Nipple Discharge (Galactorrhea): What Can I do?

What is galactorrhea?

Galactorrhea is nipple discharge that is milky in color but not related to normal breast milk during breastfeeding. This is not a disease in itself. However, it could be a sign that something is wrong somewhere. In fact, it points to an underlying problem. Also, it may prevent pregnancy.

Galactorrhea occurs usually in women. It may also occur in women who have never had children or in women that have reached menopause. It is important to note that galactorrhea can also occur in men and in infants.

Galactorrhea may occur due to the disorders of the pituitary gland, excessive breast stimulation and medication side effects. Galactorrhea often occurs due to an increase in the levels of prolactin. Prolactin is a hormone that stimulates milk production.

Sometimes, it may be difficult to determine the cause of galactorrhea and the condition may resolve on its own.

What are the causes of galactorrhea?

Galactorrhea may result from events in the pituitary gland and hypothalamus

Increased levels of prolactin will cause galactorrhea. As mentioned previously, prolactin is responsible for milk production following childbirth. Pituitary gland produces prolactin, as well as secretes and regulates several hormones. Pituitary gland is a small bean-shaped gland at the base of the brain.

Possible galactorrhea causes include:

• Birth control pills
• Chronic kidney disease
• Use of opioids (oxycodone and fentanyl)
• Medications such as antidepressants (paroxetine, selective serotonin reuptake inhibitors), high blood pressure drugs (methyldopa), and certain sedatives
• Hypothyroidism
• Herbal supplements such as fenugreek seed, anise or fennel
• Disorders of the pituitary gland such as pituitary tumor (prolactinoma)
• Stress
• Chest surgery, burns and other chest injuries resulting in nerve damage to the chest wall
• Excessive breast stimulation due to prolonged clothing friction, frequent breast self-examination or sexual activity with nipple manipulation
• Spinal cord tumors, injury or surgery

Galactorrhea may be of unknown cause (Idiopathic)

Sometimes, your doctor may not be able to find a cause for your galactorrhea. In this case, it is known as idiopathic galactorrhea. This means that your breast tissue may just be sensitive to the hormone in your blood that produces milk – prolactin. So if you are highly sensitive to prolactin, it means that a normal prolactin level in your blood may cause galactorrhea.

Can galactorrhea occur in men?

Galactorrhea may occur in men. In males, it may be associated with the deficiency of testosterone known as male hypogonadism. Galactorrhea in men usually occurs with the enlargement and tenderness of the breasts known as gynecomastia.

Can galactorrhea occur in newborns?

Sometimes, galactorrhea may occur in newborns. This happens when high levels of maternal estrogen enter the baby’s blood via the placenta. If this happens, the baby’s breast tissue may enlarge and cause a milky nipple discharge. However, this milky nipple discharge resolves on its own over time. But if the galactorrhea is persistent, speak with your doctor about it for prompt evaluation of the newborn. 

What are the symptoms of galactorrhea?

Here are the signs and symptoms of galactorrhea:

• Intermittent or persistent milky nipple discharge
• Nipple discharge from multiple milk ducts
• Vision problem
• Headache
• Manually expressed or spontaneous nipple discharge
• Irregular or absent menstrual periods
• One or the two breasts affected

When can I see a doctor?

Speak with your doctor if you have a spontaneous and persistent milky nipple discharge, and you’re not pregnant or breastfeeding. The discharge may be from one or both of your breasts.

Note that breast stimulation due to excessive nipple manipulation during sexual activity may also cause nipple discharge from multiple ducts. If this happens, you have little or no cause for worry. The nipple discharge may have signaled anything abnormal. Also, this discharge may resolve on its own.

For the umpteenth time, if you have persistent nipple discharge that doesn’t resolve, visit your doctor for evaluation.

Do you have non-milky nipple discharge? Is the nipple discharge particularly bloody, yellow or clear spontaneous and coming from one duct? Is it associated with a lump? Then you need a prompt medical attention as you may be having an underlying breast cancer.

How to diagnose galactorrhea?

There are many possibilities in diagnosing galactorrhea. Therefore, finding the underlying cause may be a complex task.

Your doctor may do the following tests:

A physical examination

Your doctor may try to express some fluid from your nipple during a physical exam. S/he will do that by gently checking the area around the nipple. Your doctor may also check for thickened breast tissue and breast lumps.

A pregnancy test

A pregnancy test is done to be sure that pregnancy is not the cause of your nipple discharge.

