Breast galactorrhea is a condition characterized by the release of milk secretions from the breast, not associated with lactation. In addition to an ambiguous symptom, the pathology can be accompanied by pain, discomfort in the mammary glands, and can also be a sign of a tumor in the chest or brain. When should you be wary and which doctor should you consult with such symptoms?

The main task of the mammary glands is to produce milk to feed the baby after birth. Violation of the processes of regulation of secretion formation leads to galactorrhea. Determining the true cause is sometimes difficult. Galactorrhea occurs in 1-3% of women, and about 90% of them are nulliparous. In some diseases it occurs in men.

Classification

Almost always, milk secretion from the breast is accompanied by an increase in prolactin levels. But in some cases, hormone levels are normal. Galactorrhea with normal prolactin occurs if the ducts of the mammary glands are dilated, as well as in unclear clinical cases. Treatment in such situations is based on correcting the functioning of all internal organs, normalizing lifestyle and nutrition. Galactorrhea is not always associated with childbirth. The classification of galactorrhea is presented in the table.

Table - Classification of the disease

Galactorrhea is considered idiopathic, in which it is impossible to establish the true causes of the disorders.

Galactorrhea of ​​the mammary gland: what is it and why does it occur?

Galactorrhea is typical for women of reproductive age. This is not a disease, but a symptom, a consequence of hormonal imbalance or serious pathologies in the body.

Excursion into physiology

To identify the reasons for such “lactation”, it is important to understand how milk is produced in the female body. Regulation of the functioning of the mammary glands occurs “along a chain” - a system of direct and feedback between structures.

• Pituitary gland. A small but very important section in the brain. It synthesizes many hormones that coordinate the work of all internal organs. Prolactin is also formed here, acting directly on the mammary glands and being responsible for the production of breast milk.
• Hypothalamus. A second, no less important area of ​​the brain releases dopamine, a substance that suppresses the synthesis of prolactin when its action is inappropriate.
• Thyroid. Malfunction leads to changes in the secretion of thyroid-stimulating hormones in the pituitary gland, and they increase the production of prolactin.

Causes of the disease

Disruption of even one link in the chain leads to various problems with the production of breast milk. The following causes of galactorrhea can be distinguished.

• Disorders at the level of the pituitary gland. Prolactinoma (pituitary adenoma) is a hormonally active benign neoplasm that leads to excessive production of prolactin. In 95% of cases, it is several millimeters in size and is detected only with targeted CT or MRI of the brain. It does not compress the surrounding nervous tissue and is usually asymptomatic, but if you experience headaches, depression or blurred vision due to prolactinoma, you should consult a specialist.
• Disorders at the level of the hypothalamus. These brain structures influence the production of dopamine, which protects against excessive prolactin production. This is possible with Chiari-Frommel syndrome, when, due to disruption of the hypothalamus, the production of prolactin is not suppressed, it blocks the synthesis of follicle-stimulating hormone and therefore follicles do not mature in the ovary, amenorrhea appears and the menstrual cycle is disrupted. The syndrome is accompanied by galactorrhea, prolonged absence of menstruation and infertility, headaches, increased hair growth and weight problems. Disturbances in the hypothalamus can occur due to tumors, injuries, inflammation, sarcoidosis, and neurotuberculosis. Since this part of the brain is responsible for a large number of important processes, its damage makes itself felt by multiple disorders in the body - the functioning of all internal organs, the thyroid gland changes, and galactorrhea appears.
• Disorders of the thyroid gland. The conditions are always accompanied by an increase or decrease in the level of thyroid hormones (T3 and T4), to which the pituitary gland reacts and, through TSH (thyroid-stimulating hormone), tries to maintain the norm. The areas of production of TSH and prolactin are located nearby, so excess or insufficient secretion of one of them leads to changes in the level of the other. More often, hyperprolactinemia is diagnosed with hypothyroidism, less often with hyperthyroidism.
• Polycystic ovary syndrome. The pathology is characterized by a violation of the production of estrogen by the ovaries, to which the pituitary gland and hypothalamus react, and hyperprolactinemia occurs with galactorrhea.
• Medications. When taking Eglonil, oral contraceptives, other drugs with estrogens, dopamine antagonists, cimetidine, antidepressants, a side effect in the form of galactorrhea may occur. The decision to continue treatment with these drugs against the background of breast discharge is decided by the doctor; in most cases, it is recommended to abandon the drug and replace it with an alternative one.
• Liver and kidney failure. Metabolism of reproductive organs and prolactin occurs in the liver. The kidneys are involved in the excretion of metabolic products. Diseases that disrupt the functioning of these organs indirectly lead to hyperprolactinemia.

