Podcast: Treatment for breast engorgement (overfull, hard, painful breasts) in breastfeeding women

Many women who are breastfeeding experience breast engorgement and this can be a very distressing condition.  Several possible treatments are known. The evidence for these were brought together in a third update to the relevant Cochrane Review in September 2020. The two authors, Irena Zakarija-Grković from Cochrane Croatia, based at the University of Split School of Medicine, and Fiona Stewart from the University of Liverpool in the UK talk about their findings in this podcast, starting with Fiona.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Many women who are breastfeeding experience breast engorgement and this can be a very distressing condition.  Several possible treatments are known. The evidence for these were brought together in a third update to the relevant Cochrane Review in September 2020. The two authors, Irena Zakarija-Grković from Cochrane Croatia, based at the University of Split School of Medicine, and Fiona Stewart from the University of Liverpool in the UK talk about their findings in this podcast, starting with Fiona.

Fiona: Hello Irena. First of all, could you tell us a little about what breast engorgement is and why it's such a problem?

Irena: Hello Fiona. Breast engorgement is a painful condition that affects a lot of breastfeeding women, especially in the first few weeks. Their breasts don't get emptied properly and become overfull, usually when they're separated from their babies or when the timing and duration of breastfeeds is restricted or their babies are having difficulty sucking. As a result, the breasts become lumpy, hard and painful, making breastfeeding really difficult. This can lead to sore nipples, breast inflammation, and a fall in the mother's milk supply.

Fiona: It's clearly important then to find interventions to ease these symptoms but are there other reasons for treating breast engorgement?

Irena:  Apart from being a painful condition, women with breast engorgement often stop breastfeeding earlier than they originally planned. This can have negative repercussions not only on the health of the baby but on the mother's health as well. That's why it's important to find a way to treat breast engorgement so that women can feed comfortably, for as long as they would like to. 

Fiona: In the previous version of the review, back in 2015, there were nine studies in the review. What was available for this 2020 update?

Irena: We now have 21 clinical trials in the review, which involved just over 2000 women and a variety of treatments for breast engorgement. At least six different types of treatments have been tested, including medicines, massage therapy and hot or cold compresses. Some of these treatments were compared to routine care and some were compared to other treatments.

Fiona: What do the trials tell us about how well these treatments work?

Irena: It's difficult to summarise because there are so many comparisons but if I focus just on breast pain for the moment, we can say that cold cabbage leaves might be better than routine care or cold gel packs; herbal compress might be better than hot compress; massage therapy plus cactus and aloe compress may be better than just massage therapy alone; and the medicine protease may be better than placebo, although this medicine is rarely used nowadays.

Fiona: That sounds promising. What about the effects on other symptoms of breast engorgement?

Irena: For breast hardness, cold cabbage leaves might work well compared with either routine care or cold gel packs, while cold gel packs may be better than routine care. And, a combination of cold cactus and aloe compress plus massage therapy may be better than either on their own. However, for other treatments, such as room temperature cabbage leaves, ultrasound treatment, Gua-Sha therapy, and the medicines serrapeptase and oxytocin, the evidence about their effects on breast pain and hardness is just too uncertain because of the way the trials were designed and because they didn't include enough women.

Fiona: Is there anything we should know about the potential harms of the treatments?

Irena: Although most of the treatments, such as cabbage leaves and hot and cold compresses, seem unlikely to cause harm, the trial reports tended not to say one way or the other if women experienced any negative effects. So, at the moment, we simply can't be sure if they might be harmful. The only details we found about potential harms were for protease and serrapeptase, with none of the women in those studies having adverse events, and for hot herbal compresses where a very small number of women had skin irritation, which tended to resolve within 24 hours.

Fiona: Overall then, what's your take-home message about treatments for breast engorgement and how can people find out more about them?

Irena: My summary would be that although some of these treatments may help reduce pain and hardness caused by breast engorgement, the evidence in general is still very uncertain. This is disappointing and we really need future trials to recruit higher numbers of women so we can get a better idea of what works and what doesn't. While we wait for that evidence, the current review is available online. If people go to Cochrane Library dot com and type 'breast engorgement' in the search box, they'll see our review at the top of the list.

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