Galactorrhea

DEFINITION

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.

CAUSES

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

Idiopathic galactorrhea

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.

SYMPTOMS

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.