Active stimulation of the nipples during sexual intercourse or wearing a tight bra can cause galactorrhea. Diseases, injuries of the spinal cord and spine are also included in the list of causes.

Symptoms of the disease

The main symptom of galactorrhea is the discharge of white fluid from the nipples. This may be watery milk or thicker colostrum, a slightly whitish secretion. The liquid is released in the form of several drops or leaks in a fairly large amount - in a stream. One or both breasts are affected. The condition should not be accompanied by discomfort, and the secreted milk should not contain blood impurities. Such signs are especially dangerous in premenopause. Otherwise, we are talking about other breast diseases, including malignant tumors. There are three degrees of galactorrhea, which are presented in the table.

Table - Degrees of galactorrhea

Secretion may be accompanied by the following symptoms:

• enlargement and pain in the mammary glands;
• increased nipple sensitivity;
• hyperemia and maceration of the skin in the nipple area;
• traces of discharge on clothes.

In men, hyperprolactinemia can be accompanied by gynecomastia - breast enlargement, as well as decreased libido and potency.

In diseases of the hypothalamus, accompanying symptoms may include amenorrhea, headaches, problems with vision and sleep. Disturbances in the pituitary gland often lead to menstrual disorders, infertility, and osteoporosis. They are also accompanied by signs of hyperandrogenism (increased levels of male sex hormones).

When is it considered normal?

Milk secretion from the breast may be a consequence of permissible hormonal changes in a woman’s body.

• During pregnancy. The lactation process begins long before childbirth, so already during pregnancy, a woman may notice the production of milk or colostrum in one breast or in two at once.
• After the baby is born. Natural lactation begins after childbirth and continues as long as the woman breastfeeds and attaches the baby to her.
• After completion of lactation. The process of milk production can continue for up to two or even three years after a woman stops breastfeeding. The secretion is not so intense - when pressing on the areola area, a few drops of whitish liquid are released. The level of hormones that regulate milk synthesis gradually returns to normal and the manifestations of galactorrhea disappear.

Galactorrhea is normally observed after early and late miscarriages, undeveloped pregnancies, as well as in the case of premature birth. The secretion goes away on its own; if necessary, medications are prescribed to reduce prolactin levels.

Examination: specialists and tests

The cause of galactorrhea not associated with lactation is determined through a series of studies. First of all, it is necessary to exclude pregnancy. In the future, the diagnostic methods presented in the table are used.

Table - Examination for galactorrhea

Method	Why is it carried out?
Inspection and palpation	To assess the appearance of the breast and identify lumps
Gynecological history collection	To obtain data on the menstrual cycle, the presence of diseases of the reproductive system
Blood tests for hormones	- To control the functioning of the thyroid gland (T3, T4 and TSH); - to control the functioning of the genital organs and adrenal glands (estradiol, progesterone, testosterone, DHEA); - to control the functioning of the pituitary gland (prolactin, proportion of macroprolactin)
Consultation with an ophthalmologist and neurologist	To exclude a tumor process in the brain
MRI or CT	For diagnosing tumors in the brain or other organs
Ultrasound of the pelvis, adrenal glands, mammary glands, mammography	To study the structure of organs and identify abnormalities

