ASK DIS: Suppression of Lactation

Women may not breastfeed their newborn babies for a variety of reasons, ranging from personal choice, HIV-infection to stillbirth
Galactorrhea is nonlactational milk production, which is usually defined as milk production one year after pregnancy and cessation of breastfeeding. It can also occur in nulliparous and postmenopausal women, and even in men

Management Algorithm:

Medication Associated Galactorrhea

Pharmacological Management

*DOPAMINE AGONIST*	*COMMON DOSAGES*	*COMMON ADVERSE EFFECTS*	*COMMENTS*
Bromocriptine	2.5 to 15 mg daily	· Both medications have similar adverse effects, · including gastrointestinal (nausea, vomiting), cardiovascular (postural hypotension, dizziness), and neurologic (drowsiness, headache); cardiac valvulopathy reported with high dose of cabergoline (more than 4 mg daily)	· Compared with bromocriptine, the adverse effects of cabergoline are usually less frequent, of shorter duration, and less severe · Bromocriptine is preferred by some women who are trying to conceive because of the larger safety database; it typically should be discontinued once pregnancy is confirmed
Cabergoline	0.25 to 1 mg twice weekly Or 0.5 to 2 mg once weekly

11 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 three trials (436 women)
Other pharmacologic agents (clomiphene, tamoxifen, prostaglandins, pyridoxine, oxytocin, L‐dopa 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

Non-Pharmacological Management

insufficient evidence to recommend the widespread use of any particular treatment
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
Washed cabbage leaves have been documented as a treatment for engorgement.
The application of cold therapy may be soothing, is unlikely to cause harm, and cabbage leaves are readily available.
Cochrane 2003, cabbage leaves and other vegetable substances on the breast did not show greater comfort than the placebos
A study by a group of nurses in Sweden (1998) did find that for women who had lost a baby, breast binding served as a concrete reality of the loss and aided in the grieving process.
More recent study (2003) found the women with bound breasts had more leakage, more pain, and needed more pain medication than the non-bound group.
Removing just enough milk to reduce the pressure in the breasts, but not enough to empty them, will gradually diminish milk production without excessive discomfort for the mother
Warm showers will help induce milk leakage and reduce pressure
With regards to pharmacological analgesia, evidence for engorgement suggests NSAIDs are effective if not contraindicated

References:

ASK DIS