Galactorrhea: Symptoms, Causes and Treatment

Galactorrhea is discharge of milky substance from breast nipples that is not related to normal milk production during breast feeding. Generally galactorrhea is not considered a disease and it is taken a sign or symptom of an underlying medical condition (disease). Commonly galactorrhea is seen among women; however it can occur among men and even in infants. Galactorrhea may be due to excessive breast stimulation, excess prolactin level or due to pituitary problem. However, it is not always possible to find a cause for galactorrhea.

What are the symptoms of galactorrhea?

Signs and symptoms of galactorrhea include,

  • Intermittent or persistent milky discharge from nipple, but without any trace of blood
  • Milky discharge is mostly spontaneous
  • One or both nipples may be involved
  • Milky discharge from multiple milk ducts
  • Menstrual cycle may be not normal (absent or irregular)
  • Headache
  • Vision problem

If you are man or if you are woman but not pregnant and having galactorrhea, you should consult your doctor immediately.

What are the causes of galactorrhea?

Possible causes of galactorrhea include,

  • Medications such as metoclopromide (dopamine receptor antagonist commonly used for vomiting), sedatives, antipsychotics, blood pressure drugs etc.
  • Excessive breast stimulation due to frequent breast self examination and nipple manipulation, sexual activity, friction with nipple
  • Drug abuse, such as cocaine or other opioids
  • Contraceptive pills (hormonal)
  • Herbal supplements containing fenugreek seeds, fennel etc.
  • Pituitary problems, including benign tumors of pituitary
  • Spinal cord injury, surgery or spinal cord tumor
  • Chronic kidney disease
  • Hypothyroidism
  • Idiopathic galactorrhea: the cause cannot be found in such cases. Breast tissue seems to be extra sensitive to prolactin, the hormone that is responsible for milk production.
  • Galactorrhea in men can be due to deficiency of testosterone. Galactorrhea in men is usually accompanied by gynecomastia or male breast.
  • Galactorrhea in newborn most commonly due to high estrogen level in baby due to estrogen crossing placenta and there is enlargement of breast in such babies along with milky discharge from newborn’s nipples.

What tests are done for finding the cause of galactorrhea?

Diagnosis of galactorrhea is not difficult and can be made by history and physical examination. If there is milky discharge from nipple and there is no trace of blood in the milky discharge, it can be considered galactorrhea. However, to find out the cause of galactorrhea, various tests have to be done, such as

  • Pregnancy test: to find out, if galactorrhea is due to pregnancy as pregnancy is a cause of galactorrhea
  • Blood tests: to find out the level of blood prolactin and TSH (thyroid stimulating hormone) because both (excess prolactin and underactive thyroid) can cause galactorrhea
  • Analysis of milky fluid to find out if fat droplets are present in milky discharge, that may help confirm diagnosis.
  • Ultrasound: to check if there is lump in breast tissue
  • Mammography: this is also done to check if there is lump in breast tissue
  • MRI: if blood test for prolactin is high, MRI of brain is done to find out if there is any tumor or growth in pituitary gland.

These tests may help find out the cause of galactorrhea and treatment modality decided based on these tests.

Treatment/management of galactorrhea:

If a cause can be found, treatment of galactorrhea aimed at treating the cause. However, sometimes the cause of galactorrhea may not be found and treatment in such situation is based on minimizing the effect of prolactin or reducing production of prolactin. Following treatment modalities are used for various causes of galactorrhea:

  • Due to certain medication: stop the medication and ask your doctor to change (switch over to another medication) the medication or change the dosage if possible.
  • Hypothyroidism: correct underactive thyroid by use of thyroxin.
  • Thyroid tumor (Prolactinoma): surgical removal of tumor or use medication to shrink the tumor.
  • Idiopathic galactorrhea usually goes away on its own in most cases and may not require any treatment

Important things to remember if you have galactorrhea:

  • Do not touch nipple during sexual act
  • Wear cloths in such a way that it reduces friction with nipples
  • Avoid breast self examination with nipple manipulation. It should not be done more than once a month.
  • Use breast pads to protect yourself from leaks due to galactorrhea and avoid embarrassment

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