How to take prolactin correctly

Prolactin is not only responsible for milk production, it is a stress hormone. To obtain correct test results, you must donate blood under the following conditions:

• draw blood from 8:00 to 11:00- in the early morning the concentration of prolactin is maximum, and in the evening it is minimum;
• avoid nipple irritation, sex the day before- this leads to an artificial increase in the level of the hormone;
• avoid excessive physical activity- within a few days before the test;
• avoid stress- even fear of the procedure for drawing blood or worry about how to quickly get to the laboratory can lead to a false result.

Normal prolactin levels are presented in the table.

Table - The result of the test for prolactin is normal

The release of milk secretion from the breast, not related to lactation, is a reason to consult a gynecologist, mammologist, endocrinologist or oncologist.

Treatment

Galactorrhea is not an independent disease - it is a symptom of pathological conditions. And in order to get rid of it, it is necessary to eliminate the root cause of the violations. Often the problem lies in changes in the regulation of brain structures and hormone imbalance. If galactorrhea is a complication caused by medications, you should stop using them.

Treatment is usually medicinal and includes taking drugs that suppress prolactin secretion. Sometimes it is completely impossible to eliminate the cause of galactorrhea, so you have to take medications constantly. Taking into account contraindications for use, dopamine agonists are prescribed, which simulate and enhance the effect of this substance and reduce the intensity of prolactin synthesis.

Surgical treatment is initiated in the presence of a brain tumor, which is accompanied by other symptoms - headache, dizziness. Radiation therapy is rarely used to remove a tumor in the pituitary gland or hypothalamus.

The table shows the main drugs and their dosage regimens for hyperprolactinemic galactorrhea.

Table - How to treat breast galactorrhea with elevated prolactin

With a slight increase in prolactin levels and accompanying symptoms of mastodynia (chest pain), herbal medicines, dietary supplements, and homeopathic remedies can be prescribed. It is popular to use Mastodinone, one capsule daily.

Traditional methods

The following herbs can be used to lower prolactin levels. However, they should not be given preference in case of serious disorders or tumors. Folk remedies will help with minor functional disorders.

• Periwinkle. Pour two tablespoons into 500 ml of hot water in a thermos in the evening. The next day, use 150 ml three times a day.
• Sage. You can eat half a teaspoon in the morning with plenty of water. You can prepare a solution. To do this, brew one tablespoon of leaves in a glass of water and drink instead of tea two to three times a day.
• Sorrel. Pour 10 g of crushed sorrel root into 200 ml of boiling water and leave for two to three hours. Take one to two tablespoons per day.
• Bee pollen. Take a tablespoon in the morning, lunch and evening.

The course of treatment with folk remedies is determined individually - until the symptoms of the disease decrease or disappear.

Infertility

Galactorrhea often accompanies infertility - this is why it is dangerous. An increase in prolactin levels disrupts the growth and maturation of follicles and provokes anovulation. Pregnancy is possible only against the background of correction of hormone levels with drugs. They are taken during planning, as preparation for IVF, and after confirmation of pregnancy, cancellation is almost always recommended. Regimen for the use of prolactin-lowering medications are agreed upon individually with the attending physician.

Treatment of galactorrhea should begin with a full examination and identification of the cause of the failure. However, reviews from women and doctors indicate that sometimes it is not possible to understand at what level the violations occurred.

Hyperprolactinemia is a condition in which the levels of the hormone prolactin in the blood are increased. The occurrence of such a situation is possible both normally (physiological hyperprolactinemia) and in pathology.

