Galactorrhea – morbid breast milk discharge – is a disease of the mammary gland in which there is a secretion of milky secretion from the mammary gland. The disease can be unilateral or bilateral and often varies in severity. Although galactorrhea is actually a painless condition, the breast may become tense, which patients may find painful.
What is galactorrhea?
Galactorrhea, or abnormal breast milk discharge, is a condition of the mammary gland in which milk secretions leak from the nipple (breast). During pregnancy and breastfeeding, the leakage of milk is normal, which is why galactorrhea is not considered a disease until outside of these periods. The milky secretion may be discharged in galactorrhea either in response to light pressure or even spontaneously. Unlike morbid mammary gland secretion (secretion of other secretions), galactorrhea is only a form of morbid fluid secretion in which milk is discharged. The disease is usually due to hormonal disorders as well as fluctuations in hormonal balance and thus has no real independent clinical picture. The hormone prolactin, which is produced by the pituitary gland, plays a significant role in the development of the disease.
Causes
The causes of galactorrhea vary widely. Usually, the condition develops due to overproduction of the hormone prolactin. This hormone promotes milk production, which naturally promotes galactorrhea. The main cause of galactorrhea is therefore hormonal disorders, but other causes are also conceivable. For example, the pituitary gland, which is responsible for the production of prolactin, may also have a prolactinoma – i.e. a tumor that produces prolactin. In most cases, such a tumor is benign. Mastitis (inflammation of the mammary gland), a benign breast tumor (mammary duct papilloma) or an early stage of breast cancer can also be causes of galactorrhea. Another cause of a physical nature, galactorrhea can occur as a result of hypothyroidism. Nonphysical causes of galactorrhea often include medications such as blood pressure medications, psychotropic or gastrointestinal drugs, and birth control pills. Drugs such as heroin and other opiates can also lead to this condition. Non-pathological causes that can also cause galactorrhea include nipple stimulation, stress and physical exertion, or sexual intercourse.
Symptoms, complaints and signs
Galactorrhea is manifested by milky or clear secretions from the nipple. The secretions are usually white to amber in color and relatively odorless. The milk may be discharged from one side of the breast or from both breasts. Usually, a few drops to a few milliliters of milk are secreted per day. Galactorrhea usually does not cause any other symptoms. However, some patients suffer from menstrual cramps, such as delayed or premature menstruation, severe period pain, or cramps in the abdomen. Occasionally, abnormal breast milk discharge is accompanied by a feeling of tightness in the breasts. Galactorrhea is classified into three grades. Grade 1 is associated with a small discharge of a few drops as well as mild menstrual pain. Grade two galactorrhea usually means a noticeable discharge, often accompanied by a feeling of tightness in the breasts and persistent menstrual cramps. In the third degree, there is spontaneous secretion and various accompanying symptoms such as a feeling of illness or even fever. Regardless of the degree of discharge, there may be inflammation around the nipples, tenderness, and overheating of the breasts. Symptoms resolve on their own after a few days to weeks and usually do not require medical treatment.
Diagnosis and course
Galactorrhea can normally only be diagnosed by a doctor. He or she will first inquire about the exact symptoms and take a medical history. The color and consistency of the discharged secretion are important for a reliable diagnosis, and the menstrual cycle and possible use of medication are also important for an accurate diagnosis. Often, palpable changes in the breast tissue can also be felt when the breast is palpated.To confirm the diagnosis of galactorrhea, a blood test is usually performed to determine the concentration of the hormones prolactin, progestin and estrogen. Thyroid levels also play into the diagnosis. In addition, ultrasound is also used for diagnosis. A mammogram is also useful. In advance of this, a so-called galactography is performed, in which a contrast medium is injected into the milk duct with a thin tube. With the mammogram, the doctor can then see whether the milk ducts are blocked or dilated. If a tumor is suspected, the physician will order either an MRI or a CT scan. As a rule, the course of galactorrhea is benign, which is why the prognosis is also quite positive. Often the symptoms can be treated well and have disappeared following therapy. Milk secretion can usually be stopped by medication. If the cause of galactorrhea is breast cancer, the further course always depends on the stage of the cancer as well as its therapy.
Complications
Galactorrhea is caused by an excess of the hormone prolactin. A common reason for this phenomenon is the use of certain psychotropic drugs that cause a hormonal change in the body (for example, certain neuroleptics). Pathological breast milk discharge is accompanied by numerous complications. The breast enlarges unnaturally, and sufferers also often experience tension pain in the breast. It is therefore not just an aesthetic problem. Too much of the hormone prolactin can also cause menstrual irregularities: This means that the natural menstrual period occurs only irregularly or fails to appear at all. In the long term, this can lead to osteoporosis in middle or mature age. In addition, a possible desire to have children often remains unfulfilled because the ovaries and uterus are “asleep”, so to speak. This is because an excess of the hormone prolactin tricks the body into thinking it is permanently pregnant, so that there is no longer any implantation. In addition, the likelihood of cancers such as breast cancer and uterine cancer is increased if galactorrhea is not treated. Affected individuals should have the hormonal abnormalities in the body treated because of the possible drastic consequences. Certain medications exist on the market that can regulate prolactin levels. If these attempts fail, additional hormones must be given, but these are again not free of risks such as an increased risk of cancer. Ideally, the medications that cause abnormal breast milk discharge can be discontinued or replaced with others that do not have these accompanying symptoms.
