of melatonin during pregnancy could help limit complications during the critical periods before and shortly after delivery (18,19).
A recent study suggested that preeclampsia was observed in those with reduced melatonin levels (19). Therefore, it has been suggested that melatonin may be helpful in having a successful pregnancy.
Melatonin may help prevent hypertension in the children of patients with a family history of hypertension (20).
“Melatonin has a good safety profile during pregnancy, with preclinical data suggesting that it is a candidate to prevent and optimize certain maternal and fetal concerns.”
~Leslie Stone, MD
An animal study in 2023 found that maternal melatonin supplementation helped positively shape the gut microbiota and protect against inflammation in the offspring. This will be an exciting area of research for us to watch and keep you informed on (21).
If you are pregnant, speak with your healthcare provider if
melatonin supplementation may benefit you.
Delivery
Research has shown that administering 10 mg of melatonin, compared with 3 mg, 5 mg, or placebo, to women before cesarean section (C-section) with spinal anesthesia was shown to: (22,23)
- reduce the severity of pain.
- reduce the duration of analgesic use postoperatively.
- facilitate the ability to be more physically active in less time after surgery.
A dose of 6 mg sublingual melatonin has been shown to decrease the amount of blood loss during a C-section, with no reported side effects (24). Women who delivered vaginally versus by C-section had higher colostrum melatonin levels (25,26), an important factor for new mothers who are planning to breastfeed.
Breastfeeding
The available data on using melatonin while breastfeeding is limited, therefore some sources suggest avoiding melatonin while breastfeeding (2). Other data reports melatonin to be “probably safe” during lactation (16). Despite that, caution should be exercised, using the low physiological dose for the shortest duration with careful monitoring (16).
Because melatonin production and circadian rhythms do not start to develop in infants until around three months of age (27), there can be colic in the newborn. Colic can be described by the “rule of 3s”: when a baby expresses significant distress through intense crying for at least 3 hours for 3 days over 3 weeks for no apparent reason.
The cause of colic is unknown but the root word colicus means "pertaining to colic” from the Greek word kolikos translating to the lower intestine. Melatonin helps relax intestinal smooth muscles (25,26). Experts have suggested that since the infant’s digestive system is still developing, in addition to the sleep and circadian rhythms forming, that melatonin may play a role (26).
But Mother Nature found a way to help little ones from day one - breastmilk.
Research suggests breast milk may help establish a sleep cycle while the newborn’s circadian rhythm develops because it contains: (28)
- macronutrients (carbohydrates, protein, and fat)
- micronutrients, including, but not limited to, B vitamins, vitamin A, zinc, iron, and iodine (29)
- bioactive compounds, such as immunoglobulins (supporting baby’s immune health), growth factors, hormones, and melatonin (30).
The composition of breast milk changes throughout the day. For example, the adrenal hormone cortisol, which is highest in the morning and responsible for helping us to “get going,” was three times higher in morning breast milk than in milk from later in the day (31). The levels of melatonin, which aid digestion and sleep, were barely present in morning milk but increased in the evening, peaking around 3:00 am, when adult melatonin production also peaks (32).
Of note, baby formula does not contain melatonin, so it is no surprise to hear that breastfed babies experience longer sleep times than formula-fed babies (32). Nutritionally, breastmilk composition also fluctuates during the day. Minerals, such as potassium, zinc, and magnesium (that help the baby grow stronger) hit their peak in the morning (33). The mother's nutritional status will impact the breastmilk's nutrition; therefore, a healthy diet and prenatal vitamins are commonly recommended (29).
Since the composition of breastmilk varies throughout the day, for pumping mothers, it’s important to note the time of day they pumped and bottle feed the expressed milk shortly after pumping or around the same time the following day (34).
Sleep for Mom and Dad
Getting enough sleep can be a challenge when becoming a parent, but sleep is a critical part of overall health. The better you feel when you wake up, the more you can care for your children throughout the day.
The bedtime routine can help establish a pattern to help the brain wind down at the end of the day. Try to limit screen use a couple of hours before going to sleep by instead reading a book before bed, or if there’s time, taking a relaxing bath.
When it comes to supplementation of melatonin - dosage is everything. Did you know that the adult brain (pineal gland) typically only produces about 0.3 mg of melatonin to promote sleep?
For long-term sleep support, we recommend Herbatonin 0.3 mg.
Sometimes after traveling across time zones or working a night shift, there may need to be additional support to re-establish sleeping rhythm. In those instances, we recommend Herbatonin® 3 mg. By taking 3 mg for short-term use of around 3-7 days, circadian rhythm and sleep cycle can be safely realigned.
