How do I stop milk supply postpartum?

From the Guidelines

To stop milk supply postpartum, the most effective approach is to use a dopamine agonist such as cabergoline, which suppresses prolactin production, although it is not mentioned in the provided studies, clonidine may reduce prolactin secretion and therefore could conceivably reduce milk production in the early postpartum period, as noted in the study by 1. The use of clonidine, as mentioned in the study by 1, may be considered as it is minimally secreted into milk and has no reports of neonatal toxicity during breastfeeding. Other methods to reduce milk production include physical techniques such as:

• Avoiding breast stimulation
• Wearing a supportive bra continuously
• Applying cold compresses to breasts for 15-20 minutes several times daily
• Avoiding expressing milk which signals your body to produce more
• Using cabbage leaves placed inside your bra and replaced when wilted to provide relief from engorgement
• Drinking sage tea (1-3 cups daily) which may help reduce milk production through natural estrogen-like effects It is essential to note that bromocriptine, a drug that blocks the release of prolactin, has been suggested as a potential therapeutic intervention for peripartum cardiomyopathy, as mentioned in the study by 1, but its use for stopping milk supply postpartum is not directly addressed in the provided studies. Regardless of the method chosen, expect some initial engorgement and discomfort as your body adjusts, and complete cessation of milk production typically occurs within 7-10 days, if you experience severe pain, redness, fever, or hard lumps in your breasts, consult a healthcare provider as these may indicate mastitis, which requires medical treatment.

From the FDA Drug Label

In rats, doses higher than 0.003 mg/kg/day (approximately 1/28 the maximum recommended human dose) from 6 days before parturition and throughout the lactation period inhibited growth and caused death of offspring due to decreased milk secretion. Use of cabergoline for the inhibition or suppression of physiologic lactation is not recommended (see PRECAUTIONS section). The prolactin-lowering action of cabergoline suggests that it will interfere with lactation.

Stopping milk supply postpartum can be achieved with cabergoline as it has a prolactin-lowering action that interferes with lactation. However, its use for this purpose is not recommended.

• The recommended dose for this use is not established.
• Side effects such as decreased milk secretion have been observed in animal studies 2.

Although a causal relationship between bromocriptine mesylate administration and hypertension, seizures, strokes, and myocardial infarction in postpartum women has not been established, use of the drug for prevention of physiological lactation, or in patients with uncontrolled hypertension is not recommended

Bromocriptine is also not recommended for stopping milk supply postpartum due to potential serious side effects such as hypertension, seizures, strokes, and myocardial infarction 3.

From the Research

Stopping Milk Supply Postpartum

To stop milk supply postpartum, several methods can be considered, including:

• Medications such as cabergoline, which has been shown to be effective in inhibiting lactation 4, 5, 6, 7
• Non-pharmacological methods, although there is limited research on their effectiveness in completely stopping milk supply

Medications for Lactation Inhibition

Cabergoline is a dopamine agonist that has been studied for its use in lactation inhibition. The evidence suggests that:

• A single oral dose of 1 mg cabergoline is effective in inhibiting lactation in postpartum women 4, 5, 6
• Cabergoline is non-inferior to bromocriptine for lactation inhibition and has fewer rebound symptoms and adverse effects 4, 5
• Common adverse effects of cabergoline include dizziness, headache, and nausea, but are self-limited 4, 6

Specific Situations

In certain situations, such as for women living with HIV, cabergoline has been shown to be a safe and effective option for lactation inhibition 6. Additionally, cabergoline has been studied for its use in preventing breast symptoms after second-trimester abortion or pregnancy loss, and has been found to be effective in decreasing breast symptoms 7.

Other Considerations

It's worth noting that insufficient milk supply can be secondary to various maternal or infant factors, and frequent, regular milk removal can help increase milk supply 8. However, this is more relevant to women who are trying to establish or maintain milk supply, rather than stop it.