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Galactorrhea

(Inappropriate Lactation)

Definition

Galactorrhea is a discharge of milk-like substance from the breast that is not associated with breastfeeding after pregnancy. This condition mainly occurs in women. It does occur in men, but much less commonly. The milky white discharge can come from one or both breasts, and the breast may leak fluid with or without stimulation.
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Causes

Galactorrhea has many causes, though sometimes the cause is unknown. Tumors of the pituitary gland, called pituitary adenomas or prolactinomas, can cause galactorrhea. The pituitary is a small gland attached to the brain. Pituitary tumors are usually not cancerous. They can cause galactorrhea when they produce excess prolactin, a hormone that stimulates milk production.
Other causes of galactorrhea include:
  • Hormonal imbalance
  • Some medications, such as:
    • Stopping or starting to take birth control pills or other hormones
    • Certain blood pressure drugs
    • Certain psychiatric medications
    • Anti-nausea drugs
    • Some antigastroesophageal reflux medications
    • Some pain killers
  • Certain herbs, such as :
  • Illicit drugs, such as marijuana and opioids
  • Sexual stimulation of the breast
  • Certain diseases, such as underactive or overactive thyroid, and chronic kidney failure, or liver disease
  • Chronic emotional stress
  • Hypothalamic tumors or disease
  • Chest wall conditions, such as:
    • Shingles
    • Trauma
    • Burns
    • Surgical scars
    • Tumors of chest wall
  • In newborns, high levels of circulating estrogen may result in enlarged breast tissue and secretion of milk

Risk Factors

Galactorrhea is more common in women. Other factors that may increase your chance of galactorrhea include:
  • Stress
  • Wearing clothing that irritates the nipple
  • Frequent breast self-exam or frequent breast stimulation

Symptoms

The primary symptom is a milky discharge from the nipple that is not associated with breast-feeding. The discharge can come from one or both breasts. Other symptoms that can occur along with the discharge include:
  • Abnormal or absent menstruation
  • Heat or cold intolerance
  • Disordered appetite, increase or decrease in weight
  • Increased thirst or urination
  • Loss of sex drive
  • Bloody or foul-smelling discharge
  • Headaches
  • Acne or abnormal hair growth
  • Visual difficulties
  • Impotence in men

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
  • A sample of the breast discharge to look at under a microscope
  • Blood tests to check hormone levels
  • Pregnancy test
  • Imaging tests to check for a pituitary gland tumor in the brain:
If the discharge is not milky or contains blood, then this is not galactorrhea. Other tests must be done to check for breast cancer or other disorders.

Treatment

Treatment depends on the cause. In some mild cases, no medical treatment is necessary, and the condition will go away on its own. In these cases, breast binders that prevent stimulation of the nipples may be effective. If medications are identified as the potential cause, safe alternatives should be sought.
If an underlying cause for galactorrhea, such as a pituitary tumor, is found, this condition may be treated.
Tumors of the pituitary gland that cause galactorrhea are usually benign. Small tumors may be treated with a medication, such as a dopamine agonist. Larger tumors that do not respond to medication may be treated with the following:
Despite treatment, pituitary gland tumors often recur.

Prevention

To reduce your risk of galactorrhea, take these steps:
  • Avoid wearing clothing that irritates the breast.
  • Avoid frequent breast self-exam; usually once a month is enough.
  • Avoid excessive sexual stimulation of the breasts.
  • Do not use illicit drugs.

RESOURCES

American Academy of Family Physicians http://familydoctor.org

National Library of Medicine http://www.nlm.nih.gov

CANADIAN RESOURCES

Canadian Family Physician http://www.cfpc.ca

Health Canada http://www.hc-sc.gc.ca

References

Eftekhari N, Mohammaalizadeh S. Pregnancy rate following bromocriptine treatment in infertile women with galactorrhea. Gynecol Endocrinol. 2009;25(2):122-124.

Galactorrhea. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/galactorrhea.html. Updated August 2010. Accessed June 11, 2013.

Hyperprolactinemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 5, 2012. Accessed June 11, 2013.

Leung AKC, Pacaud D. Diagnosis and management of galactorrhea. Am Fam Physician. 2004; 70:543-550,553-554.

Rodden A. Common breast concerns. Primary Care. 2009;36(1):103-113.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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