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GalactorrheaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/galactorrhea/DS00761
Galactorrhea (guh-lack-toe-REE-uh) is a milky nipple discharge unrelated to the normal milk production of breast-feeding. Galactorrhea itself isn't a disease, but it could be a sign of an underlying problem. It usually occurs in women, even those who have never had children or after menopause. But galactorrhea can happen in men and even in infants.
Excessive breast stimulation, medication side effects or disorders of the pituitary gland all may contribute to galactorrhea. Often, galactorrhea results from increased levels of prolactin, the hormone that stimulates milk production.
Sometimes, the cause of galactorrhea can't be determined. The condition may resolve on its own.
Signs and symptoms associated with galactorrhea include:
- Persistent or intermittent milky nipple discharge that has no trace of blood
- Nipple discharge involving multiple milk ducts
- Spontaneously leaked or manually expressed nipple discharge
- One or both breasts affected
- Absent or irregular menstrual periods
- Headaches or vision problems
When to see a doctor
If you have a persistent milky nipple discharge from one or both of your breasts and you're not pregnant or breast-feeding, make an appointment to see your doctor.
If breast stimulation — such as excessive nipple manipulation during sexual activity — triggers nipple discharge from multiple ducts, there is little cause for worry. The discharge probably doesn't signal breast cancer, but you should still see a doctor for evaluation.
Nonmilky nipple discharge — particularly bloody, yellow or clear spontaneous discharge that comes from one duct or is associated with a lump you can feel — requires prompt medical attention, as it may be a sign of an underlying breast cancer.
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 marble-sized gland at the base of your brain that secretes and regulates several hormones.
Possible causes of galactorrhea include:
- Medications, such as certain sedatives, antidepressants, antipsychotics and high blood pressure drugs
- Cocaine or opioid use
- Herbal supplements, such as fennel, anise or fenugreek seed
- Birth control pills
- Noncancerous pituitary tumor (prolactinoma) or other disorder of the pituitary gland
- Underactive thyroid (hypothyroidism)
- Chronic kidney disease
- Excessive breast stimulation, which may be associated with sexual activity, frequent breast self-exams with nipple manipulation, a skin rash on the chest or prolonged clothing friction
- Nerve damage to the chest wall from chest surgery, burns or other chest injuries
- Spinal cord surgery, injury or tumors
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.
Galactorrhea in men
In males, galactorrhea may be associated with testosterone deficiency (male hypogonadism) and usually occurs with breast enlargement or tenderness (gynecomastia). Erectile dysfunction and a lack of sexual desire also are associated with testosterone deficiency.
Galactorrhea in newborns
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.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, you may be referred to a breast health specialist instead.
What you can do
To prepare for your appointment:
- Take note of all your symptoms, even if they seem unrelated to the reason for which you scheduled the appointment.
- Review key personal information, including major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you take.
- Write down questions to ask, listing them in order of importance.
For galactorrhea, possible questions to ask your doctor include:
- What's likely causing my symptoms?
- Are there any other possible causes?
- What kind of tests might I need?
- What treatment approach do you recommend for me?
- Is there a generic equivalent for the medicine you're prescribing me?
- Are there any at-home remedies I might try?
What to expect from your doctor
Your doctor may ask you questions, such as:
- What color is your nipple discharge?
- Does nipple discharge occur in one or both breasts?
- Do you have other breast signs or symptoms, such as a lump or area of thickening?
- Do you have breast pain?
- How often do you perform breast self-exams?
- Have you noticed any breast changes?
- Are you pregnant or breast-feeding?
- Do you still have regular menstrual periods?
- Are you having trouble getting pregnant?
- What medications do you take?
- Do you have headaches or vision problems?
What you can do in the meantime
Until your appointment, follow these tips to deal with unwanted nipple discharge:
- Avoid breast stimulation to reduce your chances of nipple discharge. For instance, don't touch your nipples during sexual activity. In addition, avoid clothing that causes too much friction on your nipples.
- Use breast pads to absorb nipple discharge and prevent it from seeping through your clothing.
Tests and diagnosis
Finding the underlying cause of galactorrhea can be a complex task because there are so many possibilities.
Testing may involve:
- A physical exam, during which your doctor may try to express some of the fluid from your nipple by gently squeezing or pressing the area around your nipple. Your doctor may also check for breast lumps or other suspicious areas of thickened breast tissue.
- Analysis of fluid discharged from the nipple, to see if fat droplets are present in the fluid, which can help confirm the diagnosis of galactorrhea.
- A blood test, to check for the amount of prolactin in your system. If your prolactin level is elevated, your doctor might also check your thyroid-stimulating hormone (TSH) level.
- A pregnancy test, to exclude — or confirm — pregnancy as a possible cause of the nipple discharge.
- Mammography, ultrasound or both, to generate images of your breast tissue, if your doctor finds a lump or other suspicious breast tissue during your physical exam.
- Magnetic resonance imaging (MRI) to check for a tumor or other abnormality of your pituitary gland, if your blood test reveals elevated prolactin levels.
If your doctor suspects a medicine you're taking might be the cause of galactorrhea, your doctor might instruct you to stop taking the medicine for a short time to assess this possible cause.
Treatments and drugs
When needed, treatment focuses on resolving the underlying cause of galactorrhea.
Sometimes doctors can't determine an exact cause of galactorrhea. Your doctor might recommend treatment anyway if you have 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.
|Underlying cause of galactorrhea||Possible treatment|
|Medication use||Stop taking medication, change dose or switch to another medication. Make medication changes only if your doctor says it's OK to do so.|
|Underactive thyroid gland (hypothyroidism)||Take a medication, such as levothyroxine, to counter insufficient hormone production by your thyroid gland (thyroid replacement therapy).|
|Pituitary tumor (prolactinoma)||Use a medication to shrink the tumor or have surgery to remove it.|
|Unknown cause||Try a medication to lower your prolactin level, such as bromocriptine (Parlodel) or cabergoline, and minimize or eliminate nipple discharge. Side effects of these medications commonly include nausea, dizziness and headaches.|
Lifestyle and home remedies
Often, the milky discharge associated with idiopathic galactorrhea goes away on its own, particularly if you can avoid breast stimulation or other potential causes for the discharge.
To minimize breast stimulation:
- Don't touch your nipples during sexual activity
- Avoid performing breast self-exams and manipulating your nipples 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.
- Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-0-323-06986-1&eid=4-u1.0-B978-0-323-06986-1..C2009-0-48752-X--TOP. Accessed Jan. 2, 2013.
- Ferri FF. Ferri's Clinical Advisor 2013: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-08373-7..00002-9&isbn=978-0-323-08373-7&about=true&uniqId=343863096-23. Accessed Jan. 2, 2013.
- Snyder PJ. Causes of hyperprolactinemia. http://www.uptodate.com/index. Accessed Jan. 2, 2013.
- Mancini T, et al. Hyperprolactinemia and prolactinomas. Endocrinology and Metabolism Clinics of North America. 2008;37:67.
- Snyder PJ. Clinical manifestations and diagnosis of hyperprolactinemia. http://www.uptodate.com/index. Accessed Jan. 2, 2013.
- Snyder PJ. Treatment of hyperprolactinemia due to lactotroph adenoma and other causes. http://www.uptodate.com/index. Accessed Jan. 2, 2013.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Jan. 3, 2013.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 4, 2013.