Galactorrhea

Galactorrhea (guh-lack-toe-REE-uh) is a milky nipple discharge not linked to the making of milk for breastfeeding. Galactorrhea isn't a disease. But it can be a sign of an underlying condition.

Galactorrhea mostly happens to people assigned female at birth. It can happen even to those who haven't had children or who have gone through menopause. But galactorrhea also can happen to people assigned male at birth and even to infants.

Too much breast handling, medicine side effects or conditions of the pituitary gland may add to galactorrhea. Often, higher levels of the hormone involved in making breast milk, called prolactin, cause galactorrhea.

Sometimes, the cause of galactorrhea can't be found. The condition may clear up on its own.

Symptoms linked to galactorrhea include:

• Milky nipple discharge that's constant or comes and goes.
• Nipple discharge from more than one milk duct.
• Nipple discharge that leaks on its own or when the breast is touched.
• Nipple discharge from one or both breasts.
• Irregular or no menstrual periods.
• Headaches or trouble with vision.

When to see a doctor

If one or both breasts keep leaking milky discharge, and you're not pregnant or breastfeeding, make an appointment to see your healthcare professional.

If breast stimulation, such as handling the nipple during sex, causes nipple discharge from more than one duct, there's little cause for worry. The discharge most often doesn't mean there's a problem. And the discharge often clears up on its own.

If you keep having discharge that doesn't go away, make an appointment with your healthcare professional.

Nipple discharge that isn't milky needs medical attention right away. If the discharge is bloody, or clear and comes from one duct or there's a lump you can feel, it may be a sign of breast cancer.

Galactorrhea often results from having too much of the hormone that makes milk when you have a baby. This is called prolactin. Your pituitary gland, a small bean-shaped gland at the base of your brain involved with several hormones, makes prolactin.

Possible causes of galactorrhea include:

• Medicines, such as certain sedatives, antidepressants, antipsychotics and high blood pressure medicines.
• Opioid use.
• Herbal supplements, such as fennel, anise or fenugreek seed.
• Birth control pills.
• A noncancerous pituitary tumor, called prolactinoma, or other condition of the pituitary gland.
• Underactive thyroid, also called hypothyroidism.
• Long-term kidney disease.
• Too much handling of the breast. This may be linked with sex activity, having breast self-exams with nipple handling or long-lasting rubbing from clothing.
• Nerve damage to the chest wall from chest surgery, burns or other chest injuries.
• Spinal cord surgery, injury or tumors.
• Stress.

Idiopathic galactorrhea

Sometimes healthcare professionals can't find a cause for galactorrhea. This is called idiopathic galactorrhea. This may mean that the breast tissue is very sensitive to the milk-making hormone prolactin. If so, even typical prolactin levels can lead to galactorrhea.

Galactorrhea in males

In people assigned male at birth, galactorrhea may be linked with too little of the hormone testosterone. Called male hypogonadism, this most often also causes breasts that are enlarged or tender, called gynecomastia. Not being able to get and keep an erection, called erectile dysfunction, and not wanting to have sex also are linked with too little testosterone.

Anything that triggers the release of the hormone prolactin can increase the risk of galactorrhea. Risk factors include:

• Certain medicines, illicit drugs and herbal supplements.
• Conditions that affect the pituitary gland, such as pituitary tumors that aren't cancer.
• Certain medical conditions, such as long-term kidney disease, spinal cord injury, injuries to the chest wall and underactive thyroid.
• A lot of touching and rubbing of the breasts.
• Stress.

It can be hard to find the cause of galactorrhea because there are so many possible reasons for it.

Testing may involve:

• A physical exam. A healthcare professional may try to get some of the fluid from the nipple by gently squeezing the area around the nipple. This exam may include looking for breast lumps or other areas of thickened breast tissue.
• A blood test. This is to check the level of prolactin in your system. If your prolactin level is high, your healthcare professional may check your thyroid-stimulating hormone level, too.
• A pregnancy test. This is to rule out pregnancy as a cause of nipple discharge.
• Diagnostic mammography, ultrasound or both. You may have these imaging tests if your healthcare professional finds a breast lump or sees other breast or nipple changes during your physical exam.
• MRI of the brain. This is to check for a tumor or other issue of your pituitary gland if your blood test shows a high prolactin level.

When needed, galactorrhea treatment aims to resolve the underlying cause.

Sometimes healthcare professionals can't find an exact cause of galactorrhea. Then you may have treatment if your nipple discharge bothers you. A medicine that blocks the effects of prolactin or lowers your body's prolactin level could help get rid of galactorrhea.

Often, milky discharge linked with idiopathic galactorrhea goes away on its own. This is most likely if you don't handle your breasts a lot or take medicines that are known to cause nipple discharge.

To lessen breast stimulation:

• Try not to overdo touching the nipples during sexual activity.
• Avoid squeezing, pinching or otherwise handling your nipples.

You're likely to start by seeing your main healthcare professional or gynecologist. But you may be sent to a breast health specialist instead.

What you can do

To prepare for your appointment:

• Take note of all your symptoms, even if they don't seem linked to the reason for which you made the appointment.
• Review key personal information, including major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you take, including how much you take and when you take them.
• Write down questions to ask your healthcare professional.

For galactorrhea, possible questions to ask include:

• What's likely causing my symptoms?
• Are there other possible causes?
• What tests might I need?
• What treatment approach do you suggest for me?
• Are there any at-home treatments I might try?

What to expect from your doctor

Your healthcare professional may ask you questions, such as:

• What color is your nipple discharge?
• Does nipple discharge come from one or both breasts?
• Do you have other breast symptoms, such as a lump or area of thickening?
• Do you have breast pain?
• How often do you do breast self-exams?
• Have you found any breast changes?
• Are you pregnant or breastfeeding?
• Do you still have regular menstrual periods?
• Are you having trouble getting pregnant?
• What medications do you take?
• Do you have headaches or trouble seeing?

What you can do in the meantime

Until your appointment, follow these tips to deal with unwanted nipple discharge:

• Don't handle your breasts. This can help to ease nipple discharge. For instance, don't rub your nipples during sex. Don't wear clothing that rubs on your nipples.
• Use breast pads. Small pads worn in the bra can soak up nipple discharge and prevent it from seeping through your clothes.