Galactorrhea or Milky Nipple Discharge in Women

You probably aren’t familiar with this condition unless you’ve experienced the often worrying and unpleasant symptoms.  It affects as many as 1 out of every 4 or 5 women. Galactorrhea is a discharge of milk or a milk-like secretion from the breast in women who aren’t breast feeding or in women six months post-partum. The condition can affect women of all ages, including infants, teenage girls and more rarely, men. It often indicates a more serious underlying condition.

The discharge can occur from one or both breasts, in either small or large quantities and can be continuous or intermittent. The discharge can also be encouraged by massaging the breast and nipple. After infancy, the condition in women is usually brought on by medication and can in rare instances be stress related. The most common physical cause of galactorrhea is a pituitary tumor. Galactorrhea most commonly presents in women aged 20 to 35 years of age.

Additional symptoms that can accompany galactorrhea

Depending on the underlying cause of the condition, it can be accompanied by other symptoms that can help your doctor correctly identify the reason you’re experiencing galactorrhea. These can include;

• An absence of menstrual periods or periods that aren’t regular.
• Headaches.
• Vision loss.
• Decreased sex drive.
• Increase in hair growth on your chin or chest.
• Erectile dysfunction in men.
• Temperature intolerances
• Nervousness, restlessness and increased sweating

Potential underlying causes

• Pharmacological. Oral contraceptives are the most common pharmacologic cause of galactorrhea
• An increase in the hormone prolactin (a condition known as hyperprolactinemia), which produces milk.  Prolactin is produced by the pituitary gland, a small gland at the base of your brain. Related symptoms may include decreased libido, infertility, oligomenorrhea or amenorrhea, and impotence
• Galactorrhea may occur if you take sedatives or marijuana.
• High doses of estrogen can cause galactorrhea. Women who have this often have irregular menstrual periods or their periods have stopped.
• Galactorrhea can also, in some instances, be caused by a pituitary gland tumor. These tumors are rarely cancerous.
• Hypothalamic and pituitary stalk lesions with head-aches, visual disturbances, temperature intolerance, seizures, disordered appetite, polyuria, and polydipsia as related symptoms.
• Thyroid disorders with tiredness, cold intolerance, and constipation as associated symptoms. Nervousness, restlessness, increased sweating, heat intolerance, and weight loss despite an increase in appetite suggest thyrotoxicosis.
• Chronic renal (kidney) failure
• Chronic Stress that affects hormone levels

Medication’s associated with galactorrhea

If you’re taking any of the medications listed below, these could very possibly be the cause of your symptoms and this is one of the first avenues your doctor will explore in diagnosing your condition.

Dopamine-receptor blockade

Butyrophenones

Metoclopramide (Reglan)

Phenothiazines

Risperidone (Risperdal)

Selective serotonin reuptake inhibitors

Sulpiride (not available in the US)

Thioxanthenes

Tricyclic antidepressants

Dopamine-depleting agents

Methyldopa (Aldomet)

Reserpine (Serpasil)

Inhibition of dopamine release

Codeine

Heroin

Morphine

Histamine-receptor blockade

Cimetidine (Tagamet)

Stimulation of lactotrophs

Oral contraceptives

Verapamil (Calan)

Pituitary Tumors

Pituitary tumors are the most common pathologic cause of galactorrhea. These can result in hyperprolactinemia by producing prolactin or blocking the passage of dopamine from the hypothalamus to the pituitary gland. Prolactinomas are the most common type of pituitary tumor and are associated with galactorrhea, amenorrhea, and marked hyperprolactinemia.

The serum level of prolactin usually correlates with the size of the tumor. A minority of patients have gigantism/acromegaly with elevated levels of prolactin and growth hormone. Macroprolactinomas are associated more often with visual field defects, headache, neurologic deficits, and loss of anterior pituitary hormones.

