The suppression of lactation by stilbestrol

THE

SUPPRESSION (From

OF LACTATION

BY

STILBESTROL”

CRAIG W. ~\~ucKL~, M.D., PHILADELPHIA, Pennsyltxnin Hospital, Philnddphin Lybg-In

PA.

the

Hospital)

NHIEiITION or suppression of lactat.ion in the puerperium is frequently necessary. This procedure is usually ‘prolonged, painful, and occasionally is difficult to accomplish. Recently we have employed a synthetic estrogenie substance for this purpose with satisfact,ory results. We have administered stilbeshrol orally to 75 puerperal women for the purpose of suppressing or inhibiting lactation. The duration of the pregnancies is shown in Table I. I

TABLE

I.

DDRATION

OF

PREGNAKCIES

O-21 weeks 22-28 weeks 29-37 weeks Over 37 weeks

3 6 9 57 75

Total

The indications Table II. TABLE

for II.

the suppression of la&&on

INDICATIONS

Insufficient lactation Elective Neonatal death Stillbirth Inverted or tender Abnormal milk Bick baby Eclampsia Maternal tuberculosis

FOR SWI~RESSION

are shown in

OF LWTATION 22 19 11 11 6 3 2 1 1

nil)ples

Total

75

The majority of these women were private patients, and the indications listed are those given by the physicians in charge. Insufficient lactation was the reason given most frequently for drying the breasts. A number of t,hese patients were able to provide only from one-half to one ounce at each nursing, but had firm and painful breasts. These women were considered as having “insufficient lactation. ” While such breasts can often be dried by the usual methods without great difficulty, the patients are more comfortable and the period of lactation is shortened if stilbestrol is employed. The number of days following delivery before the administration of stilbestrol was started is shown in Table III. *Read

at

a meeting

of

the

Philadelphia

Obstetrical

133

Society.

March

7, 1910.

--__---

.-_..

4 7 x 14 -, ..I~?-.

_-8,) ; 1:

.._..

An a.rhitrary close of 5 mp. of stilbestrol lry mouth 3 times a c1a.y for a total of six doses was employt~tl. The pat,ients were encouraged to drink liquids freely. Tight 1)reast bintit~rs M cre not employed? laxatives were ordered only fw c*ortstipatioil, ailtl the tiruc-hon.ort:d application of warm ca.mphoratecl toil was omitteivrti a total of 30 mg. of stilbestrol Two other paGents inot ilrwithin thirty-six to forty-eight Hondas. eluded in this series) received 10 trig. three times a dn.y for a total of 60 mg. Only two pa.tients w(‘rt: nauseated, anal these were bot,h on the smaller dosage. 111neither instance! was it. necessary to stop K;o other untoward eficct.s werc~ the adnlinistl,a,tion of the drn~. noted. S1’MXhRY

Stilbestrol has been used in a series of 75 puerperal women for the purpose of inhibiting or suppressing lactation. Five milligrams of stilbest,rol administ,ered three times a day for a tolal of 6 doses .rt’lieved the ljreast engorgement. .an(l decreased or prevented lactation there was a in every case. In 40 per cent of 23 patients followed, secondary recurremac of lactatiotl. This was usually painless and slight in amount. Only 2 patients wt-re nauseatrd in a series of 75 \I’e feel that. the use of stilbestrol is an Gnen receiving stilbestrol. efficient and safe method of suppressing lactation early in the puerperium.

PAYSE We stilbestrol

wish

AND

used

to

STILBESTROL

MUCKLE:

thank in this

Dr. J. A. study.

Morrell

IX of

E.

MESOPAUSAL

R.

Squibb

C

SYMPTOMS Son

for

supplying

135 the

REFEREXCES

Foss,

G. L.,

Anat. 60: 341, 64: 782, 1938. 1928. ‘Winterton,

M. J. 2: 887, 1938. Nelson, IV. 0.: Am. J. and Phillips, P.: Brit. 1937. Rnmos, d. P.. and Colombo, 3.: I>eutsche med. TV&n&r. Stricker, P., and Grueters: Compt. rend. Sac. d. biol. 99: 1978, TF. R., and MacGregor, T. N.: Brit. M. J. 1: 10, 1939.

STILBESTROL

FRANKLIN

IN L.

PAYNE,

THE

TREATMENT SYMPTOMS”

M.D.,

AND

CRAIG

WRIGHT

PHILBDELPHIA,

(From

OF

MENOPAUSAL

MUCK&

M.D.,

PA.

Gynecology, University Of

the Department of Obstetrics and Pennsyluania Medical

School)

T

HE clinical effects of stilbestrol have been reported in more These reports confirm the estrothan one hundred publications. genie properties of the substance but many of them question the safety of its therapeutic administration. Our experience further attests to its clinical effectiveness and casts doubt upon its potentialities of harm, provided it is administered conservatively. We have used stilbestrol by oral administration in a series of 52 patients who were suffering from climacteric symptoms. There were 16 whose treatment was temporarily suspended for a number of weeks, to be resumed later. This enables us to present the results of 68 courses of treatment which varied from one to six months in duration. The patients were classed into three groups, according to the origin of the menopausal symptoms: (1) Those still having menstrual periods. (2) Those with spontaneous menopause. (3) Those with surgical or radiologic menopause. In this study we used the relief of flushes as the criterion of therapeutic effectiveness. Other general and local reactions were noted and recorded. Efforts were made to determine the minimal effective dose and to identify any untoward or toxic reactions. It became apparent quite early that comparatively small doses were adequate. The requirements for relief seemed to vary according to the origin of the menopausal reaction. In the group in whom menstruation had not ceased, although climacteric symptoms had begun, mild doses of 0.1 mg. to 0.3 mg. per day usually were effective. For the spontaneous menopause group, the requirement increased to 1.0 mg. a day. The cases of radiologic or surgical menopause not only presented the most severe symptoms but needed the largest doses, usually requiring from 1.0 to 3.0 mg. a day (Table I). Following an adequate initial dose, symptomatic improvement usually occurred within from four t,o seven days. The duration of treat*Read

at a meeting

of the

Obstetrical

Society

of

Philadelphia,

March

7. 1940.