If you have any questions about adding Herbatonin to your nighttime routine, please contact our medical team at medical.team@symphonynaturalhealth.com.
Herbatonin 0.3 mg is the only plant melatonin in the world. It is a 100% natural plant concentrate from a particular variety of rice, alfalfa, and chlorella with a standardized level of 0.3 mg of melatonin per capsule, safe for extended use on a nightly basis.
✓ The world's first plant melatonin: All other melatonin is animal or synthetic*
✓ Supports sleep cycles, restful sleep, and improved mental health*
✓ Low dose: 0.3 mg is the same amount of melatonin naturally produced by the brain, making it a non-habit forming, long-term use sleep aid*
✓ Slow release: Slow sustained release through the natural breakdown of the plant cell structure*
✓ Natural & pure: Contains no magnesium stearate, silicon dioxide, fillers, flavors, or excipients
References:
1. Andersen LPH, Gögenur I, Rosenberg J, Reiter RJ. The Safety of Melatonin in Humans. Vol. 36, Clinical Drug Investigation. 2016.
2. Natural Medicines [Internet]. 2023 [cited 2023 Jan 31]. Melatonin-Monograph. Available from: https://naturalmedicines-therapeuticresearch-com.scnmlib.idm.oclc.org/databases/food,-herbs-supplements/professional.aspx?productid=940
3. Menczel Schrire Z, Phillips CL, Chapman JL, Duffy SL, Wong G, D’Rozario AL, et al. Safety of higher doses of melatonin in adults: A systematic review and meta-analysis. Vol. 72, Journal of Pineal Research. 2022.
4. Cosme P, Rodríguez AB, Garrido M, Espino J. Coping with Oxidative Stress in Reproductive Pathophysiology and Assisted Reproduction: Melatonin as an Emerging Therapeutical Tool. Antioxidants. 2022 Dec 30;12(1):86.
5. Tan DX, Reiter RJ, Zimmerman S, Hardeland R. Melatonin: Both a Messenger of Darkness and a Participant in the Cellular Actions of Non-Visible Solar Radiation of Near Infrared Light. Biology (Basel). 2023 Jan 6;12(1):89.
6. Soleimani Rad S, Abbasalizadeh S, Ghorbani Haghjo A, Sadagheyani M, Montaseri A, Soleimani Rad J. Serum Levels of Melatonin and Oxidative Stress Markers and Correlation between Them in Infertile Men. J Caring Sci. 2013;2(4).
7. Rad SS, Abbasalizadeh S, Haghjo AG, Sadagheyani M, Montaseri A, Rad JS. Evaluation of the melatonin and oxidative stress markers level in serum of fertile and infertile women. Iran J Reprod Med. 2015;13(7).
8. Kratz EM, Piwowar A, Zeman M, Stebelová K, Thalhammer T. Decreased melatonin levels and increased levels of advanced oxidation protein products in the seminal plasma are related to male infertility. Reprod Fertil Dev. 2016;28(4).
9. Kratz EM, Piwowar A. Melatonin, advanced oxidation protein products and total antioxidant capacity as seminal parameters of prooxidant-antioxidant balance and their connection with expression of metalloproteinases in context of male fertility. Vol. 68, Journal of Physiology and Pharmacology. 2017.
10. Hosseini FS, Shamsipour M, Yazdekhasti H, Akbari-Asbagh F, Shahraki Z, Aghaee-Bakhtiari SH. The effect of oral melatonin supplementation on MT-ATP6 gene expression and IVF outcomes in Iranian infertile couples: a nonrandomized controlled trial. Naunyn Schmiedebergs Arch Pharmacol. 2021 Jul 8;394(7):1487–95.
11. Olcese JM. Melatonin and Female Reproduction: An Expanding Universe. Vol. 11, Frontiers in Endocrinology. 2020.
12. Berbets AM, Davydenko IS, Barbe AM, Konkov DH, Albota OM, Yuzko OM. Melatonin 1A and 1B Receptors’ Expression Decreases in the Placenta of Women with Fetal Growth Restriction. Reproductive Sciences. 2021;28(1).
13. Fernando S, Rombauts L. Melatonin: Shedding light on infertility? - A review of the recent literature. Journal of Ovarian Research. 2014.
14. Bao Z, Li G, Wang R, Xue S, Zeng Y, Deng S. Melatonin Improves Quality of Repeated-Poor and Frozen-Thawed Embryos in Human, a Prospective Clinical Trial. Front Endocrinol (Lausanne). 2022 May 13;13.
15. Zhu Q, Wang K, Zhang C, Chen B, Zou H, Zou W, et al. Effect of melatonin on the clinical outcome of patients with repeated cycles after failed cycles of in vitro fertilization and intracytoplasmic sperm injection. Zygote. 2022;
16. Vine T, Brown GM, Frey BN. Melatonin use during pregnancy and lactation: A scoping review of human studies. Vol. 44, Brazilian Journal of Psychiatry. 2022.
