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'Risk of bias' graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 1

'Risk of bias' graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgments about each risk of bias item for each included study.
Figures and Tables -
Figure 2

'Risk of bias' summary: review authors' judgments about each risk of bias item for each included study.

Comparison 1 Ergot derivatives versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum.
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Analysis 1.1

Comparison 1 Ergot derivatives versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum.

Comparison 1 Ergot derivatives versus placebo, Outcome 2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days.
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Analysis 1.2

Comparison 1 Ergot derivatives versus placebo, Outcome 2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days.

Comparison 1 Ergot derivatives versus placebo, Outcome 3 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days.
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Analysis 1.3

Comparison 1 Ergot derivatives versus placebo, Outcome 3 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days.

Comparison 1 Ergot derivatives versus placebo, Outcome 4 Rebound lactation.
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Analysis 1.4

Comparison 1 Ergot derivatives versus placebo, Outcome 4 Rebound lactation.

Comparison 2 Oestrogen preparations versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.
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Analysis 2.1

Comparison 2 Oestrogen preparations versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.

Comparison 2 Oestrogen preparations versus placebo, Outcome 2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days.
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Analysis 2.2

Comparison 2 Oestrogen preparations versus placebo, Outcome 2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days.

Comparison 3 Antioestrogen preparations versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.
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Analysis 3.1

Comparison 3 Antioestrogen preparations versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.

Comparison 3 Antioestrogen preparations versus placebo, Outcome 2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days.
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Analysis 3.2

Comparison 3 Antioestrogen preparations versus placebo, Outcome 2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days.

Comparison 4 Pyridoxine versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.
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Analysis 4.1

Comparison 4 Pyridoxine versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.

Comparison 5 Combined oestrogen and androgen preparations versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.
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Analysis 5.1

Comparison 5 Combined oestrogen and androgen preparations versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.

Comparison 6 Androgen preparations versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.
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Analysis 6.1

Comparison 6 Androgen preparations versus placebo, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days.

Comparison 7 Pharmacologic treatment versus nonpharmacologic treatment, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain.
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Analysis 7.1

Comparison 7 Pharmacologic treatment versus nonpharmacologic treatment, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain.

Comparison 7 Pharmacologic treatment versus nonpharmacologic treatment, Outcome 2 Rebound lactation.
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Analysis 7.2

Comparison 7 Pharmacologic treatment versus nonpharmacologic treatment, Outcome 2 Rebound lactation.

Comparison 8 Comparison of two pharmacologic treatments, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum.
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Analysis 8.1

Comparison 8 Comparison of two pharmacologic treatments, Outcome 1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum.

Comparison 8 Comparison of two pharmacologic treatments, Outcome 2 Rebound lactation.
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Analysis 8.2

Comparison 8 Comparison of two pharmacologic treatments, Outcome 2 Rebound lactation.

Comparison 8 Comparison of two pharmacologic treatments, Outcome 3 Use of second line drug or method to achieve suppression of lactation.
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Analysis 8.3

Comparison 8 Comparison of two pharmacologic treatments, Outcome 3 Use of second line drug or method to achieve suppression of lactation.

Comparison 8 Comparison of two pharmacologic treatments, Outcome 4 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤14 days.
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Analysis 8.4

Comparison 8 Comparison of two pharmacologic treatments, Outcome 4 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤14 days.

Comparison 9 High versus low dose quinestrol, Outcome 1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum.
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Analysis 9.1

Comparison 9 High versus low dose quinestrol, Outcome 1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum.

Comparison 10 Low versus high dose terguride, Outcome 1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at days 0 ‐15.
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Analysis 10.1

Comparison 10 Low versus high dose terguride, Outcome 1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at days 0 ‐15.

Comparison 10 Low versus high dose terguride, Outcome 2 Side effect: dizziness.
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Analysis 10.2

Comparison 10 Low versus high dose terguride, Outcome 2 Side effect: dizziness.

Comparison 11 High versus low dose cabergoline, Outcome 1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain.
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Analysis 11.1

Comparison 11 High versus low dose cabergoline, Outcome 1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain.

Comparison 12 Long course tamoxifen versus short course tamoxifen, Outcome 1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at D0‐15.
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Analysis 12.1

Comparison 12 Long course tamoxifen versus short course tamoxifen, Outcome 1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at D0‐15.

