Introduction:
Galactorrhea is a condition with milky nipple discharge from the breasts that is not associated with breastfeeding. This condition usually affects women, but it can occur in men and sometimes in infants as well. The primary cause of galactorrhea is the overproduction of the hormone prolactin by the pituitary gland. The symptoms of galactorrhea are variable, but the milky nipple discharge remains constant in all the patients.
What Is Galactorrhea?
Galactorrhea can be defined as the production of breast milk in women, men, and infants that are not related to breastfeeding (lactation). This milk discharge can occur on stimulation of the breasts by touching or on their own. Galactorrhea itself is not a disease, but it is a symptom of another underlying systemic problem in the body.
How Common Is Galactorrhea?
Galactorrhea commonly occurs in women; it is uncommon in men and rare in infants. It has been reported that approximately five to thirty-two percent of the women population are affected by galactorrhea. Another report suggests that it can affect as many as one out of every four to five women. It most commonly occurs between the age of twenty to thirty-five who have previously given birth to a child. But cases have also been reported in women who have never given birth to a child and also in women who have undergone menopause.
What Causes Galactorrhea?
The primary cause of galactorrhea is the over-production of the hormone prolactin by the pituitary gland. And this excess of prolactin in the body can be due to several factors; therefore, the possible causes include:
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Prolactinoma: A hormone-secreting, noncancerous tumor of the pituitary gland. Prolactinomas are initially small, but they can grow in size later on. Sometimes these tumors do not produce prolactin; when they are located just above the pituitary gland, they exert pressure on the pituitary stalk, and this prevents the hormone dopamine from reaching the pituitary gland. Dopamine in the pituitary gland acts to suppress the production of prolactin.
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Drugs: Overproduction of the hormone prolactin may also occur to the effect of certain drugs and medications. These drugs include antihypertensives like Methyldopa and Verapamil. Antipsychotic drugs, opioids, and serotonin reuptake inhibitors can also cause an increase in the production of prolactin. Proton pump inhibitors have also been reported to cause galactorrhea.
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Birth Control Pills: Taking birth control pills regularly can also lead to increased levels of prolactin which eventually leads to galactorrhea.
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Herbal Supplements: Certain herbal supplements like fennel, anise, and fenugreek seeds can also cause galactorrhea.
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Excess Breast Stimulation: Overstimulation of the breasts by touching, self-examination, or friction from very tight and rough clothes can also cause galactorrhea.
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Disorders Outside Pituitary Gland: Certain disorders that occur outside the pituitary gland can also cause galactorrhea. These disorders include hypothyroidism (underactive thyroid), kidney diseases, liver diseases, certain lung cancers, injury to the spinal cord, chest injuries, etc. In rare cases, stress can also be a causative factor for galactorrhea.
What Are the Signs and Symptoms of Galactorrhea?
The most common symptoms of galactorrhea are:
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Milk discharge unrelated to breastfeeding is the most common and sometimes the only symptom of galactorrhea. This milk discharge may be persistent or intermittent.
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Absence or irregular menstrual cycles (also known as amenorrhea).
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Vaginal dryness because of the low level of estrogen present in the case of prolactinomas. This dryness causes discomfort during sexual intercourse.
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Headaches.
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Acne.
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New hair growth on the chest or chin areas (hirsutism).
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Infertility in women and sometimes in men.
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Low sex drive and erectile dysfunction in men.
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Loss of vision if the cause of galactorrhea is a prolactinoma pressing on the visual nerve.
What Is Idiopathic Galactorrhea?
Sometimes, the doctors are unable to find the exact cause of galactorrhea, and this type of condition is referred to as idiopathic galactorrhea. It is speculated in the case of idiopathic galactorrhea that the breast tissues are oversensitive to prolactin hormone.
How Is Galactorrhea Diagnosed?
The diagnosis of galactorrhea is made based on blood examinations and imaging tests:
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Blood Examination: Blood samples are collected, and the prolactin level present in the blood is evaluated. In the case of galactorrhea, the prolactin level will be sharply elevated.
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Imaging Tests: Imaging examinations like a CT scan (computed tomography) or MRI (magnetic resonance imaging) are done to check for the presence of prolactinoma or any other tumor near the pituitary gland. The size and location of the tumor are accessed through these tests.
How Is Galactorrhea Treated?
The treatment modalities of galactorrhea solely depend upon the underlying cause of the condition. In addition, the following methods are used to treat the condition:
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Drugs to Block Prolactin Production: Drugs are given that might mimic the action of dopamine since it is responsible for blocking prolactin production. Drugs that mimic dopamine are Bromocriptine and Cabergoline. The patient might require to take these medications for a long time. In most cases, these drugs successfully reduce prolactin levels, increase estrogen levels in women and testosterone in men, regulate menstrual cycles, and stop galactorrhea, along with restoring fertility. These drugs can also shrink the size of pituitary gland tumors.
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Surgery or Radiation Therapy: When the prolactin levels are high due to the presence of a tumor, and the drug therapy is not responding as efficiently as it should, then the doctor might suggest surgery. The tumor is surgically removed, and this surgery is most often followed by radiation therapy.
Can Galactorrhea Be Prevented?
Galactorrhea cannot be prevented, unfortunately. However, after knowing the cause of the condition, it can be treated and managed efficiently.
What Are the Complications Associated With Galactorrhea?
The following complications are known to be associated with either galactorrhea or its treatment:
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Osteoporosis in men and women due to low estrogen and testosterone levels, respectively.
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Some medicines used to treat galactorrhea may increase the chances of infertility.
What Is the Prognosis of the Condition?
The prognosis of the condition is excellent, and after removing the underlying cause of the condition, galactorrhea can be completely stopped. The availability of drugs, surgery, or radiation therapy is an important factor affecting the prognosis of the condition.
Conclusion:
Galactorrhea is defined as milk secretion from the breast that is not associated with breastfeeding. The condition can occur due to a tumor of the pituitary gland, drug side effects, or the condition may be idiopathic. The diagnosis of galactorrhea is based on blood examinations and image testing. The treatment of galactorrhea includes the administration of prolactin-blocking drugs that mimic the action of dopamine and surgical removal of the tumor. The outlook of the condition is excellent, and it can be successfully treated with the above-mentioned treatment modalities.
