Galactorrhea

What is Galactorrhea?

Galactorrhea is the spontaneous flow of milk from the breast in a woman who is not pregnant or nursing a child. It can occur both in men and women. The milky discharge is from both the breasts and the milk may be secreted spontaneously or expressed. Though galactorrhea itself cannot be considered as a disease it is a sign of an underlying problem.

Galactorrhea is derived from the Greek words “galakt” meaning ‘milk’ and “rhoea” meaning ‘a flow’.

Since around 90 % of women suffering from galactorrhea have high levels of the hormone prolactin, galactorrhea is also known as hyperprolactinemia. Elevated levels of prolactin when not pregnant or breastfeeding can affect normal menstrual function and fertility.

What are the Causes of Galactorrhea?

• Pregnancy: Pregnant and breast feeding women may lactate from the second trimester and continue to produce milk up to two years after stopping breast-feeding.
• Nipple stimulation: during sexual activity or due to constant friction of tight clothes.
• Fluctuating hormone levels: during puberty and menopause.
• Exposure to maternal hormones in an unborn child: can produce gynaecomastia and galactorrhea in the newborn.
• Oral Contraceptives: The oral birth control pills include combined oral contraceptives and depot contraceptives.

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• Stress
• Hypothyroidism: An underactive thyroid can cause raised levels of prolactin which can result in galactorrhea.
• Drug induced – antipsychotics (phenothiazines and haloperidol), blood pressure medications (beta blockers, alpha-methyldopa), H2 antagonists (ranitidine, cimetidine).
• Tumors in the Pituitary gland: These tumors are known as prolactinomas which produce very high levels of the hormone prolactin.
• Herbal supplements: These include fenugreek seed (methi), fennel (saunf), asparagus (shatavari), nettle leaf (bichu patta).
• Substance abuse - such as marijuana, cocaine, and opiates.
• Chronic kidney disease.
• Injury or trauma to the chest or spinal cord.
• Idiopathic: In about forty percent of patients the exact cause for galactorrhea cannot be found.

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What are the Symptoms of Galactorrhea?

• Persistent or intermittent breast milk secretion when not breast feeding or pregnant. The breast milk may be spontaneous or expressed manually.
• Irregular or absence of menstrual periods.
• Infertility.
• Acne and increase in hair growth on the chin and chest.
• Hot flushes, decreased sex drive and painful sex due to vaginal dryness.
• Osteoporosis (thinning and weakening of the bones) and osteopenia (reduced bone density).
• Headaches or visual disturbances may occur if hyperprolactinemia is due to a pituitary tumor.
• Erectile dysfunction in men.

How do you Diagnose Galactorrhea?

The diagnosis of galactorrhea is based on the individual symptoms, medical history, medication use, and also ruling out pregnancy in a woman.

• Pregnancy test: to exclude pregnancy as a possible cause of nipple discharge.
• Analysis of fluid discharged from the nipple: Presence of fat droplets help confirm the diagnosis of galactorrhea.
• Ultrasound / mammogram: if your doctor finds a breast lump or observes other suspicious breast or nipple changes during your physical exam.

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• Thyroid Function Tests: These tests are performed to rule out low levels of thyroid hormone, as a cause of galactorrhea.
• Measure prolactin levels: A blood test is done to measure the amount of prolactin in the blood. Prolactin levels above 25 nanogram/milliliter, in women who are not pregnant, are considered elevated.
• Renal and liver function tests
• MRI of the Brain and Pituitary: to check for a tumor or other abnormality of the Pituitary gland, if your blood tests reveal an elevated Prolactin level.
• Microscopy: If the nature of breast secretions is unclear.

How do you Treat Galactorrhea?

The treatment is directed at the underlying cause.

• If some medication is suspected, doctor may ask you to stop taking the medicine, lower the medicine dosage or change the medicine.
• Thyroid hormone: if hypothyroidism is the causative factor, thyroxin, a synthetic thyroid hormone is given to counter insufficient hormone production.
• Medications: Bromocriptine and Cabergoline are mostly used to treat cases where the exact cause for galactorrhea is unknown. These medications limit the production of Prolactin from the pituitary and Prolactin levels drop in about two to three weeks. These medicines mimic dopamine (a brain chemical) and are used for a majority of patients suffering from elevated Prolactin.
• Surgical treatment: This is the treatment of choice for high Prolactin level due to a large pituitary tumor (macroadenoma). This surgical procedure is known as Transsphenoidal Adenoma Resection.
• Hormone treatment: Testosterone and estrogen may be given to men and women respectively to help to prevent osteoporosis and also reduce the symptoms.

What is the Prognosis of Galactorrhea?

This depends on the underlying cause. In cases of galactorrhea due to hypothyroidism, medications, microadenomas the prognosis is favorable. However, there is an increased risk of osteoporosis in patients if prolactin levels in the blood remain high.