Puerperal lactation is regulated by a complex system of hormones, including in particular prolactin. Prevention of lactation is in a few instances necessary on medical grounds, although far more often inhibition of lactation is carried out because the mother does not want to nurse.
Several methods to prevent puerperal lactation have been developed. Bromocriptine blocks pituitary prolactin release which results in a sharp decline of plasma prolactin. In puerperal women. normoprolactinaemia is reached within 24 to 48 hours after initiation of bromocriptine treatment. At the same time initiation of lactation is blocked almost completely with no engorgement or pain of the breasts. In all studies which compared this compound with other methods of lactation prevention, it was concluded that bromocriptine was clearly a superior and more specific inhibitor of lactation. It is also effective in the suppression of already established lactation. The optimal dosage schedule for the inhibition of lactation is 2.5mg twice daily for the first 2 weeks after delivery. A rebound phenomenon is likely to occur in some women and continuation of the treatment (2.5mg a day) for the third week may be necessary in some instances. Suppression of established lactation can be achieved with 2.5mg daily for 1 week followed by 2.5mg once daily for an additional week. The drug must be taken during meals.
As normoprolactinaemia is reached in puerperal women due to the administration of bromocriptine. normal ovarian function is restored. The first ovulation is likely to occur within 4 weeks after delivery. This effect is comparable to that seen in hyperprolactinaemic. amenorrhoeic women when they are treated with bromocriptine. Therefore suitable contraception advice must be given to patients if bromocriptine is to be used for inhibition of lactation.