British Journal of Obstetrics and Gynaecology September 1976. Vol83. pp 679-682
SERUM PROLACTIN AND THE SUPPRESSION OF LACTATION BY
D. WEINSTEIN
M. BEN-DAVID AND
W. Z . POLISHUK Departments of Obstetrics and Gynecology and Pharmacology Hadassah University Hospital and Hebrew University Hadassah Medical School, Jerusalem, Israel
Summary Bromocriptine (2 bromo-a-ergocryptine), stilboestrol, clomiphene citrate, testosterone propionate and a placebo were given to 75 postpartum women for the suppression of puerperal lactation. An additional 15 women who breast-fed their babies served as a control group. Blood samples were taken for the determination of serum prolactin levels by a specific homologous double antibody radioimmunoassay. Concurrently, the clinical effectiveness of the various treatments was assessed. High levels of prolactin were found at the time of delivery. Bromocriptine effectively reduced serum prolactin and prevented lactation ; stilboestrol increased serum prolactin and partially suppressed lactation; clomiphene citrate and testosterone propionate both lowered serum prolactin levels and partially suppressed lactation. The placebo showed almost no effect on serum prolactin. It appeared that bromocriptine was the drug of choice in the suppression of puerperal lactation. similar with respect to age, parity, duration of the last pregnancy and previous experience of lactation. All women wore a simple brassiere. Five ml of blood was obtained from each patient every morning from the time before delivery until the patients were discharged from hospital. In the breast-feeding group the blood samples were obtained 30 minutes after breast-feeding had begun. The serum was frozen and stored at -20 "C until assayed by a homologous radioimmunoassay (Ben-David and Chrambach, 1974). The effectiveness of the treatment was assessed three times daily for five days by recording engorgement of the breast, complaints of pain, tenderness, and milk secretion. Uterine involution and side effects were noted. On the fifth day the responses were graded as good, fair or poor,
PUERPERAL lactation depends on pituitary prolactin, and as we are now able to measure prolactin levels in plasma (Guyda and Friesen, 1971; Ben-David and Chrambach, 1974), it is possible to assess the relation between prolactin, lactation, and treatment for the suppression of lactation. The purpose of this investigation was to compare the effectiveness of a placebo, stilboestrol, clomiphene citrate, testosterone propionate and bromocriptine (2 bromo-a-ergocryptine) in the suppression of lactation and the reduction of serum levels of prolactin. METHODS Ninety healthy puerperal women volunteered for this study: 15 breast-fed their babies; and the 75 others were randomly assigned to one of five treatment groups. All six groups were 679
680
WEINSTEIN, BEN-DAVID AND POLISHUK
Treatment All 15 breast-feeding women fed their babies regularly and did not receive any treatment; they served as a control group. Beginning 8 hours after delivery the remaining 75 women, 5 groups each of 15 women, received at random one of the following medications : placebo, 1 tablet three times daily for 14 days; stilboestrol 5 mg three times daily for 14 days; clomiphene citrate 50 mg twice daily for 14 days; testosterone propionate as a single injection of 75 mg; and bromocriptine 2 . 5 mg twice daily for 14 days. The patients were allowed home after five days and were asked to record symptoms until they were seen at the outpatient clinic six weeks after delivery.
early clinical responses are shown in Table I, and prolactin levels in Figure 1. Prolactin and early responses to treatment Suckling and maternal prolactin levels. Postpartum suckling raised the serum prolactin levels to more than twice the basal, pre-delivery, value: 622&23 ng/ml after four days of nursing (p
SERUM PROLACTIN AND THE SUPPRESSION OF LACTATION BY
D. WEINSTEIN
M. BEN-DAVID AND
W. Z . POLISHUK Departments of Obstetrics and Gynecology and Pharmacology Hadassah University Hospital and Hebrew University Hadassah Medical School, Jerusalem, Israel
Summary Bromocriptine (2 bromo-a-ergocryptine), stilboestrol, clomiphene citrate, testosterone propionate and a placebo were given to 75 postpartum women for the suppression of puerperal lactation. An additional 15 women who breast-fed their babies served as a control group. Blood samples were taken for the determination of serum prolactin levels by a specific homologous double antibody radioimmunoassay. Concurrently, the clinical effectiveness of the various treatments was assessed. High levels of prolactin were found at the time of delivery. Bromocriptine effectively reduced serum prolactin and prevented lactation ; stilboestrol increased serum prolactin and partially suppressed lactation; clomiphene citrate and testosterone propionate both lowered serum prolactin levels and partially suppressed lactation. The placebo showed almost no effect on serum prolactin. It appeared that bromocriptine was the drug of choice in the suppression of puerperal lactation. similar with respect to age, parity, duration of the last pregnancy and previous experience of lactation. All women wore a simple brassiere. Five ml of blood was obtained from each patient every morning from the time before delivery until the patients were discharged from hospital. In the breast-feeding group the blood samples were obtained 30 minutes after breast-feeding had begun. The serum was frozen and stored at -20 "C until assayed by a homologous radioimmunoassay (Ben-David and Chrambach, 1974). The effectiveness of the treatment was assessed three times daily for five days by recording engorgement of the breast, complaints of pain, tenderness, and milk secretion. Uterine involution and side effects were noted. On the fifth day the responses were graded as good, fair or poor,
PUERPERAL lactation depends on pituitary prolactin, and as we are now able to measure prolactin levels in plasma (Guyda and Friesen, 1971; Ben-David and Chrambach, 1974), it is possible to assess the relation between prolactin, lactation, and treatment for the suppression of lactation. The purpose of this investigation was to compare the effectiveness of a placebo, stilboestrol, clomiphene citrate, testosterone propionate and bromocriptine (2 bromo-a-ergocryptine) in the suppression of lactation and the reduction of serum levels of prolactin. METHODS Ninety healthy puerperal women volunteered for this study: 15 breast-fed their babies; and the 75 others were randomly assigned to one of five treatment groups. All six groups were 679
680
WEINSTEIN, BEN-DAVID AND POLISHUK
Treatment All 15 breast-feeding women fed their babies regularly and did not receive any treatment; they served as a control group. Beginning 8 hours after delivery the remaining 75 women, 5 groups each of 15 women, received at random one of the following medications : placebo, 1 tablet three times daily for 14 days; stilboestrol 5 mg three times daily for 14 days; clomiphene citrate 50 mg twice daily for 14 days; testosterone propionate as a single injection of 75 mg; and bromocriptine 2 . 5 mg twice daily for 14 days. The patients were allowed home after five days and were asked to record symptoms until they were seen at the outpatient clinic six weeks after delivery.
early clinical responses are shown in Table I, and prolactin levels in Figure 1. Prolactin and early responses to treatment Suckling and maternal prolactin levels. Postpartum suckling raised the serum prolactin levels to more than twice the basal, pre-delivery, value: 622&23 ng/ml after four days of nursing (p