When should you see a doctor?
Women who have secretions coming out of their breasts without having been pregnant and who have recently given birth should see a doctor. Breast milk production outside of a gestation is considered unusual and should be examined by a physician. If breast tenderness occurs that is not related to the onset or presence of menstrual bleeding soon, as well as pregnancy, a physician should be consulted. In case of hormonal imbalances, mood swings and changes in libido, it is advisable to consult a doctor. If there are persistent tearful moods, aggressive behavioral tendencies or melancholic phases without comprehensible reasons, a doctor should be consulted. Irregularities of the female cycle, a strong stress experience as well as changes in life circumstances can trigger galactorrhea. Medical help should be sought as soon as medical support is needed to cope with the events. If breast milk leaks repeatedly as well as sporadically, or if the amount of fluid increases, the symptoms should be clarified by a doctor. In case of breast pain, a general feeling of illness, inner restlessness or malaise, a doctor should be consulted. If the woman suffers from the aesthetic problem, feelings of shame develop or emotional problems set in, it is advisable if the complaints are discussed with a doctor.
Treatment and therapy
The therapy of galactorrhea strongly depends on the cause of the disorders. In cases of hormonal imbalances and fluctuations, the physician will probably seek drug treatment with bromocriptine. This agent inhibits the action of the hormone prolactin. This drug is also often used for prolactinoma.Only if treatment with medication is unsuccessful is it necessary to remove the prolactin – but this is very rarely the case. If galactorrhea is only an accompanying symptom of another disease, the underlying disease must first be treated in a targeted manner. If galactorrhea has developed as a result of inflammation of the breast, it makes sense to prescribe anti-inflammatory drugs or even antibiotics. If galactorrhea is caused by taking medication, it can be assumed that it will also disappear when the corresponding medication is discontinued. However, discontinuation of medications should be done only after consultation with a doctor in case of suspicion. Emergency there are also alternatives to the previous preparation.
Outlook and prognosis
The prognosis of galactorrhea depends on the presenting cause. If milk leakage occurs in women during the lactation period, it is considered natural and is not considered a disease or disorder. With the process of weaning, there is normally an automatic regression of the symptoms until there is a complete recovery. In the case of a hormonal disorder, relief of symptoms is rarely documented without treatment. They symptoms remain constant over a longer period of time or increase in intensity and extent. The hormone balance should be treated with medication so that there is an improvement in the patient’s health. With optimal therapy, most patients experience a cure. In addition, a chronic course of the disease is also possible. As soon as treatment is interrupted, a relapse of the symptoms is to be expected. Patients in whom an inflammatory process is identified as the cause have a good chance of recovery. As soon as the pathogens have been killed and transported out of the organism, a regression of the complaints sets in. The healthier the body’s defense system, the faster the healing process. In the case of stress-induced galactorrhea, a change in lifestyle is crucial for a cure. As soon as the emotional and mental stresses are relieved, the symptoms ease.
Prevention
Galactorrhea cannot be effectively prevented. General measures for prevention are not known, since the pathological breast milk discharge can be attributed to a wide variety of causes.
Aftercare
In most cases, the possibilities or measures of aftercare for galactorrhea are very limited. In this case, the affected person is primarily dependent on a rapid and, above all, early diagnosis, so that further complications and complaints do not occur. Only by early detection of this complaint can further restrictions on the quality of life be avoided. Therefore, the early diagnosis of galactorrhea is in the foreground. The treatment itself is usually carried out by taking medication, although it is not possible for the condition to heal itself. Since antibiotics are also taken in most cases, those affected should ensure that they are taken regularly and also in the correct dosage. In most cases, the antibiotics must continue to be taken even after the symptoms have subsided. They should also not be taken together with alcohol, otherwise their effect is weakened. In the case of galactorrhea, the nipples should also be checked regularly for inflammation so that this can also be detected and treated at an early stage. If the symptoms have subsided, no further follow-up is necessary. The patient’s life expectancy is also not negatively affected by this disease.
What you can do yourself
In the case of galactorrhea, to avoid unpleasant situations in everyday life, patients should make sure that they wear protected clothing. This should be chosen in such a way that a milk discharge cannot be seen by people in the environment and, consequently, soaking is avoided. It is suitable to use nursing pads, which can be purchased in drugstores. Since the disease causes a feeling of tension in the breast, the wearing of very tight clothes should be avoided. This increases the internal pressure and the existing tension by another. With loose-fitting clothing, the patient often has the feeling that he or she can breathe more easily and feels more comfortable. Talking to relatives, doctors and other patients helps to reduce worries and fears.On the Internet, there are various digital contact points where those affected can exchange information with each other and provide mutual assistance for coping with the symptoms in everyday life. The tips described there can be tried out independently and strengthen the patient’s well-being. In addition, relaxation techniques have proven effective in reducing stress in everyday life. Via techniques such as yoga or meditation, those affected can perform exercises on their own responsibility and according to individual preferences in order to build up their mental strength.
