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Magill’s Medical Guide, 9th Edition

Galactorrhea

by Janine Ungvarsky

Category: Disorder

Also known as: Inappropriate lactation

Anatomy or system affected: Mammary glands, breasts, endocrine system, pituitary gland

Specialties and related fields: Endocrinology, gynecology, oncology

Definition: Mammary gland discharge without pregnancy and lactation.

Key terms:

dopamine: Neurotransitter that inhibits the release of prolactin.

galactorrhea: a condition in which the body produces a milk-like discharge outside of pregnancy and breastfeeding. While it usually occurs in women, it can occur in males and even in children.

gynecomastia: Breast development in men.

hypogonadism: Underdevelopment of the gonads

prolactin: a hormone released by the anterior lobe of the pituitary gland that stimulates milk production by the mammary glands.

CAUSES AND SYMPTOMS

The primary symptom of galactorrhea is a milky discharge from the nipple area of one or both breasts in a patient who is neither pregnant nor nursing a child. When this happens during sexual activity, it is nearly always a result of stimulation and is no cause for alarm, though a physician should be consulted as a precaution. If a discharge contains blood or is yellow or clear, the patient does not have galactorrhea. These types of discharges often indicate infection or even cancer, especially if the discharge only appears in one breast and there is a lump in the same area.

The discharges associated with galactorrhea can occur on their own without any stimulation or may appear when the nipple is squeezed or otherwise exposed to pressure. The condition can be persistent or may come and go. It is most likely to occur within six months of childbirth or six months after the end of breastfeeding, especially in women ages twenty to thirty-five and in teenage girls. Up to thirty-two percent of women experience galactorrhea at least once in their lives; the incidence is much lower in males.

Other symptoms of galactorrhea include abnormal or missed menstrual periods and infertility, breast enlargement, lack of interest in sex, headaches, vision disturbances, acne, unusual hair growth, nausea, and vomiting. Teens with galactorrhea may experience delays in puberty, while men may experience decreased libido, impotence, infertility, or even breast enlargement and development (gynecomastia).

Galactorrhea is usually caused by an excessive production of the hormone prolactin (hyperprolactinemia), which is responsible for stimulating the flow of breastmilk during nursing. A host of different causes can trigger substantially increased levels of prolactin. Physiologic causes include pregnancy, nipple stimulation and breast exams or stress. Food does not seem affect blood prolactin levels. One trigger that appears in people of all sexes and ages is a prolactin-secreting pituitary tumor known as a prolactinoma or lactotroph adenoma.

Additionally, the neurotransmitter dopamine negatively regulates prolactin secretion: Therefore any condition that interferes with dopamine secretion by neurons in the hypothalamus can cause hyperprolactinemia, and, subsequently, galactorrhea. Thus, benign (e.g., craniopharyn giomas) or malignant (e.g., metastatic breast carcinomas) tumors of the hypothalamus, invasive diseases of the hypothalamus (e.g., sarcoidosis), surgery or head trauma that damages the stalk that connects the pituitary gland to the hypothalamus, or other types of adenomas of the pituitary can decrease dopamine delivery to the pituitary and induce hyperprolactinemia.

In addition to prolactinoma, galactorrhea can be triggered by several other health conditions including chronic kidney disease, liver disease, some forms of lung cancer, and hypothyroidism, or underactive thyroid. It can also be brought on by several different types of prescription drugs: (1) estrogen-containing birth control pills, (2) antipsychotics such as risperidone, phenothiazines, and haloperidol, (3) the antidepressant clomipramine, (4) gastric motility drugs such as lopramide and domperidone, and (5) methyldopa, a medication for high blood pressure. Galactorrhea can also be triggered by illegal or street drugs such as opioids and marijuana. Some herbal supplements have also been known to cause galactorrhea, including anise, fennel, thistle, fenugreek seed, and nettle. Injuries to the chest or breast may also trigger galactorrhea.

Galactorrhea is usually triggered in infants by the presence of some of the mother’s estrogen in the child’s system when this hormone crosses into the child’s bloodstream through the placenta before birth. In males, galactorrhea may be caused by a testosterone deficiency (hypogonadism). It also can cause the male’s breasts to grow and become tender (gynecomastia).

