Galactorrhea
Galactorrhea is a condition characterized by a milk-like discharge from the breasts in individuals who are not pregnant or breastfeeding. While it predominantly affects women, it can also occur in men and children. Galactorrhea is typically a symptom rather than a standalone disease and can stem from various underlying causes, some of which may require medical attention. Elevated levels of the hormone prolactin are a common trigger, often linked to conditions such as pituitary tumors, chronic kidney disease, and hormonal imbalances.
In instances where no serious underlying condition is present, lifestyle modifications—such as minimizing breast stimulation and avoiding certain medications—can help prevent galactorrhea. The primary signs include a milky discharge that may occur spontaneously or with pressure, as well as potential additional symptoms like irregular menstrual periods and infertility in women. Diagnosis generally involves a thorough medical evaluation, including hormone level tests and imaging studies to rule out potential causes. While galactorrhea itself is not considered a health risk, addressing its root causes is essential for effective management and relief from any discomfort it may cause.
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Galactorrhea
Galactorrhea is a condition in which the body produces a milk-like discharge outside of pregnancy and breastfeeding. It is sometimes called inappropriate lactation. While it usually occurs in women, it can occur in males and even in children. The condition itself is considered a symptom and not a disease; it is not serious and can be treated. However, galactorrhea can be a symptom of a serious condition, including certain kinds of tumors.
Galactorrhea that is not related to an underlying medical condition can sometimes be prevented. Some cases are brought on by excessive stimulation of the breast. In this case, galactorrhea can be prevented by limiting breast self-exams to once a month, limiting breast stimulation during sex, and avoiding clothing that rubs on the breasts and causes irritation. Since some medications can trigger galactorrhea, avoiding these when possible can reduce the risk of developing the condition, as can avoiding the use of street drugs, which are also known triggers.
Background
The word galactorrhea comes from the Greek words galakt, meaning "milk," and rhoia, meaning "flow." The word first came into use in the nineteenth century in reference to the production of what appears to be milk in the breasts of a woman who is not breastfeeding. The term has since been applied to a milky discharge from the breasts of men as well. Children can also develop the condition. It is seen in up to 5 percent of infants of both sexes; it was once referred to as witch's milk because it was believed that it was produced as nourishment for a witch's familiar, or animal companion, such as a black cat.
The primary symptom of galactorrhea is a milky discharge from the nipple area of one or both breasts in a patient who is neither pregnant nor nursing a child. When this happens during sexual activity, it is nearly always a result of stimulation and no cause for alarm, though a physician should be consulted as a precaution. A discharge that is not milky but is another color, such as yellow or clear, or that contains blood, is not galactorrhea. These types of discharges often indicate an infection or possibly cancer, especially if there is a lump in the same area as the discharge and it appears in only one breast.
The discharges associated with galactorrhea can happen on their own without any stimulation, or may appear when the nipple is squeezed or otherwise exposed to pressure. The condition can be persistent or may come and go. It is most likely to occur within six months of childbirth or the end of breastfeeding, especially in women ages twenty to thirty-five and in teenage girls. Up to thirty-two percent of women experience galactorrhea at least once in their lives; the incidence is much lower in males.
Other symptoms of galactorrhea include abnormal or missed menstrual periods and infertility, breast enlargement, lack of interest in sex, headaches, vision disturbances, acne, unusual hair growth, nausea, and vomiting. Teens with galactorrhea may experience delays in puberty, while men may experience impotence.
Galactorrhea is usually caused by an excessive amount of the hormone prolactin, which is responsible for stimulating the flow of breastmilk during nursing. The high levels of prolactin can be triggered by a number of things. One cause that occurs in people of all genders and ages is a pituitary tumor, or prolactinoma. These are generally benign but can press on part of the pituitary gland and suppress the release of dopamine, which normally helps to prevent high prolactin levels.
In addition to prolactinoma, galactorrhea can be triggered by several other health conditions including chronic kidney disease, liver disease, some forms of lung cancer, and hypothyroidism, or underactive thyroid. It can also be brought on by a number of prescription drugs, including birth control pills and other medications that contain hormones, and certain medications used to treat pain, psychiatric conditions, high blood pressure, nausea, and gastroesophageal reflux. It can also be caused by illegal or street drugs such as opioids and marijuana. Some herbal supplements have also been known to cause galactorrhea, such as anise, fennel, thistle, fenugreek seed, and nettle. Injuries to the chest or breast may also trigger galactorrhea, as can prolonged stress.
In infants, galactorrhea is usually caused by some of the mother's estrogen remaining in the child's system. This hormone crosses into the child's bloodstream through the placenta before birth. In males, galactorrhea may be caused by a testosterone deficiency, or hypogonadism. It often also causes the male's breasts to grow and become tender, which is known as gynecomastia.
Diagnosis and treatment
Diagnosing galactorrhea includes determining the underlying cause. A physician conducts an examination, which includes questions about the patient's medical history and collection of a sample of the discharge. This is examined under a microscope to determine its makeup and confirm that it is the result of galactorrhea and not another condition. The physician generally orders blood tests to check the levels of several hormones. Women are also given a pregnancy test, since the breasts can leak a milky substance during pregnancy. A breast exam and mammogram or breast ultrasound will likely be ordered to check for any abnormalities. A magnetic resonance imaging test (MRI) or a computerized tomography (CT) scan may also be conducted to look for pituitary tumors.
Galactorrhea does not present a health risk and does not require treatment other than to alleviate any discomfort or embarrassment it may cause. Treatment usually involves resolving the underlying cause. When a medication is suspected as the cause of the galactorrhea, the physician may stop that treatment and/or change dosages to see if that stops the discharge. When the condition is caused by an underactive thyroid, taking levothyroxine will treat the thyroid and could resolve the discharge as well. If the cause is another condition such as kidney or liver disease, treating the condition could also resolve the galactorrhea. For discharge caused by a pituitary tumor, treating the tumor with medication or surgery should stop it.
In some cases, the physician can determine that prolactin levels are elevated but cannot find the cause. In these instances, drugs such as cabergoline or bromocriptine can be used to treat the elevated prolactin and stop the discharge. When the discharge is brought on by physical stimulation, binding the breasts to reduce this can help control galactorrhea.
Bibliography
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