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 process ...

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 ...

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 is a compound that activates dopamine receptors. There are two families of dopamine receptors, D1-like and D2-like. They are all G protein-coupled receptors. D1- and D5-receptors belong to the D1-like family and the D2-like ...

are routinely prescribed to women following a stillbirth in the UK under the

NHS The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...

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 occ ...

Methods

Medication

are currently the preferred medication for suppressing lactation, which work by suppressing

prolactin Prolactin (PRL), also known as lactotropin and mammotropin, 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 secr ...

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 ...

(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 malig ...

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 occ ...

. Although the preferred method of treatment for breast abscess and mastitis is actually to continue

breastfeeding Breastfeeding, also known as nursing, is the process where breast milk is fed to a child. Infants may suck the milk directly from the breast, or milk may be extracted with a Breast pump, pump and then fed to the infant. The World Health Orga ...

, 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 multi-system disorder specific to pregnancy, characterized by the new onset of hypertension, high blood pressure and often a significant amount of proteinuria, protein in the urine or by the new onset of high blood pressure a ...

is a contraindication for prescribing dopamine agonists. In the past, hormonal therapies such as

were routinely used in the

postpartum The postpartum (or postnatal) period begins after childbirth and is typically considered to last for six to eight weeks. There are three distinct phases of the postnatal period; the acute phase, lasting for six to twelve hours after birth; the ...

period, but these are no longer recommended due to side effects such as nausea and vomiting, and severe potential side effects such as

thromboembolism Thromboembolism is a condition in which a blood clot (thrombus) breaks off from its original site and travels through the bloodstream (as an embolus) to obstruct a blood vessel, causing tissue ischemia and organ damage. Thromboembolism can affe ...

, cerebral accident, and myocardial infarction. Estrogen containing birth control pills may have the same side effect, but like

is inappropriate for use in the postpartum period due to the risk of side effects.

Pseudoephedrine Pseudoephedrine, sold under the brand name Sudafed among others, is a sympathomimetic medication which is used as a decongestant to treat nasal congestion. It has also been used off-label for certain other indications, like treatment of lo ...

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 Slurry, slurries, by mechanical action, typically converted from electrical energy into hydraulic or pneumatic energy. Mechanical pumps serve in a wide range of application ...

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.& ...

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.

References

{{Infants and their care Breastfeeding

Reasons

Methods

Medication

Other methods

See also

References