Treatments for suppression of lactation

Various pharmacologic and nonpharmacologic interventions have been used to suppress lactation after childbirth and relieve associated symptoms. Despite the large volume of literature on the subject, there is currently no universal guideline on the most appropriate approach for suppressing lactation in postpartum women.

To evaluate the effectiveness and safety of interventions used for suppression of lactation in postpartum women (who have not breastfed or expressed breastmilk) to determine which approach has the greatest comparative benefits with least risk.

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2007).

Randomised trials evaluating the effectiveness of treatments used for suppression of postpartum lactation.

Two authors independently assessed trial quality and extracted data.

We included 46 trials (5164 women). The trials were generally small and of limited quality. Five trials (206 women) indicated that bromocriptine significantly reduced the proportion of women lactating compared to no treatment at or within seven days postpartum (three trials, 107 women; relative risk (RR) 0.36, 95% confidence interval (CI) 0.24 to 0.54). Six trials involving oestrogen preparations (diethylstilbestrol, quinestrol, chlorotrianisene, hexestrol) suggested that they significantly reduced the proportion of lactating women compared to no treatment at or within seven days postpartum (RR 0.41, 95% CI 0.29 to 0.59). We found no trials comparing nonpharmacologic methods with no treatment. Trials comparing bromocriptine with other pharmacologic agents suggested similarity in their effectiveness (RR 0.79, 95% CI 0.54 to 1.17). Side effects were poorly reported in the trials and no case of thromboembolism was recorded in the four trials that reported it as an outcome.

There is weak evidence that some pharmacologic treatments (most of which are currently unavailable to the public) are better than no treatment for suppressing lactation symptoms in the first postpartum week. No evidence currently exists to indicate whether nonpharmacologic approaches are more effective than no treatment. Presently, there is insufficient evidence to address the side effects of methods employed for suppressing lactation. When women desire treatment, bromocriptine may be considered where it is registered for lactation suppression in those without predisposition to its major side effects of public concerns. Large randomised trials are needed to compare the effectiveness of pharmacologic (especially bromocriptine) and nonpharmacologic methods to no treatment. Such trials should consider acceptability of the intervention and lactation symptoms of concern to women and be large enough to detect clinically important differences in major side effects between comparison groups.