How to suppress lactation in a postpartum woman who does not intend to breastfeed?

From the Guidelines

To suppress lactation in a postpartum woman who does not intend to breastfeed, the most effective approach is to avoid breast stimulation and milk expression, and consider the use of medications such as cabergoline or diuretics, with cabergoline being the most commonly prescribed medication for this purpose, as evidenced by the fact that diuretics can suppress lactation, but may require neonatal follow-up 1. The body naturally reduces milk production when milk isn't removed, so wearing a supportive bra (not too tight) 24 hours a day until the discomfort subsides, and using cold compresses applied to the breasts for 15-20 minutes several times daily can help reduce inflammation and discomfort. For pain relief, over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (650-1000mg every 6 hours) can help with both pain and inflammation. Cabbage leaves placed in the bra and replaced when wilted may also provide relief. In cases of severe engorgement, minimal hand expression just enough to relieve discomfort is acceptable. Avoid heat applications, as they can increase blood flow and worsen engorgement. Most women experience significant reduction in milk production within 7-10 days using these methods. The body stops producing milk through a natural feedback mechanism - when milk isn't removed, pressure builds in the breasts, signaling cells to stop production. Clonidine may also reduce prolactin secretion and therefore could conceivably reduce milk production in the early postpartum period, as it is minimally secreted into milk 1. However, cabergoline is generally the preferred medication for suppressing lactation due to its efficacy and safety profile. It is essential to note that while bromocriptine has been studied for its potential to improve LVEF recovery in women with acute peripartum cardiomyopathy, its use for suppressing lactation is not typically recommended due to potential hypercoagulability and the need for prophylactic-dosed anticoagulation 1.

From the FDA Drug Label

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. Due to this interference with lactation, cabergoline should not be given to women postpartum who are breastfeeding or who are planning to breastfeed Cabergoline is not indicated for the inhibition or suppression of physiologic lactation Use of bromocriptine, another dopamine agonist for this purpose, has been associated with cases of hypertension, stroke, and seizures.

Cabergoline is not recommended for suppressing lactation in a postpartum woman who does not intend to breastfeed, as it is not indicated for this purpose and its use has been associated with serious adverse effects in other dopamine agonists 2 2.

From the Research

Suppression of Lactation

To suppress lactation in a postpartum woman who does not intend to breastfeed, the following methods can be considered:

• Cabergoline, a synthetic ergoline, has been shown to be effective in inhibiting prolactin secretion and suppressing lactation 3, 4.
• A single dose of cabergoline 1.0mg has been found to be as effective as bromocriptine 2.5mg twice daily for 14 days in preventing puerperal lactation 3.
• Cabergoline 0.25mg twice daily for 2 days has been shown to be effective in suppressing established puerperal lactation in about 85% of women 3.
• It is essential to provide emotional support and education to the mother on what to expect and how to manage the discontinuation of milk production to make the process smoother and more comfortable 5.

Comparison with Other Methods

• Cabergoline has been found to be more effective and better tolerated than bromocriptine in the prevention and suppression of puerperal lactation 3, 4.
• The use of bromocriptine has been associated with an increased risk of serious thromboembolic events, whereas there are no such reports with cabergoline 3.

Considerations

• The mother should be educated on how to provide self-care and manage the discontinuation of milk production to prevent engorgement and mastitis 5.
• The emotional support of the grieving process, particularly in cases of infant loss, is crucial, and resources should be offered to the bereaved family 5.