What is galactorrhea and how does it differ from other discharges?
With galactorrhea, the discharge is usually white or milky, appearing from both glands and from several ducts, often with pressure. This is a sign that the gland tissue is responding to a hormonal signal. Sometimes a small amount of secretion remains for up to a year or longer after the end of feeding - this is the norm. A completely different situation is spontaneous bloody or clear discharge from one duct: they occur with intraductal papilloma, ductal ectasia, and less often with cancer, so they are assessed separately.
- Milky discharge on both sides - most often hormonal cause
- Greenish or thick – often ductal ectasia
- Purulent with pain and redness - inflammation
- Bloody from one duct - require examination of the ducts
Reasons
The main mechanism is an increase in prolactin. It is produced by the pituitary gland and inhibited by dopamine. Anything that reduces the effects of dopamine or stimulates prolactin production can cause galactorrhea. Often the cause is found in the medications taken, so the doctor needs to name all the medications. There is also idiopathic galactorrhea, when prolactin is normal, and the cause is not identified: in the absence of other symptoms, it is usually simply observed.
- Prolactinoma and other pituitary tumors
- Hypothyroidism - decreased function of the thyroid gland
- Antipsychotics, some antidepressants and antiemetics
- Frequent breast stimulation, tight underwear, chest injuries
- Chronic kidney and liver disease
- Recent pregnancy, abortion or miscarriage
Associated symptoms
A hormonal cause is indicated by signs that appear simultaneously with the discharge. In women, increased prolactin suppresses ovarian function; in men, it reduces testosterone levels. A large pituitary tumor can put pressure on the optic chiasm and nerves, causing headaches and narrowing of the visual field. It is important to tell your doctor about these complaints, even if they do not seem to be related to the breast.
- Irregular, scanty or absent periods
- Difficulty getting pregnant
- Decreased libido, vaginal dryness
- In men - decreased potency, breast enlargement
- Headache, blurred vision
- Weakness, chilliness, weight gain with hypothyroidism
Diagnostics
The doctor clarifies the color and nature of the discharge, their connection with pressure, examines and palpates the glands and lymph nodes. The first tests are prolactin and TSH, and in women of childbearing age pregnancy must be excluded. Prolactin is taken in the morning, in a calm state, without breast stimulation the day before, since stress and examination can increase it. If prolactin is persistently elevated, an MRI of the pituitary gland is prescribed. Ultrasound of the mammary glands or mammography according to age helps to exclude changes in the breast itself.
- Examination and palpation of the mammary glands
- Prolactin, repeat if necessary
- TSH and free T4
- Pregnancy test (HCG)
- Breast ultrasound or mammography
- MRI of the pituitary gland with high prolactin
Treatment
Treatment is directed to the cause. If galactorrhea is caused by a medication, the doctor decides whether it can be replaced: you cannot stop medications, especially psychiatric ones, on your own. For hypothyroidism, thyroid hormones are prescribed and the discharge usually resolves. Prolactinoma is most often treated with dopamine agonist tablets, which reduce prolactin and reduce tumors; Surgery is rarely needed. Idiopathic galactorrhea without cycle disorders often does not require treatment - it is enough not to stimulate the breasts and to be observed.
- Replacement of the provoking drug according to the decision of the attending physician
- Correction of hypothyroidism
- Dopamine agonists for hyperprolactinemia
- Neurosurgical treatment - in rare cases
- Do not express or test secretions with pressure.
- Prolactin control and dynamic examination