Breastmilk is a nutrient-rich fluid produced and secreted by the breast tissue (mammary glands) after childbirth. It can arise in pregnancy and usually persists for months or even years after giving birth. This is the appropriate time for breastmilk production and secretion. However, it can sometimes be present in women at inappropriate times meaning that there is no pregnancy, recent childbirth or breastfeeding. In these cases it is referred to as galactorrhea. Although it arises more commonly in women, galactorrhea can also occur in men and even babies.
Breastmilk production is largely regulated by the hormone prolactin secreted from the pituitary gland. Normally prolactin is released when the pituitary gland is stimulated by other hormones or impulses from the breast tissue as is seen with the suckling infant. However, in galactorrhea there is usually an excess of prolactin levels in women when it should not normally be so. Galactorrhea is not a disease on its own but a sign of an underlying disturbance in the body which may be pathological (disease process).
Causes of Galactorrhea
Although galactorrhea is often a consequence of elevated prolactin levels, it can occur without any such elevation. Sometimes galactorrhea occurs for no known reason (idiopathic) but most of the time galactorrhea is due to one or more of the following causes :
- Excessive stimulation of the breasts as is the case in sexual activity or frequent self-examination of the breast. A skin rash on the chest, injury to the chest wall and even tight clothing rubbing against the breast can also stimulate the breast tissue.
- Prolactinoma which is a benign tumor of the pituitary gland composed of those cells that produce prolactin.
- Hypothyroidism which is low levels of thyroid hormones due to underactivity of the thyroid gland.
- Medication such as birth control pills, antidepressants or hypertensive drugs.
- Herbal remedies containing fenugreek or fennel.
Less frequently other conditions may also be responsible like kidney diseases and spinal cord injury.
Other Signs and Symptoms
Galactorrhea is marked by the secretion of a milky white discharge from the breast. The discharge may only be occasional or persistent and does not contain blood or have a foul odor. Any discharge from the breast that is sticky, yellowish, green or brown and has a foul odor and/or blood is not galactorrhea. It may instead be due to an infection or other injury within the breast caused by diseases like breast tumors.
In galactorrhea, the milky discharge may be from one or both breasts. It can be secreted on its own without any effort (spontaneous) or manually expressed. The presence of other symptoms like headaches, vision problems and menstrual disturbances may be indicative of conditions like a prolactinoma or hypothyroidism if no medication or herbal supplements are being used.
Treatment of Galactorrhea
Since galactorrhea is not a disease on its own but a feature of some underlying disorder, the causative factor needs to be identified and removed or treated. This may involve stopping any medication and herbal supplements, undergoing surgery to remove pituitary tumors, or use medication to shrink pituitary tumors and normalize the thyroid levels in hypothyroidism.