17. Verteramo R, Pierdomenico M, Greco P, Milano C. The Role of Melatonin in Pregnancy and the Health Benefits for the Newborn. Biomedicines. 2022 Dec 14;10(12):3252.
18. Aversa S, Pellegrino S, Barberi I, Reiter RJ, Gitto E. Potential utility of melatonin as an antioxidant during pregnancy and in the perinatal period. Vol. 25, Journal of Maternal-Fetal and Neonatal Medicine. 2012.
19. Zeng K, Gao Y, Wan J, Tong M, Lee AC, Zhao M, et al. The reduction in circulating levels of melatonin may be associated with the development of preeclampsia. J Hum Hypertens. 2016;30(11).
20. Ivanov DO, Evsyukova II, Mironova ES, Polyakova VO, Kvetnoy IM, Nasyrov RA. Maternal melatonin deficiency leads to endocrine pathologies in children in early ontogenesis. Vol. 22, International Journal of Molecular Sciences. 2021.
21. Li F, Lai J, Ma F, Cai Y, Li S, Feng Z, et al. Maternal melatonin supplementation shapes gut microbiota and protects against inflammation in early life. Int Immunopharmacol. 2023 Jul;120:110359.
22. Kiabi FH, Emadi SA, Jamkhaneh AE, Aezzi G, Ahmadi NS. Effects of preoperative melatonin on postoperative pain following cesarean section: A randomized clinical trial. Annals of Medicine and Surgery. 2021;66.
23. Albzea W, Almonayea L, Aljassar M, Atmeh M, Al Sadder K, AlQattan Y, et al. Efficacy and Safety of Preoperative Melatonin for Women Undergoing Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Medicina (B Aires). 2023;59(6).
24. Khezri MB, Reihany MD, Dabbaghi Ghaleh T, Mohammadi N. Effect of Melatonin on Blood Loss After Cesarean Section: A Prospective Randomized Double-Blind Trial. Journal of Obstetrics and Gynecology of India. 2019;69(5).
25. Çallśkan C, Çelik S, Hatirnaz S, Çelik H, Avcl B, Tinelli A. The Role of Delivery Route on Colostrum Melatonin and Serum Il-6 Levels: A Prospective Controlled Study. Z Geburtshilfe Neonatol. 2021;225(6).
26. Namll Kalem M, Kalem Z, Yuce T, Baklrarar B, Söylemez F. Comparison of Melatonin Levels in the Colostrum between Vaginal Delivery and Cesarean Delivery. Am J Perinatol. 2018;35(5).
27. Minich DM, Henning M, Darley C, Fahoum M, Schuler CB, Frame J. Is Melatonin the “Next Vitamin D”?: A Review of Emerging Science, Clinical Uses, Safety, and Dietary Supplements. Nutrients [Internet]. 2022;14(19). Available from: https://www.mdpi.com/2072-6643/14/19/3934/htm
28. Ballard O, Morrow AL. Human Milk Composition. Nutrients and Bioactive Factors. Vol. 60, Pediatric Clinics of North America. 2013.
29. Allen LH. B Vitamins in Breast Milk: Relative Importance of Maternal Status and Intake, and Effects on Infant Status and function. Advances in Nutrition. 2012 May;3(3):362–9.
30. Engler AC, Hadash A, Shehadeh N, Pillar G. Breastfeeding may improve nocturnal sleep and reduce infantile colic: Potential role of breast milk melatonin. Eur J Pediatr. 2012;171(4).
31. Pundir S, Wall CR, Mitchell CJ, Thorstensen EB, Lai CT, Geddes DT, et al. Variation of Human Milk Glucocorticoids over 24 hour Period. J Mammary Gland Biol Neoplasia. 2017 Mar 31;22(1):85–92.
32. Qin Y, Shi W, Zhuang J, Liu Y, Tang L, Bu J, et al. Variations in melatonin levels in preterm and term human breast milk during the first month after delivery. Sci Rep. 2019;9(1).
33. Karra M V., Kirksey A. Variation in Zinc, Calcium, and Magnesium Concentrations of Human Milk within a 24-Hour Period from 1 to 6 Months of Lactation. J Pediatr Gastroenterol Nutr. 1988 Jan;7(1):100–6.
34. Sánchez CL, Cubero J, Sánchez J, Chanclón B, Rivero M, Rodríguez AB, et al. The possible role of human milk nucleotides as sleep inducers. Nutr Neurosci. 2009 Feb 19;12(1):2–8.