Galactorrhea
Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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The term galactorrhea (galactorrhea) stands for the leakage of mostly milky fluid from the mammary glands in women who are neither pregnant nor breastfeeding a child. The “milk flow” is mostly evident on both breasts and can be differently pronounced. Possible causes of galactorrhea are, for example, mechanical stimuli, the use of certain medications, and various illnesses. Read more about the causes, diagnosis and treatment of galactorrhea here.
Galactorrhea: description
Doctors speak of galactorrhea when a - usually milky - liquid escapes from the breast in women outside of pregnancy and breastfeeding. Usually both breasts show the "flow of milk". Galactorrhea is often associated with menstrual disorders, but can also occur with a normal menstrual cycle. The most common causes are hormonal imbalances and the use of certain medications.
About 0.5 to one percent of pre-menopausal women experience galactorrhea. Women in their fourth decade of life are particularly affected.
Galactorrhea: Grade 1 to 3
According to the extent of the galactorrhea, there are three grades:
- Degree 1: emergence of a drop
- Grade 2: several drops emerge
- Grade 3: spontaneous secretion
Differentiation from "witch's milk"
Even in newborns of both sexes, a milky secretion occasionally emerges from the mammary glands, but this is not referred to as galactorrhea. This "witch's milk" is colorless or milky-yellow and is formed under the influence of maternal hormones.
Galactorrhea: causes and possible diseases
The causes of galactorrhea can be inside or outside the chest. In many cases, the “milk flow” is an expression of an increased prolactin level (hyperprolactinemia). Prolactin is a hormone produced by the pituitary gland (pituitary gland) and, among other things, stimulates the production of milk in the breasts. Possible causes of hyperprolactinemia - and thus any associated galactorrhea - are, for example:
Mechanical stimulation
Stimulating the nipples increases the level of prolactin in the blood, which in some women leads to the secretion of a milky liquid.
Medication
Certain drugs can raise the prolactin level and cause galactorrhea. Examples are certain drugs for depression (tricyclic antidepressants), antihypertensive drugs (antihypertensive drugs such as reserpine, clonidine) and drugs for mental illness (neuroleptics such as promethazine, haloperidol, sulpiride). Even after discontinuation of oral anticoagulants (oral anticoagulants), a “milk flow” can occur.
Disorders in the pituitary gland
Galactorrhea as a result of an increased prolactin level can also be caused by a so-called prolactinoma. This is a benign tumor of the anterior pituitary gland that uncontrollably produces prolactin and releases it into the blood. An excessive increase (hyperplasia) of the prolactin-releasing cells of the pituitary gland can cause galactorrhea.
Disorders in the area of the hypothalamus
The hypothalamus is part of the diencephalon and controls, among other things, the pituitary gland. Various diseases in this area can therefore lead to galactorrhea by influencing the release of prolactin from the pituitary gland. Examples are tumors, encephalitis, sarcoid and empty sella syndrome. In the latter disease, a bulging of the subarachnoid space (gap-shaped space between the middle and inner meninges) filled with cerebral fluid presses on the pituitary gland.
Disorder in the area of the pituitary stalk
The pituitary gland is connected to the hypothalamus via the pituitary stalk. If this area is damaged as a result of an operation or an accident, the prolactin release can also increase and galactorrhea result.
Other diseases
A number of other diseases can also trigger galactorrhea by increasing the prolactin level. These include, for example, psychiatric illnesses, shingles (herpes zoster), kidney weakness (renal insufficiency), endometriosis, acute porphyria (a metabolic disease) and "real" hypothyroidism (primary hypothyroidism).
Breast disorders can also be associated with galactorrhea. Both with a benign tumor of the milk ducts (milk duct papilloma) and with breast cancer, fluid (usually bloody) often escapes from the mammary gland.
Other causes of galactorrhea
Other factors that increase the prolactin level and thus possibly trigger galactorrhea are, for example, the IUD of contraception (intrauterine IUD), low blood sugar (hypoglycemia), burn scars in the chest area (thorax), thoracic trauma (e.g. from an accident) and acute stressful situations.
Galactorrhea: When Should You See a Doctor?
If the “milk flow” cannot be explained, you should see a doctor to clarify the cause. This is especially true if the galactorrhea only occurs in one mammary gland and / or the exuding secretion is mixed with blood.
Galactorrhea: what does the doctor do?
First, the doctor collects the medical history (anamnesis). He asks, for example, how long has the galactorrhea existed, whether it occurs spontaneously or only after mechanical stimulation, how strong the “milk flow” is, what color the secretion is and whether it is secreted from both breasts or just one. He also asks about any other complaints (such as menstrual disorders), existing illnesses (such as a thyroid dysfunction) and the use of medication.
As part of a physical exam, the doctor palpates the chest. For example, he checks whether mechanical stimulation triggers the galactorrhea. A sample of the secreted fluid (smear) is analyzed in the laboratory in order to identify suspicious or abnormally changed cells.
This is followed by further examinations - which ones are decided by the doctor on a case-by-case basis. The following methods are available to clarify galactorrhea:
An important imaging procedure in breast exams is mammography (x-ray of the mammary gland). In addition, galactography can be useful for women with galactorrhea - the X-ray of a milk duct with the help of contrast media. To do this, the doctor inserts a very thin probe into the mouth of the milk duct and injects a small amount of contrast medium. The subsequent chest x-ray (mammography) reveals changes in the milk ducts that are responsible for galactorrhea.
You can also check the milk ducts directly from the inside for possible changes using ductoscopy. This means a minimally invasive examination of the milk ducts with the help of a very thin endoscope.
In certain cases, the doctor will perform ductal lavage, i.e. rinse the milk ducts: For this purpose, a saline solution is injected into the duct system and, after flushing through all ducts, removed again in order to examine them for changed cells washed up with them.
As a further imaging method in addition to mammography, an ultrasound examination (sonography) can provide information about the cause of galactorrhea.
If altered cells are suspected or detected, the doctor can take a tissue sample from the breast (biopsy) and have it examined in the laboratory.
The prolactin stimulation test (also metoclopramide test, MCP test) can be used to clarify whether the galactorrhea is due to an increased prolactin level (hyperprolactinemia). The test must be carried out in the luteal phase (i.e. after ovulation and before the next menstrual period). First, the basal prolactin level is measured using a blood sample.
Then the woman is given an injection with metoclopramide, an active ingredient that stimulates the release of prolactin. The prolactin level is determined again after 25 minutes. If both measured values are elevated, there is manifest hyperprolactinemia. If only the second value is increased, it is a question of latent hyperprolactinemia.
In specific suspected cases of the cause of the galactorrhea, further tests can provide certainty. For example, a determination of the thyroid values can reveal a dysfunction of the thyroid gland as a possible cause of the “milk flow”.
This is how the doctor treats galactorrhea
If possible, the doctor will treat the underlying cause of the galactorrhea: If the "milk flow" occurs, for example, as a side effect of a certain medication, this is discontinued or replaced by another preparation. If a benign or malignant tumor triggers secretion from the mammary gland, surgery may be necessary.
In some cases of galactorrhea, a prolactin inhibitor is also given. It inhibits the formation and release of prolactin, which can bring the “milk flow” to a standstill.
Galactorrhea: you can do it yourself
Getting rid of galactorrhea generally requires medical treatment for the underlying cause. But there is something you can do yourself too: Avoid self-stimulation of the breast by regularly stroking the breast tissue, as this can maintain or even increase galactorrhea.
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