Comparison 1. Ergot derivatives versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum Show forest plot

3

107

Risk Ratio (IV, Fixed, 95% CI)

0.36 [0.24, 0.54]

1.1 Bromocriptine versus placebo

3

107

Risk Ratio (IV, Fixed, 95% CI)

0.36 [0.24, 0.54]

2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days Show forest plot

2

76

Risk Ratio (IV, Random, 95% CI)

0.18 [0.03, 1.08]

2.1 Bromocriptine versus placebo

2

76

Risk Ratio (IV, Random, 95% CI)

0.18 [0.03, 1.08]

3 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days Show forest plot

1

32

Risk Ratio (IV, Fixed, 95% CI)

0.19 [0.07, 0.48]

3.1 Cabergoline versus placebo

1

32

Risk Ratio (IV, Fixed, 95% CI)

0.19 [0.07, 0.48]

4 Rebound lactation Show forest plot

1

40

Risk Ratio (IV, Fixed, 95% CI)

15.26 [1.01, 231.20]

Figures and Tables -
Comparison 1. Ergot derivatives versus placebo
Comparison 2. Oestrogen preparations versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days Show forest plot

7

971

Risk Ratio (IV, Random, 95% CI)

0.40 [0.29, 0.56]

1.1 Diethylstilbestrol versus placebo

4

376

Risk Ratio (IV, Random, 95% CI)

0.33 [0.12, 0.89]

1.2 Quinestrol versus placebo

3

342

Risk Ratio (IV, Random, 95% CI)

0.47 [0.30, 0.73]

1.3 Chlorotrianisene versus placebo

1

153

Risk Ratio (IV, Random, 95% CI)

0.51 [0.36, 0.73]

1.4 Hexestrol versus placebo

1

100

Risk Ratio (IV, Random, 95% CI)

0.41 [0.29, 0.57]

2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days Show forest plot

2

103

Risk Ratio (IV, Random, 95% CI)

0.19 [0.03, 1.34]

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Comparison 2. Oestrogen preparations versus placebo
Comparison 3. Antioestrogen preparations versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days Show forest plot

1

30

Risk Ratio (IV, Fixed, 95% CI)

1.0 [0.51, 1.95]

1.1 Clomiphene versus placebo

1

30

Risk Ratio (IV, Fixed, 95% CI)

1.0 [0.51, 1.95]

2 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 14 days Show forest plot

1

140

Risk Ratio (IV, Fixed, 95% CI)

0.71 [0.62, 0.82]

2.1 Tamoxifen versus placebo

1

140

Risk Ratio (IV, Fixed, 95% CI)

0.71 [0.62, 0.82]

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Comparison 3. Antioestrogen preparations versus placebo
Comparison 4. Pyridoxine versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days Show forest plot

2

258

Risk Ratio (IV, Fixed, 95% CI)

0.98 [0.89, 1.09]

1.1 Pyridoxine versus placebo

2

258

Risk Ratio (IV, Fixed, 95% CI)

0.98 [0.89, 1.09]

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Comparison 4. Pyridoxine versus placebo
Comparison 5. Combined oestrogen and androgen preparations versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days Show forest plot

3

436

Risk Ratio (IV, Fixed, 95% CI)

0.15 [0.10, 0.22]

1.1 Testosterone oenanthate + oestradiol valerate

3

436

Risk Ratio (IV, Fixed, 95% CI)

0.15 [0.10, 0.22]

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Comparison 5. Combined oestrogen and androgen preparations versus placebo
Comparison 6. Androgen preparations versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days Show forest plot

1

30

Risk Ratio (IV, Fixed, 95% CI)

1.13 [0.60, 2.11]

1.1 Testosterone propionate versus placebo

1

30

Risk Ratio (IV, Fixed, 95% CI)

1.13 [0.60, 2.11]

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Comparison 6. Androgen preparations versus placebo
Comparison 7. Pharmacologic treatment versus nonpharmacologic treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain Show forest plot

2

Risk Ratio (IV, Random, 95% CI)

Subtotals only

1.1 Bromocriptine versus any nonpharmacologic treatment

2

96

Risk Ratio (IV, Random, 95% CI)

0.31 [0.16, 0.61]

1.2 DIethylstibestrol versus any nonpharmacologic treatment

1

36

Risk Ratio (IV, Random, 95% CI)

0.19 [0.07, 0.49]

1.3 Oestradiol + testosterone esters versus any non pharmacologic treatment

1

36

Risk Ratio (IV, Random, 95% CI)

0.46 [0.28, 0.76]

1.4 Bendrofluazide versus any nonpharmacologic treatment

1

36

Risk Ratio (IV, Random, 95% CI)

0.68 [0.48, 0.94]

2 Rebound lactation Show forest plot

1

60

Risk Ratio (IV, Fixed, 95% CI)

5.0 [0.25, 99.95]

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Comparison 7. Pharmacologic treatment versus nonpharmacologic treatment
Comparison 8. Comparison of two pharmacologic treatments

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum Show forest plot

12

Risk Ratio (IV, Random, 95% CI)

Subtotals only

1.1 Bromocriptine versus oestrogen preparations

4

340

Risk Ratio (IV, Random, 95% CI)

0.58 [0.25, 1.38]

