Eight multiparous Holstein cows averaging 570 +/- 43 kg of body weight and 60 +/- 20 d in milk were used in a double Latin square design with four 21-d experimental periods to determine the effects of feeding ground or whole flaxseed with or without monensin supplementation (0.02% on a dry matter basis) on milk production and composition, feed intake, digestion, blood composition, and fatty acid profile of milk. Intake of dry matter was similar among treatments. Cows fed whole flaxseed had higher digestibility of acid detergent fiber but lower digestibilities of crude protein and ether extract than those fed ground flaxseed; monensin had no effect on digestibility. Milk production tended to be greater for cows fed ground flaxseed (22.8 kg/d) compared with those fed whole flaxseed (21.4 kg/d). Processing of flax-seed had no effect on 4% fat-corrected milk yield and milk protein and lactose concentrations. Monensin supplementation had no effect on milk production but decreased 4% fat-corrected milk yield as a result of a decrease in milk fat concentration. Feeding ground compared with whole flaxseed decreased concentrations of 16:0, 17:0, and cis6-20:4 and increased those of cis6-18:2, cis9, trans11-18:2, and cis3-18:3 in milk fat. As a result, there was a decrease in concentrations of medium-chain and saturated fatty acids and a trend for higher concentrations of long-chain fatty acids in milk fat when feeding ground compared with whole flaxseed. Monensin supplementation increased concentrations of cis9 and trans11-18:2 and decreased concentrations of saturated fatty acids in milk fat. There was an interaction between flaxseed processing and monensin supplementation, with higher milk fat concentration of trans11-18:1 for cows fed ground flaxseed with monensin than for those fed the other diets. Flaxseed processing and monensin supplementation successfully modified the fatty acid composition of milk fat that might favor nutritional value for consumers.