Nipple discharge analysis

An analysis of the fluid discharged from your nipple will be done. Analysis will help find if fat droplets are present in the fluid, thus confirming galactorrhea diagnosis.

Mammography and ultrasound

Your doctor may recommend mammography and/or ultrasound depending on the outcome of a physical examination.

Mammography and/or ultrasound will be done to get images of your breast tissue. These images will show if you’ve a breast lump and the state of the lump. They may also show other suspicious breast or nipple changes.

A blood test

A blood test will check the level of prolactin in your blood. If your prolactin level is high, your doctor will also check your blood level of thyroid stimulating hormone.

Magnetic resonance imaging (MRI)

MRI of the brain can be done to check for a tumor or other disorder of the pituitary gland. Your doctor may recommend this test if your prolactin level is elevated.

As mentioned previously, certain medications can cause galactorrhea. So if your doctor suspects that your galactorrhea may be due to a medicine you’re taking, s/he may ask you to stop taking it for a while to assess whether that is the possible cause.

What are the treatment options for galactorrhea?

In treating galactorrhea, your doctor will focus on the underlying cause. Sometimes, your doctor may not determine the cause of your galactorrhea.

However, if you have persistent and bothersome nipple discharge, your doctor will recommend treatment anyway. For example, s/he may recommend you take a medication that blocks the effects of prolactin.  Similarly, a medication that lowers your body level of prolactin will help eliminate galactorrhea.

1. Possible underlying causes and treatment:

Use of certain medications

If your galactorrhea is due to the use of medication(s), your doctor will ask you to stop taking the medication(s). You need to make medication changes based only on your doctor’s recommendations.

Hypothyroidism (underactive thyroid gland)

Hypothyroidism will be treated by taking a medication such as levothyroxine (such as Synthroid or Levothroid). This drug helps to counter inadequate production of hormone by your thyroid gland. This is also known as thyroid replacement therapy.

Prolactinoma (Pituitary tumor)

Your doctor can recommend a medication to shrink the tumor. S/he may also ask you to have a surgery to remove the tumor.

Idiopathic galactorrhea (unknown cause)

If your galactorrhea is found to be of unknown cause, you may take a medication such as bromocriptine or cabergoline. These drugs help lower your blood level of prolactin and minimize or even stop milky nipple discharge.

However, common side effects of bromocriptine and cabergoline include dizziness, headache and nausea.

2. Possible lifestyle and home remedies

It is important to note that milky nipple discharge due to idiopathic galactorrhea often stops on its own. This is more so if you can avoid breast stimulation or medications that may cause nipple discharge.

What can you do to reduce breast stimulation? Here are a few simple ways to get your breast less stimulated:

• Avoid manipulating your nipples
• Avoid pinching or squeezing your nipples
• Wear clothes that do not cause friction between your nipples and the fabric
• During sexual activity try not to overstimulate your nipples

How do I prepare to visit the doctor?

Do you want to see your family doctor or gynecologist for evaluation? Or, do you want to see a breast health specialist for proper examination and treatment?

To prepare for your appointment with the doctor, you have to do the following:

• Take note and remember all your symptoms, including those that seem unrelated to the reason for your appointment.
• Be ready to provide your personal information including recent life changes and major stresses.
• Take note of all the medications you take.
• Prepare your questions for the doctor.

What are the important questions to ask your doctor?

• What is the most likely cause of my symptoms?
• What are the other possible causes?
• Are there tests to do and what kinds of tests do I need?
• What is your treatment recommendation for me?
• Can I try any at-home remedies and what are they?

What are the questions your doctor may ask you?

• What is the color of your nipple discharge?
• Are your two breasts affected or is it only one breast that is affected?
• Do you have other breast symptoms such as area of thickness or a lump?
• How often do you self-exam your breasts?
• Do you experience breast pain?
• Are you pregnant or breastfeeding?
• Have you observed any breast changes?
• Are your menstrual periods regular?
• Do you find it difficult to get pregnant?
• Are you on medications? If yes, name them.
• Do you have vision problems or headache?

Conclusion

Most people with galactorrhea recover fully once the cause is determined. Medications can help manage any symptoms pituitary gland tumors cause.

Until you meet with your doctor, try and deal with your nipple discharge by avoiding breast stimulation. In addition, use breast pads to absorb nipple discharge and prevent it from staining your clothing.

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