Treatments for suppression of lactation

Abstract

Women cannot always breastfeed after birth. Reasons may be because the infant dies or is adopted, or the mother is too ill, or for the wellbeing of the mother or infant. HIV-positive mothers, particularly those not on antiretroviral drugs during pregnancy, avoid breastfeeding to reduce the risk of passing on the virus to their infants. Some mothers do not breastfeed on personal or social grounds. Without an infant suckling, milk production (lactation) eventually stops of its own accord. In the meantime, women can experience breast engorgement, leakage of milk, discomfort and pain. Clinicians may provide treatment to suppress lactation and reduce these symptoms. Binding the breasts or wearing a tight brassiere, applying an infra-red lamp, fluid and diet restrictions, external application of jasmine flower and ice packs are tried non-drug approaches. Drug treatments include oestrogens and bromocriptine which lowers prolactin levels. However, increased risks of thromboembolism, cerebral accident and myocardial infarction have been reported with their use. The evidence to support treatments for preventing lactation is limited. The review authors identified 46 controlled trials that randomised a total of 5164 mothers to receive the treatment under investigation, no treatment or another treatment. The trials were generally of limited quality and most were conducted among healthy women who chose not to breastfeed for personal reasons at hospitals in industrialized countries before 1980. Half of the trials involved bromocriptine. Five trials (206 women) reported that taking bromocriptine was better than no treatment in suppressing lactation in the first week after giving birth. The nine trials using oestrogen preparations (diethylstilbestrol, quinestrol, chlorotrianisene, hexestrol) also showed suppression of lactation. A combination of testosterone and oestrogen preparations was of some benefit in reducing symptoms in two trials (346 women). Other pharmacologic agents (clomiphene, tamoxifen, prostaglandins, pyridoxine, oxytocin and homeopathic preparation) were tested in single small trials. Generally, side effects were poorly reported and no case of thromboembolism was recorded among trials that included it as an adverse treatment outcome. Most of the drugs tested are currently not available or registered for suppressing lactation. No trials compared non-drug approaches to no treatment and none of the included trials provided reliable data on women’s satisfaction with the treatment