Breast discharge or galactorrhea

During pregnancy and especially postpartum, a hormone called prolactin, which is responsible for activating it to produce milk. If the prolactin rises outside the milk production which can be observed spontaneously or by squeezing the nipple. This is what we call galactorrhea and it does not have to be a serious problem, but it is convenient to study it to find out the cause and be able to give a treatment. It should be noted that the discharge is white and yellowish or bloody fluid is not considered galactorrhea.

What can cause discharge from the breasts?

The causes of galactorrhea are basically three: endocrine problems, side effects of certain chemicals, and mechanical stimulation. There are also rarer cases in which it is associated with systemic or infectious diseases or kidney or liver problems. And in a significant percentage there is no apparent cause.

Endocrine problems

It is produced by a dysfunction of a gland that secretes a hormone in excess or defect. At the base of the brain there is a gland called the pituitary that acts as a central command giving orders to other peripheral glands such as the thyroid, ovaries, or mammary gland. It is in the pituitary gland that this hormone called prolactin.

• If there is a tumor secreting prolactin, called prolactinoma, we will find high levels of this hormone in the blood and one of the symptoms it will cause is the secretion of milk and, in the case of women, the suppression of menstruation. These prolactinomas are benign, often small tumors that are treated with a drug that inhibits prolactin production. Only if they are large can they cause alterations in vision due to their proximity to the optic nerve or headaches. In these cases in a relatively simple way, since the gland is approachable through an incision below the upper lip, accessing from the maxilla through the base of the nose.
• Other times prolactin may rise as a result of a thyroid disorder When there is a kind of "crossover" and an over-functioning thyroid stimulating hormone, it ends up stimulating the thyroid hormone and prolactin at the same time.
• There are newly born who can present galactorrhea in the first days of life as a result of the high levels of prolactin from the mother who received before birth through the umbilical cord.

Drugs or substances

There are different drugs and substances capable of increasing prolactin levels.

• Different groups of drugs such as some antidepressants or anxiolytics, antiemetics, antihypertensives, antipsychotics and some hormonal treatments.
• Some Dietary supplements Herbs containing nettle, thistle, fennel, red clover, anise, or fenugreek seed.
• The drugs like amphetamines, cannabis, opiates ...

Mechanical stimulation

In the establishment of lactation there is a large hormonal component due to the secretion of prolactin, but there is an important part secondary to the repeated nipple stimulation.

• Example: it is possible that a woman that has not given birth establish breastfeeding. This is sometimes the case of adoptive mothers, there have also been frequent cases in tribes without access to formula milk in which grandmothers manage to breastfeed newborns when the mother has died in childbirth. In the same way, if the nipple is overstimulated during sexual intercourse or due to certain behaviors of the woman, it can cause a secondary galactorrhea.

How can I avoid it?

Treatment will depend on the cause. If it is a side effect of any treatment or substance, it is recommended suppress it whenever possible, as if it is a mechanical overstimulation of the nipple. It should also be ruled out by prolactin level determinations or CT imaging tests or the presence of a prolactinoma in the pituitary. If the cause is another endocrine problem such as a hypothyroidism, the treatment will be. Specialist in gynecology and obstetrics