Galactorrhea - Specialists and Information on Milk Discharge Outside of Breastfeeding

In most cases, galactorrhea is associated with increased production of the hormone prolactin. This hormone is responsible for stimulating milk production in the mammary glands during breastfeeding.

Normally, prolactin levels in the blood are elevated only during pregnancy and breastfeeding. If prolactin levels are high outside of these periods, it is a sign of an underlying medical condition.

A prolactinoma is often the cause of pathological breast milk discharge. This specific pituitary tumor is capable of producing prolactin. It is one of the most common tumors of the pituitary gland.

In most cases, these tumors are benign. Pituitary cancer is very rare. Doctors distinguish between microprolactinomas and macroprolactinomas based on their size.

Medications can also trigger galactorrhea.

These include, in particular:

• birth control pills
• Psychotropic drugs
• Neuroleptics
• Opiates
• certain blood pressure medications
• Some medications for gastrointestinal conditions
• Circulatory medications

It is important to note that while such medications can trigger the condition, they do so only occasionally.

In addition, in rare cases, other diseases can also lead to elevated prolactin levels and galactorrhea.

These include, among others:

• Lung tumors
• Liver cirrhosis
• Kidney disease and
• Hypothyroidism

Excessive stress, whether physical or psychological, can also trigger abnormal discharge from the nipples.

In galactorrhea, the breasts produce milk even though the woman is not breastfeeding @ Siniehina /AdobeStock

The human body is a marvel. This is evident not least in the interplay of hormones. They respond to external stimuli and internal signals.

When a situation is frightening, the body releases adrenaline, and we humans develop astonishing strength as a result. The rise and fall of hormones influence a woman’s monthly cycle. These messenger substances influence metabolism during various bodily functions.

The hormone prolactin also plays a role in this hormonal interplay. Among other things, it signals that a pregnancy is underway. 

As a result, many affected women experience less frequent menstrual bleeding or a complete cessation of menstruation. 

Ovulation may also cease. Libido, or the desire for sexual intercourse, often decreases, and in some cases, infertility may result. In men, high prolactin levels in the blood can occasionally lead to erectile dysfunction.

However, if discharge occurs on only one side, this indicates changes in the milk duct. The milk ducts carry breast milk to the nipple during breastfeeding. If cysts or polyps form here, or if ductal cancer develops, this leads to discharge from the breast.

If you notice discharge from your nipples, you should have this checked by a doctor as soon as possible. Only a doctor can make the correct diagnosis and initiate the appropriate treatment. Your primary care physician will refer you to a specialist if necessary.

First and foremost, the doctor will test your blood to determine whether your prolactin levels are elevated. In doing so, they will often also check estrogen and progesterone levels in women and testosterone levels in men. 

Your doctor will ask you about any medications you are taking. This will help them determine whether the galactorrhea is a side effect of a medication. 

If the prolactin level in your blood is too high, they will use a CT scan or MRI to check for a prolactinoma.

If the discharge is only on one side, a mammogram or an X-ray examination of the milk ducts using a contrast agent is usually performed. A ductoscopy or a cell examination may also be considered.

A mammogram is recommended if galactorrhea is suspected @ Gorodenkoff /AdobeStock

Doctors classify galactorrhea into four different grades:

• In Grade 1, only a few drops of discharge are present
• In Grade 2, at least one milliliter of fluid can be expressed
• In Grade 3, discharge occurs intermittently and unpredictably
• In Grade 4, there is a constant flow of milk

Galactorrhea is particularly easy to treat when it occurs as a side effect of medication. In this case, your doctor simply needs to switch your medication and work out a new treatment plan with you.

Elevated prolactin levels in the blood can be easily lowered with medication. Often, the medications that lower prolactin levels also cause an existing tumor to shrink. 

Surgery is not necessary. Radiation therapy for the tumor is only required if patients do not respond to medication or surgical intervention.

In general, you should discuss the risks and benefits of the treatment options with a specialist. For example, a woman who does not wish to have children will not have any problems if ovulation and her monthly period stop. 

Doctors also do not necessarily have to remove a tumor if it is a microprolactinoma. If you decide against surgery, an annual CT or MRI scan is recommended.