1.2 Bromocriptine versus ergot derivative

3

228

Risk Ratio (IV, Random, 95% CI)

1.12 [0.37, 3.42]

1.3 Bromocriptine versus prostaglandins

1

43

Risk Ratio (IV, Random, 95% CI)

0.55 [0.19, 1.60]

1.4 Bromocriptine versus pyridoxine

1

97

Risk Ratio (IV, Random, 95% CI)

0.93 [0.75, 1.15]

1.5 Quinestrol versus other oestrogen preparations

3

208

Risk Ratio (IV, Random, 95% CI)

0.68 [0.32, 1.44]

2 Rebound lactation Show forest plot

4

149

Risk Ratio (IV, Fixed, 95% CI)

0.65 [0.39, 1.10]

2.1 Bromocriptine versus oestrogen preparations

2

67

Risk Ratio (IV, Fixed, 95% CI)

0.61 [0.34, 1.07]

2.2 Bromocriptine versus ergot derivative

1

39

Risk Ratio (IV, Fixed, 95% CI)

2.11 [0.43, 10.19]

2.3 Bromocriptine versus prostaglandins

1

43

Risk Ratio (IV, Fixed, 95% CI)

0.24 [0.03, 1.96]

3 Use of second line drug or method to achieve suppression of lactation Show forest plot

3

Risk Ratio (IV, Fixed, 95% CI)

Subtotals only

3.1 Bromocriptine versus oestrogen preparations

1

31

Risk Ratio (IV, Fixed, 95% CI)

0.31 [0.01, 7.15]

3.2 Bromocriptine versus ergot derivatives

1

40

Risk Ratio (IV, Fixed, 95% CI)

2.67 [0.82, 8.62]

3.3 Bromocriptine versus pyridoxine

1

97

Risk Ratio (IV, Fixed, 95% CI)

0.07 [0.01, 0.51]

4 Failure to suppress lactation as indicated by milk secretion, breast engorgement or breast pain at ≤14 days Show forest plot

6

Risk Ratio (IV, Random, 95% CI)

Subtotals only

4.1 Bromocriptine versus carbegoline

2

308

Risk Ratio (IV, Random, 95% CI)

1.38 [0.93, 2.05]

4.2 Bromocriptine versus diethylstilbestrol

1

38

Risk Ratio (IV, Random, 95% CI)

0.30 [0.07, 1.30]

4.3 Bromocriptine versus cyclofenil

1

24

Risk Ratio (IV, Random, 95% CI)

3.5 [0.16, 78.19]

4.4 Bromocriptine versus chlorotrianisene

1

39

Risk Ratio (IV, Random, 95% CI)

0.35 [0.19, 0.66]

4.5 Quinestrol versus other oestrogen preparations

1

99

Risk Ratio (IV, Random, 95% CI)

2.84 [1.56, 5.18]

Figures and Tables -
Comparison 8. Comparison of two pharmacologic treatments
Comparison 9. High versus low dose quinestrol

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at ≤ 7 days postpartum Show forest plot

1

132

Risk Ratio (IV, Fixed, 95% CI)

0.51 [0.33, 0.81]

1.1 Quinestrol 4 mg versus Quinestrol 2 mg

1

132

Risk Ratio (IV, Fixed, 95% CI)

0.51 [0.33, 0.81]

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Comparison 9. High versus low dose quinestrol
Comparison 10. Low versus high dose terguride

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at days 0 ‐15 Show forest plot

1

45

Risk Ratio (IV, Fixed, 95% CI)

0.5 [0.29, 0.88]

1.1 Terguride 0.5‐1.0 mg vs terguride 0.25 mg

1

45

Risk Ratio (IV, Fixed, 95% CI)

0.5 [0.29, 0.88]

2 Side effect: dizziness Show forest plot

1

45

Risk Ratio (IV, Fixed, 95% CI)

1.55 [0.07, 35.89]

2.1 Terguride 0.5‐1.0 mg vs terguride 0.25 mg

1

45

Risk Ratio (IV, Fixed, 95% CI)

1.55 [0.07, 35.89]

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Comparison 10. Low versus high dose terguride
Comparison 11. High versus low dose cabergoline

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain Show forest plot

1

80

Risk Ratio (IV, Fixed, 95% CI)

0.14 [0.03, 0.59]

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Comparison 11. High versus low dose cabergoline
Comparison 12. Long course tamoxifen versus short course tamoxifen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure to suppress lactation as described by milk secretion, breast engorgement or breast pain at D0‐15 Show forest plot

1

65

Risk Ratio (IV, Fixed, 95% CI)

0.75 [0.61, 0.92]

1.1 Tamoxifen (14 days course) vs tamoxifen (6 days course)

1

65

Risk Ratio (IV, Fixed, 95% CI)

0.75 [0.61, 0.92]

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Comparison 12. Long course tamoxifen versus short course tamoxifen