Hypothalmic and Pituitary Stalk Lesions

Hypothalamic lesions such as craniopharyngioma, primary hypothalamic tumor, meta-static tumor, histiocytosis X, tuberculosis, sarcoidosis and empty sella syndrome, and pituitary stalk lesions—traumatic or secondary to the mass effects of sellar tumors—are infrequent but significant causes of galactorrhea. These lesions destroy dopamine-producing neurons in the hypothalamus and block the passage of dopamine from the hypothalamus to the pituitary gland. This results in lifting of the inhibitory effect of dopamine on lactotrophs.

Thyroid disorders

Hypothyroidism (enlarged thyroid) is a rare cause of galactorrhea in children and adults. In patients with hypothyroidism, there is increased production of thyrotropin-releasing hormone, which may stimulate prolactin release. Hyperprolactinemia also may result from decreased hypothalamic dopamine secretion and decreased metabolic clearance of prolactin. Occasionally, galactorrhea may result from thyrotoxicosis, possibly because of an increase in estrogen-binding globulin or alterations in estrogen metabolism that change the free estrogen level.

Chronic Renal Failure

Approximately 30 percent of patients with chronic renal failure have elevated prolactin levels, possibly because of decreased renal clearance of prolactin. Although galactorrhea in these patients is rare, it can result from the elevated prolactin levels.

Neurogenic Causes

Neurogenic stimulation may repress the secretion of hypothalamic prolactin inhibitory factor, which results in hyperprolactinemia and galactorrhea. Galactorrhea may be caused by prolonged, intensive breast stimulation, such as from suckling, self-manipulation, or stimulation during sexual activity. Galactorrhea caused by breast stimulation is more common in parous (women who have given birth) women but has been reported in virgins, postmenopausal women, and men.

Neurogenic causes of galactorrhea include chest surgery, burns, and herpes zoster that affects the chest wall. Stimuli are thought to pass along the intercostal nerves to the posterior column of the spinal cord, to the mesencephalon, and finally to the hypothalamus, where the secretion of prolactin inhibitory factor is reduced. Galactorrhea may develop as a complication of spinal cord injury. Chronic emotional stress may be a neurogenic cause of galactorrhea.

Neonatal Galactorrhea

High levels of estrogens in the placental-fetal circulation can result in gynecomastia (enlarged breasts) in newborn infants. Enlargement of the breasts, which may be associated with secretion of milk (so-called “witch’s milk”), often is transient but may last longer in breastfed infants. In one large-scale study of 984 examinations of 640 healthy infants from birth to two months of age, galactorrhea was found in 45 examinations (4.6 percent) of 38 infants (5.9 percent)

Diagnosis and Treatment

Your doctor will do a physical exam and review your symptoms. He or she will ask about your health history and lifestyle, and what medicines you take. Your doctor may order blood tests to check your hormone levels. For women, your doctor may order a pregnancy test. Certain types of pregnancy tests can determine if you were pregnant and possibly miscarried without being aware of it.

If the doctor suspects a tumor, he or she can order an MRI (magnetic resonance imaging). This test scans your head to see if you have a tumor or defect of the pituitary gland. Your doctor can order a mammogram and/or ultrasound to check for cancer. A sample of the discharge can be checked onsite by your doctor to determine if there is fat present in the sample, a clear indicator of galactorrhea.

Treatment will largely be determined by the underlying cause of your condition. Benign tumors can be treated with medicine or surgery. Medicine can help if your body is producing too much of a hormone, such as prolactin. It also helps treat problems, such as hypothyroidism. If a certain medicine causes galactorrhea, your doctor may prescribe a different medicine.

In many cases, no treatment is necessary. Over time, the condition may go away on its own. Until then, there are some things you can do to help.

• Avoid stimulating your breasts.
• Avoid touching your nipples during sexual activity.
• Don’t do breast self-exams more than once a month.
• Avoid clothes that are too tight or rub and irritate your skin.
• Wear pads in your bra (women) to absorb the milky discharge.