Decreasing a large milk supply

How do I decrease my large milk supply?

There are several ways to decrease a large milk supply, including “block feeding,” contraceptives, decongestants, and other medication. With block feeding, mothers limit the baby to one breast for at least three hours over one or more days. That allows the other breast to become very full, which eventually decreases production. Consult your health-care provider if you plan to use contraceptives or pseudoephedrine. Some other medications such as lisuride and cabergoline can have side-effects and should probably only be used as a last resort. Herbs including sage, parsley, and peppermint have not been proven effective but are likely safe. 

A) Describing reducing a large milk supply

Some mothers with a large milk supply find that decreasing their milk production reduces some breast problems. During and after any attempt to decrease your supply, make sure your baby is growing well.

The options for decreasing milk supply are:

Consult your health-care providers for more information about medication use and safety. 

Mothers should not decrease their milk supply for the following reasons:

  • Green stools, which are normal when a mother has a large milk supply
  • Hindmilk-foremilk concerns
  • Choking at the breast, which is normal and can be managed in other ways
  • Tummy cramps or gas in the baby, which are normal and can be managed in other ways

B) Block feeding

Block feeding is the practice of limiting the baby to one breast for three or more hours over one or more days. This allows the other breast to become very full during this time, which eventually causes the milk supply to decrease. It produces an outcome similar to skipping a feed and not expressing.

In one study, several women needed block times of 3 to 12 hours along with expressing up to one time each day to fully empty the breast at the start of the process and manage very over-full breasts (van Veldhuizen-Staas 2007).

If you wish to try block feeding:

  • Consider emptying the breasts by expressing before the start of block feeding.
  • Start with three-hour blocks continually for one whole day before resuming your previous pattern.
  • You should start to feel less full by the third day.
  • If this does not work, try two and then three days of block feeding.
  • Some mothers may choose to use longer blocks.
  • You can express a small amount for comfort if your non-breastfeeding side feels too full.

Block feeding may at first increase your risk of other breast problems.

There is little research on the subject.

C) Combination contraceptives

If you choose combination contraceptives, you should notice a decrease in your milk supply within the first week but it may take two to six weeks until you are satisfied with the effect.

Stop the medication once your milk supply has reached the desired level. You may have a light period after stopping your pills.

Once the supply is reduced, it does not generally increase.

Oral contraceptives should not be used if you are over the age of 35 or smoking 15 or more cigarettes a day. Other reasons for not using oral contraceptives include (Bonnema 2010):

  • High blood pressure (hypertension)
  • Previous blood clots
  • Heart disease
  • A history or risk of stroke
  • Certain types of migraine
  • Liver cirrhosis, tumours, or other disease
  • Diabetes with complications
  • Lupus with antiphospholipid antibodies
  • Previous reactions to combination birth control pills

D) Decongestants

Pseudoephedrine, an over-the-counter cold remedy, has been shown to decrease breast milk after only one dose (Aljazaf 2003). The effect is generally temporary if just one dose is taken. The effect may last longer if the drug is taken for several days.

This medication is a decongestant and works by narrowing blood vessels in the nose, thereby reducing the ability of the nasal lining to make secretions. However, its actions are not limited to the nose.

Pseudoephedrine is a stimulant and can cause:  

  • Nervous stimulation (nervousness, excitability, dizziness, insomnia, seizures, stroke)
  • Major mental health effects (psychosis) when combined with other drugs
  • Heart-racing or irregular heartbeat
  • High blood pressure

It should not be combined with some drugs, including certain antidepressants and other stimulant drugs. It should not be used if you have:

Pseudoephedrine should not be used as a medication by children under the age of six, but the amount of pseudoephedrine in breast milk is low, about 4% of the mother’s dose (Aljazaf 2003; Health Canada 2016). Still, there have been reports of babies being irritable after the mother has taken pseudoephedrine. Researchers have recommended against its use while breastfeeding (Soussan 2014).

Please work with your health-care providers if you choose to use pseudoephedrine. It can be prepared with different doses and is available in short- or long-acting forms. Avoid preparations that contain other ingredients, such as pain-relievers. Follow the directions on the package and consider starting with lower doses to avoid or minimize side-effects.

E) Other medication and herbs

Peppermint, sage, and parsley are said to reduce breast milk production, but no research has confirmed their effectiveness (Eglash 2014). 

The main ingredient in peppermint is menthol. Interestingly, a study (Suzuki 2020) of mouse milk-producing cells showed that menthol blocked milk production. Peppermint can be taken as a candy (e.g. Altoids) or in capsule form (e.g. IBgard).  

Sage is taken as a tea: one cup three times each day and is prepared by steeping 5 ml (1 tsp) in 250 ml (1 cup) of hot water for 5 minutes. 

Parsley is eaten as a food, as in tabouli salad.

Medications intended to stop milk production, such as lisuride and cabergoline, can have side-effects and should be used only as a last resort (Oladapo 2012). Low doses used over a short period should also be used to limit the severity of any side-effects.

Bromocriptine is no longer recommended for this purpose.

References

Aljazaf K, Hale TW, Ilett KF, et al. Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol. 2003 Jul;56(1):18-24
 
Bonnema RA, McNamara MC, Spencer AL. Contraception choices in women with underlying medical conditions. Am Fam Physician. 2010 Sep 15;82(6):621-8
 
Eglash A. Treatment of maternal hypergalactia. Breastfeed Med. 2014 Nov;9(9):423-5
 
Health Canada, Recalls and Alerts. Health Canada reminds parents not to give cough and cold medication to children under 6 years old. Ottawa: Health Canada; 2016 Mar 24 [cited 2017 Sep 17]
 
Oladapo OT, Fawole B. Treatments for suppression of lactation. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD005937
 
Soussan C, Gouraud A, Portolan G, et al. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014 Nov;70(11):1361-6

Suzuki N, Tsugami Y, Wakasa H, et al. Menthol from Mentha Piperita Suppresses the Milk Production of Lactating Mammary Epithelial Cells In Vivo and In Vitro. Mol Nutr Food Res. 2020 Nov 14:e2000853

van Veldhuizen-Staas CG. Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeed J. 2007 Aug 29;2:11