Do not use drugs to prevent onset of lactation. Relieve the discomfort and wait.

Prescrire international 2013 Jul

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Breast-feeding is not advisable in certain situations and some women do not want to breast-feed. If the woman does not breast-feed, lactation ceases after one or two weeks. Where does the evaluation of methods used to prevent onset of lactation stand in 2012? To answer this question, we reviewed the available evidence, based on the standard Prescrire methodology. Among the physical methods sometimes proposed, breast binding causes greater discomfort than wearing a bra. Dopamine agonists, such as bromocriptine, are effective in inhibiting lactation. But the serious, mainly cardiovascular, adverse effects they provoke are disproportionate to the discomfort they prevent.These drugs are best avoided. High doses of oestrogens inhibit lactation, but the risk of thromboembolism they pose is unreasonable in the postpartum setting. Neither diuretics nor homeopathy have been shown to have any tangible efficacy against the discomfort associated with onset of lactation. In practice, a standard analgesic such as paracetamol generally eases the few days of discomfort or pain associated with the onset of lactation. Wearing a bra is risk-free and sometimes provides relief. Breast discomfort, however intense, does not justify exposing women to the serious adverse effects linked to postpartum administration of dopamine agonists or oestrogens.