From the Guidelines
Estrogen should not be used to stop lactation due to safety concerns and the availability of safer alternatives. When considering the cessation of lactation, it is crucial to prioritize methods that minimize risks to the mother's health. Historically, estrogen was considered for lactation suppression, but its use has been largely discontinued due to significant safety concerns, including an increased risk of venous thromboembolism, particularly in postpartum women 1.
Alternatives to Estrogen for Lactation Suppression
Instead of estrogen, several safer alternatives are now recommended for suppressing lactation. These include:
- Wearing a supportive bra to help reduce breast engorgement
- Applying cold compresses to alleviate discomfort
- Avoiding breast stimulation to decrease prolactin release
- Taking pain relievers like ibuprofen (400-600mg every 6 hours) for discomfort management
- Using dopamine agonists such as cabergoline (a single 1mg dose) or bromocriptine (2.5mg twice daily for 14 days), which directly inhibit prolactin secretion and are more effective and safer than estrogen therapy, as suggested by recent understandings of lactation physiology and the role of prolactin inhibitors like bromocriptine in conditions related to prolactin dysregulation 1.
Recommendation
Given the potential risks associated with estrogen therapy and the effectiveness of safer alternatives, women requiring lactation suppression should discuss these modern options with a healthcare provider. The choice of lactation suppression method should be based on the latest clinical guidelines and the individual's health status, prioritizing safety and efficacy. In the context of peripartum cardiomyopathy, for instance, the use of bromocriptine to block prolactin release has been proposed as a therapeutic intervention based on its pathophysiological role 1, highlighting the importance of tailored approaches to lactation management.
From the Research
Estrogen and Lactation Suppression
- Estrogen can be used to stop lactation, as suggested by studies 2, 3, 4
- The use of estrogen preparations, such as diethylstilbestrol, quinestrol, chlorotrianisene, and hexestrol, has been shown to significantly reduce the proportion of lactating women compared to no treatment at or within seven days postpartum 2
- However, the use of estrogen alone or in combination with an androgen for lactation suppression has been associated with an increased incidence of postpartum thromboembolic disease 3, 4
- Estrogen has been found to delay rather than prevent breast engorgement, and its use for lactation suppression may not be entirely effective 3
Safety and Efficacy of Estrogen for Lactation Suppression
- The safety and efficacy of estrogen for lactation suppression are not well established, and its use may be accompanied by significant side effects, including thromboembolic disease 3, 4, 5
- The use of estrogen for lactation suppression may not be recommended due to the potential risks and limited benefits 3, 4
- Alternative methods for lactation suppression, such as the use of bromocriptine or nonpharmacologic approaches, may be considered 2, 4
Hormonal Contraception and Lactation
- Hormonal contraceptive measures, including estrogen-containing methods, can affect lactation and milk volume 6
- Progestin-only contraceptives are preferable to estrogen-containing methods for lactation suppression and do not appear to affect milk volume or composition 6
- The use of estrogen-containing contraceptives may decrease milk volume, but no detrimental effects have been shown on infant growth or development 6