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Galactorrhea

Introduction
Signs and symptoms
Causes
Screening and diagnosis
Treatment
Self-care

Galactorrhea is a milky discharge from the nipple not associated with the normal milk production of breast-feeding. It usually occurs from both breasts. Galactorrhea isn't a specific disease but rather a sign of an underlying problem. Although it occurs most often in females, it can affect males.

In females, galactorrhea may be associated with excessive breast stimulation, medication side effects or disorders of the hypothalamus or pituitary glands. In males, it may be associated with erectile dysfunction and a lack of sexual desire due to testosterone deficiency (male hypogonadism). Sometimes the cause of galactorrhea can't be determined. But it often results from increased levels of prolactin, the hormone that stimulates milk production.

Galactorrhea sometimes occurs in newborns. High maternal estrogen levels cross the placenta into the baby's blood. This can cause enlargement of the baby's breast tissue, which may be associated with a milky nipple discharge.

Galactorrhea most commonly affects women ages 20 to 35 who've had at least one previous pregnancy. The hallmark sign of galactorrhea is nipple discharge. Usually the discharge is white or clear, but it can be yellow or green. Bloody nipple discharge isn't galactorrhea.

Fluid may leak from one or both breasts, either spontaneously or when you manually manipulate your breasts. You may notice a persistent discharge, or it may occur intermittently.

Nipple discharge that is bloody, spontaneous and persistent from one duct may be a sign of an underlying breast cancer. Nipple discharge that involves multiple ducts and occurs after breast stimulation - not spontaneously - more likely points to a noncancerous (benign) condition.

Galactorrhea often results from too much prolactin - the hormone responsible for milk production (lactation) when you have a baby. Prolactin is produced by your pituitary gland, a pea-sized gland at the base of your brain that secretes and regulates several hormones.

Possible causes of galactorrhea include:

• Medications, such as certain tranquilizers, antidepressants and high blood pressure drugs
• Herbal supplements, such as fennel, anise or fenugreek seed
• Birth control pills
• A noncancerous pituitary tumor (prolactinoma) or other disorder of the pituitary gland
• An underactive thyroid (hypothyroidism)
• Chronic kidney disease
• Excessive breast stimulation, such as during sexual activity, from clothing rubbing against your breast or frequent breast self-exams
• Nerve damage to the chest wall, such as may occur during surgery or burns to the chest
• Spinal cord injury

Sometimes doctors can't find a cause for galactorrhea. This is called idiopathic galactorrhea, and it may just mean that your breast tissue is particularly sensitive to the milk-producing hormone prolactin in your blood. If you have increased sensitivity to prolactin, even normal prolactin levels can lead to galactorrhea.

Finding the underlying cause of galactorrhea can be a complex task. Because there are so many possible causes, your doctor must exclude each of the various causes in turn.

First, your doctor will ask about your medical history and perform a physical examination. He or she may try to express some of the fluid from your breasts by gently squeezing or pressing the area around your nipple. Your doctor will check your breasts for lumps or other suspicious areas.

Your doctor may also ask you:

• Whether you're still having regular menstrual periods
• If you're having trouble getting pregnant
• What medications you're taking
• Whether you're experiencing headaches or vision problems

Your doctor may collect some of the fluid discharged from your nipple to send for laboratory analysis. You may need to provide a blood sample to check certain hormone levels. A pregnancy test is often appropriate as well.

If your doctor finds a breast lump or other abnormality during the physical exam, he or she may recommend imaging tests of your breasts, including mammography or ultrasound. You may also need a breast biopsy or surgery to check for breast cancer.

If results from the blood test reveal elevated prolactin levels in your blood, you may undergo magnetic resonance imaging (MRI) to check for a tumor or other abnormality of the pituitary gland.

If your doctor suspects your galactorrhea may be related to medication use, you might be instructed to stop taking the drug temporarily so that your doctor can assess this possible cause.

Galactorrhea may not require treatment. Often, the condition goes away on its own. When needed, treatment focuses on resolving the underlying cause of the condition.

You may need to stop taking or adjust your medications, if they're found to be the reason why you're experiencing galactorrhea.

For an underactive thyroid gland (hypothyroidism), thyroid replacement therapy usually resolves galactorrhea.

Galactorrhea caused by a pituitary tumor (prolactinoma) may require medication to shrink the tumor or surgery to remove it.

Sometimes doctors can't determine an exact cause for galactorrhea, but it needs to be treated anyway. This might be the case if you experience bothersome or embarrassing nipple discharge. In such instances, you might be given a medication to block the effects of prolactin or to lower the amount of prolactin in your body. Reducing prolactin levels may eliminate galactorrhea. Medications used to treat galactorrhea include bromocriptine (Parlodel) and cabergoline (Dostinex).

Often, no treatment is necessary for galactorrhea, and the milky discharge eventually goes away on its own. Until that time, you can minimize the likelihood of experiencing nipple discharge by avoiding stimulating your breasts. These tips may help:

• Don't touch your nipples during sexual activity.
• Avoid performing breast self-exams more frequently than once a month.
• Wear clothing that minimizes friction between the fabric and your nipples.

You could also use breast pads to protect yourself from leaks that might otherwise be embarrassing.