Diagnosing galactorrhea includes determining the underlying cause. A physician conducts an examination, which includes questions about the patient’s medical history, and collects a sample of the discharge. This sample is examined under a microscope to determine its makeup and confirm that it is the result of galactorrhea and not another condition. The physician generally orders blood tests to check the levels of several hormones. Women are also given a pregnancy test, since the breasts can leak a milky substance during pregnancy. A breast exam and mammogram or breast ultrasound will likely be ordered to check for any abnormalities. A magnetic resonance imaging test (MRI) or a computerized tomography (CT) scan may also be conducted to look for pituitary tumors.

TREATMENT AND THERAPY

Galactorrhea does not present a health risk and does not require treatment unless the patient wishes to alleviate any discomfort or embarrassment the condition may cause. Treatment usually involves resolving the underlying cause. When a medication is suspected as the cause of the galactorrhea, the physician may stop that treatment and/or change dosages, then wait to see if the discharge ceases. When the condition is caused by an underactive thyroid, taking levothyroxine will treat the thyroid and could resolve the discharge as well. If it is caused by another condition such as kidney or liver disease, treating the condition could also resolve the galactorrhea. For discharge caused by a pituitary tumor, treating the tumor with medication or surgery should stop symptoms.

In some cases, the physician can determine that prolactin levels are elevated but cannot find the cause. In these instances, drugs that act like dopamine such as bromocriptine or the better tolerated cabergoline can be used to treat the elevated prolactin levels and stop the discharge. When the discharge is brought on by physical stimulation, binding the breasts to reduce stimulation can help control galactorrhea.

PERSPECTIVE AND PROSPECTS

The word galactorrhea comes from the Greek words galakt, meaning “milk,” and rhoia, meaning “flow.” The word first came into use in the nineteenth century in reference to the production of what appeared to be milk in the breasts of women who were not breastfeeding. The term has since been applied to a milky discharge from the breasts of men and children as well. It is seen in up to 5 percent of infants of both sexes, and it was once referred to as witch’s milk because it was believed to be produced as nourishment for a witch’s familiar, or animal companion, such as a black cat.

For Further Information:

1 

Basu, Reshmi. “Galactorrhea of the Newborn (Witch’s Milk).” PediatricsConsultantLive, 17 Nov. 2010. www.pediatricsconsultantlive.com/photoclinic/galactorrhea-newborn-witch’s-milk. Accessed 11 Nov. 2016.

2 

Chapman, Ian M. “Galactorrhea.” Merck Manuals, www.merckmanuals.com/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/galactorrhea. Accessed 11 Nov. 2016.

3 

“Galactorrhea.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/galactorrhea/home/ovc-20167592. Accessed 11 Nov. 2016.

4 

“Galactorrhea.” University of Michigan Hospitalsand Health Centers, www.med.umich.edu/1info/FHP/practiceguides/breast/Galactorrhea.pdf. Accessed 11 Nov. 2016.

5 

“Galactorrhea.” Mount Sinai, www.mountsinai.org/patient-care/health-library/diseases-an d-conditions/galactorrhea. Accessed 11 Nov. 2016.

6 

“Hyperprolactinemia and Galactorrhea.” VCU Health, www.vcuhealth.org/?id=1049&sid=1. Accessed 11 Nov. 2016.

7 

Leung, Alexander K. C. and Daniele Pacaud. “Diagnosis and Management of Galactorrhea.” American Family Physician, Aug. 2004, 1, 70 (3), 543-550. www.aafp.org/afp/2004/0801/p543.html. Accessed 11 Nov. 2016.

8 

Ryan-Krause, Patricia. “Galactorrhea in an Adolescent Girl.” Journal of Pediatric Health Care, Sept. 2008. www.jpedhc.org/article/S0891-5245(08)00279-4/abstract. Accessed 11 Nov. 2016.

Citation Types

Type
Format
MLA 9th
Ungvarsky, Janine. "Galactorrhea." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_0540.
APA 7th
Ungvarsky, J. (2022). Galactorrhea. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Ungvarsky, Janine. "Galactorrhea." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed October 22, 2025. online.salempress.com.