Galactorrhea - abnormal milk production

introduction

As galactorrhea (also Galactorrhea) describes the leakage of breast milk or milk-like secretions from the female breast without the woman having been pregnant or having recently given birth. However, galactorrhea can also occur in men and children.
The causes are diverse and should always be clarified diagnostically. In most cases the causes are harmless. A visit to the doctor is nevertheless advisable if the milk flow persists.

Symptoms

Galactorrhea manifests itself in the emergence of milky secretions from the nipple.
It can occur either spontaneously or when the nipple is squeezed together. The amount of secretion can vary widely and range from a few drops to several milliliters.
In most cases, milk flow is not dangerous, but certain symptoms can suggest a serious cause.
This includes, for example, if the flow of milk only occurs on one side, if it persists, if it is associated with pain, if it is sticky or foul-smelling, purulent or bloody.
Even if the breast appears to be inflamed (swollen, overheated or reddened), it is important to have a doctor assess the flow of milk to rule out any more serious causes such as breast cancer
Other symptoms, such as the absence of a menstrual period (Amenorrhea) can for example on a Prolactinoma point to the cause of galactorrhea.

More on this: Pituitary Tumor

Galactorrhea in menopause

During menopause, there is typically a deficiency of the female sex hormones estrogen and progesterone. The reason for this is that the ovaries are no longer as active and also restrict hormone production. At the end of the menopause, the ovaries have completely stopped producing hormones. However, galactorrhea is more likely to be triggered by an increased production of the hormone estrogen, so that galactorrhea is rather untypical during menopause.
Another cause of galactorrhea could be a tumor called a prolactinoma. The tumor grows in the pituitary gland and causes the hormone prolactin to be released more than normal. Elevated levels of prolactin can lead to galactorrhea. So this would be a possible reason for galactorrhea in menopause. However, prolactinomas most commonly occur between the ages of 20 and 40. This means that the prolactinoma most often manifests itself before menopause.
Furthermore, various drugs can cause an increased production of prolactin, which can then lead to galactorrhea. These drugs include certain antidepressants and antihypertensive drugs such as clonidine or reserpine. In addition, individual drugs from the group of neuroleptics can trigger galactorrhea. Neuroleptics are used for various mental illnesses.

You may also be interested in this topic: Symptoms of menopause

Galactorrhea in men

There are many causes of galactorrhea in men. For one, a deficiency in the hormone testosterone can lead to reactive galactorrhea.
In rare cases, as in women, a prolactinoma, i.e. a tumor on the pituitary gland, can trigger galactorrhea in men. The classic symptoms of a prolactinoma in men are, however, loss of libido and potency. In some cases, the prolactinoma can also trigger an increased growth of mammary gland tissue, which is then called gynecomastia.
It is also conceivable that, similar to the female gender, various drugs can trigger galactorrhea as a side effect. These drugs include some antidepressants, antihypertensive drugs, and drugs that are used for psychiatric illnesses.

Also read our article: Testosterone Deficiency

causes

Galactorrhea can have different causes.
A natural cause is pregnancy or breastfeeding. In some women, the breast already secretes small amounts of secretion during pregnancy. This is only an expression of the beginning production of breast milk and is normally harmless. The same applies to spontaneous milk flow during breastfeeding.

However, in some women, milk leaks from the mammary gland even though they are neither pregnant nor breastfeeding, for example when they pinch the nipple with two fingers.
This is not a common condition per se, but it does not necessarily have to be a symptom of an illness.
The mechanical irritation of the nipple can lead to the release of the hormone prolactin, which plays an important role in the production of breast milk during breastfeeding. The secretion of prolactin is also stimulated by sucking the nipple of an infant. However, other factors can also affect prolactin levels.
These include, for example, hormonal contraceptives such as the birth control pill, but some blood pressure medication and neuroleptics can also increase the prolactin level.
Drugs and psychological stress can also lead to an increase in prolactin and thus to milk production.

Ultimately, however, galactorrhea can also hide a more serious cause, as it can also be an expression of a malignant disease of the mammary gland, for example breast cancer.
Also a pituitary gland tumor called a pituitary adenoma, respectively Prolactinoma, can lead to an increase in the prolactin level if it is hormone-active and produces it. A galactorrhea can therefore also be an expression of such a tumor.

The flow of milk in newborns is usually harmless. It is assumed that maternal hormones, which are supposed to stimulate milk production, get into the child's bloodstream and also cause milk to flow there. This disappears within two weeks after the birth.
In half of the cases, however, the cause of galactorrhea remains unexplained.

Also read our topic: Side effects of the pill

Galactorrhea from stress

Persistent physical or psychological stress leads to the hormone prolactin being released more frequently. An increased blood level of prolactin can in turn lead to galactorrhea. However, not everyone automatically develops galactorrhea as a result of prolonged stress.

diagnosis

The diagnosis of galactorrhea is best made by a gynecologist. He will first inquire about the exact symptoms in the anamnesis and ask about other symptoms.
Medication taken, previous illnesses and other factors that can influence the milk production of the female breast are also important. This is followed by an examination of the breast, in which the doctor looks at the breast, feels it for changes and possibly also carries out an ultrasound examination of the breast tissue.
In addition, we are interested in various hormone levels in the blood that are important for milk production, for example prolactin and other female sex hormones. Thyroid levels can also be important.
In order to examine the breast even further, a mammography, i.e. an X-ray of the breast, can also be performed.
If it is suspected that the galactorrhea may be caused by a tumor in the pituitary gland, computed tomography (CT) or magnetic resonance imaging (MRI) of the brain will be done. Galactorrhea can usually be sufficiently clarified with these different methods.

therapy

Galactorrhea is treated according to the underlying disease. If the cause is a tumor of the pituitary gland, a so-called dopamine agonist is usually used. This is a medicine that stops the production of the hormone prolactin. In most cases it is not necessary to remove the usually benign tumor.
If the cause lies in the use of certain medications, these should be discontinued. The galactorrhea then persists by itself.
Antibiotics are often prescribed for underlying breast inflammation, and breast cancer must be treated with surgery and / or chemotherapy and / or radiation.
Galactorrhea occurring in infants after birth does not require treatment, as it disappears on its own after a few weeks

Drugs for galactorrhea

Therapy with medication is in the foreground in galactorrhea. The most common drugs are the dopamine agonists such as bromocriptine or lisuride. Their action lowers the level of the hormone prolactin. The hoped-for effect of the lower hormone level is the cessation of galactorrhea. The side effects of these drugs are typically nausea and vomiting, as well as low blood pressure, which can lead to dizziness. Furthermore, the drugs can have damaging consequences for the heart valves.

forecast

The prognosis for galactorrhea is very good. In general, the prognosis depends on the cause.
However, since the causes are usually easily treatable, galactorrhea can usually be managed well.
If breast cancer is the cause of the symptoms, the prognosis depends on how successfully the breast cancer can be treated.

prophylaxis

A direct prophylaxis to avoid galactorrhea there is not any.
The causes are very diverse, so you can get them do not specifically avoid can.

history

Galactorrhea, which can occur in babies after birth, was also called in the Middle Ages Witch milk designated.
This term has survived to this day, but is based on the fact that people in the past could not explain why a baby could flow milk.
It was assumed that the devil had his fingers in the game and sent enchanted birds and witches to the children and made them sick.
The flow of milk in newborns was mistakenly believed to be toxic and ended up being called witch's milk.