Lactation suppression refers to the act of suppressing
lactation
Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The proces ...
by medication or other non pharmaceutical means. The breasts may become painful when engorged with milk if breastfeeding is ceased abruptly, or if never started. This may occur if a woman never initiates breastfeeding, or if she is weaning from breastfeeding abruptly. Historically women who did not plan to breastfeed were given
diethylstilbestrol
Diethylstilbestrol (DES), also known as stilbestrol or stilboestrol, is a nonsteroidal estrogen medication, which is presently rarely used. In the past, it was widely used for a variety of indications, including pregnancy support for those with a ...
and other medications after birth to suppress lactation. However, its use was discontinued, and there are no medications currently approved for lactation suppression in the US and the UK.
Dopamine agonists
A dopamine agonist (DA) is a compound that activates dopamine receptors. There are two families of dopamine receptors, D2-like and D1-like, and they are all G protein-coupled receptors. D1- and D5-receptors belong to the D1-like family and the ...
are routinely prescribed to women following a stillbirth in the UK under the
NHS
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
.
Reasons
After birth, some women may desire to stop the production of breast milk, for example when the mother decides to
bottle feed from birth, or in the case when the
infant dies or is
surrendered at birth. Additionally, women who are breastfeeding may need to stop breastfeeding abruptly, for instance if she is taking
medication contraindicated for breastfeeding or undergoes surgery. The abrupt weaning process may lead to severe
engorgement
Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and cu ...
, extremely painful breasts, and possibly
mastitis
Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs ...
.
Methods
Medication
Dopamine agonists
A dopamine agonist (DA) is a compound that activates dopamine receptors. There are two families of dopamine receptors, D2-like and D1-like, and they are all G protein-coupled receptors. D1- and D5-receptors belong to the D1-like family and the ...
are currently the preferred medication for suppressing lactation, which work by suppressing
prolactin
Prolactin (PRL), also known as lactotropin, is a protein best known for its role in enabling mammals to produce milk. It is influential in over 300 separate processes in various vertebrates, including humans. Prolactin is secreted from the pit ...
production.
Cabergoline
Cabergoline, sold under the brand name Dostinex among others, is a dopaminergic medication used in the treatment of high prolactin levels, prolactinomas, Parkinson's disease, and for other indications. It is taken by mouth.
Cabergoline is an er ...
(Dostinex™) is currently most effective option currently available, as it is available as a single dose (as opposed to
bromocriptine
Bromocriptine, originally marketed as Parlodel and subsequently under many brand names, is an ergoline derivative and dopamine agonist that is used in the treatment of pituitary tumors, Parkinson's disease, hyperprolactinaemia, neuroleptic maligna ...
which must be taken twice daily for 2 weeks.)
It may be prescribed in the case of
breast abscess
Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs ...
. Although the preferred method of treatment for breast abscess and mastitis is actually to continue
breastfeeding
Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that br ...
, if the decision is made to stop breastfeeding, then chemical lactation suppression is indicated, particularly for severe cases. Carbergoline is not indicated for treatment of discomfort caused by engorgement.
In the UK dopamine agonists are routinely prescribed following a stillbirth.
Pre-eclampsia
Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease ...
is a contraindication for prescribing dopamine agonists.
In the past, hormonal therapies such as
diethylstilbestrol
Diethylstilbestrol (DES), also known as stilbestrol or stilboestrol, is a nonsteroidal estrogen medication, which is presently rarely used. In the past, it was widely used for a variety of indications, including pregnancy support for those with a ...
were routinely used in the
postpartum
The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal perio ...
period, but these are no longer recommended due to side effects such as nausea and vomiting,
and severe potential side effects such as
thromboembolism
Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thro ...
, cerebral accident, and myocardial infarction.
Estrogen containing birth control pills may have the same side effect, but like
diethylstilbestrol
Diethylstilbestrol (DES), also known as stilbestrol or stilboestrol, is a nonsteroidal estrogen medication, which is presently rarely used. In the past, it was widely used for a variety of indications, including pregnancy support for those with a ...
is inappropriate for use in the postpartum period due to the risk of side effects.
Pseudoephedrine
Pseudoephedrine (PSE) is a sympathomimetic drug of the phenethylamine and amphetamine chemical classes. It may be used as a nasal/sinus decongestant, as a stimulant, or as a wakefulness-promoting agent in higher doses.
It was first characteri ...
may also suppress lactation, as it is known to cause
low supply.
In the US. Spitz et al. in a 100-year review of all available information concluded that there was nothing new or helpful to assist with the mammary involution or milk suppression process or to treat the pain or discomfort of severely engorged breasts.
Other methods
By simply not stimulating the breasts after birth, after a few days the production of milk will decease. If breastfeeding has already been established, the production of milk typically takes longer to decrease and may take several weeks. Women may experience pain and discomfort from engorgement. This discomfort is may be relieved by hand-expressing milk or the use of a
pump
A pump is a device that moves fluids (liquids or gases), or sometimes slurries, by mechanical action, typically converted from electrical energy into hydraulic energy. Pumps can be classified into three major groups according to the method they u ...
to reduce engorgement and prevent mastitis.
The discomfort can also be treated with analgesics. However, as much as one third of all women will experience severe pain in this process.
Historically,
binding the breasts by use of tight-fitting bras or ace bandages was used, but this is now discouraged as this may cause blocked milk ducts and mastitis.
Fluid restriction is also not recommended as it is likely ineffective and unnecessary.
Cabbage
Cabbage, comprising several cultivars of ''Brassica oleracea'', is a leafy green, red (purple), or white (pale green) biennial plant grown as an annual vegetable crop for its dense-leaved heads. It is descended from the wild cabbage ( ''B.&nb ...
leaves are a common recommendation to reduce discomfort from engorgement. However, a Cochrane review of three studies on this subject concluded that there was no statistically significant evidence that interventions were associated with a more rapid resolution of symptoms; in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment.
According to the Cochrane review other interventions such as hot/cold packs, Gua-Sha (scraping therapy), acupuncture, and proteolytic enzymes may be promising for the treatment of breast engorgement, but there is insufficient evidence to justify widespread implementation.
See also
*
Hypothalamic–pituitary–prolactin axis
The hypothalamic–pituitary–prolactin axis (HPP axis), also known as the hypothalamic–pituitary–mammary axis or hypothalamic–pituitary–breast axis, is a hypothalamic–pituitary axis which includes the secretion of prolactin (PRL; lute ...
*
Prolactin modulator
A prolactin modulator is a drug which affects the hypothalamic–pituitary–prolactin axis (HPP axis) by modulating the secretion of the pituitary hormone prolactin from the anterior pituitary gland. ''Prolactin inhibitors'' suppress and ''pro ...
References
{{Infants and their care
Breastfeeding