Physiology of prolactin production

Human prolactin is a protein hormone whose main function is to regulate lactation. Prolactin is secreted by the adenohypophysis. The pituitary gland together with the hypothalamus play the role of the main regulator of the endocrine system. In this case, the pituitary gland is closely connected with the hypothalamus and is controlled by it. It is divided into two parts - the adenohypophysis and the neurohypophysis. The neurohypophysis produces substances such as vasopressin and oxytocin. The adenohypophysis produces: somatotropic hormone, thyriotropic hormone and prolactin. The release of prolactin is controlled by the level of dopamine, a substance produced by the hypothalamus that can suppress the secretion of prolactin.
The main function of prolactin is the regulation of lactation. When a woman begins to breastfeed, irritation of the receptors in the nipple area is transmitted to the brain, the hypothalamus “gives a signal” to the pituitary gland to release a large amount of prolactin.
In addition, prolactin is necessary to inhibit the ovulatory cycle - a woman’s body’s way of preventing pregnancy during breastfeeding; promotes the growth of mammary glands; has an analgesic effect; contributes to the onset of orgasm, etc.

Norm prolactin

Normally, the average prolactin content in the blood is no more than 15 ng/ml, it secreted in impulses, on average there are up to 14 emissions per day. Prolactin reaches its maximum values ​​between 5:00 and 7:00 in the morning, and its minimum values ​​a few hours (3-4 hours) after waking up. During lactation, irritation of receptors in the nipple area leads to the release of prolactin. In addition, the secretion of prolactin is influenced by the levels of estrogen, thyroid hormones and some others. Physical and emotional stress and taking certain medications can also increase hormone levels.

The most common standards are:

Adult women - 64 – 595 mIU/l (from 1* to 27-29 ng/ml)
Adult men - 78 – 380 mIU/l (from 1* to 18 ng/ml)

In addition, prolactin levels in women fluctuate (albeit slightly and within normal limits) depending on the phase of the cycle:

Follicular: 252 – 504 mIU/l (4.5 – 23 ng/ml)
Periovulatory: 361 - 619 mIU/l (5 – 32 ng/ml)
Luteal: 299 – 612 mIU/l (4.9 – 30 ng/ml)

All these norms are very relative.

Reasons for increased prolactin

The main causes of hyperprolactinemia include: 1. Physiological reasons:
- Newborn - Nipple irritation - Pregnancy, the entire postpartum period (for non-lactating mothers - from 1 to 7 days) - Eating, sleep, stress, sexual intercourse. 2. Pathological causes: - Pathology of the hypothalamus and pituitary stalk (empty sella syndrome, cysts, tumor lesions, neurosyphilis, histiocytosis X, sarcoidosis, tuberculosis, mechanical damage) - Pathology of the pituitary gland

• Pituitary adenoma (prolactinoma, somatotropinoma, corticotropinoma, hormonally inactive adenoma)
• Craniopharyngioma
• Primary hypothyroidism
• Metastases of malignant tumors
• Sarcoidosis, tuberculosis

- Major operations, general anesthesia - Pathology of the chest (burn, herpes zoster) - Cirrhosis of the liver - Chronic renal failure - in 20-75% of women. The level returns to normal after kidney transplantation. 3. Taking medications:
- Dopamine receptor blockers - Drugs that reduce dopamine levels (methyldopa, reserpine, estrogens, verapamil, etc.) - Phenothiazines (thioxanthenes, butyrophenones, amoxapine, etc.) - Oral contraceptives Functional hyperprolactinemia is observed with endometriosis, uterine fibroids, inflammatory processes. Transient hyperprolactinemia, often accompanying infertility, is manifested by the luteolytic effect of prolactin on the corpus luteum. Functional hyperprolactinemia is observed in about a third of women with PCOS, which is caused by a violation of dopaminergic control of not only the synthesis and release of GnRH (Gonadotropin-releasing hormone or gonadorelin, gonadotropin-releasing hormone, gonadotropin-releasing factor), but also prolactin. In addition, chronic hyperestrogenism (sustained increase in estrogens, in particular estradiol) in PCOS has a stimulating effect on prolactin synthesis.

The effect of hyperprolactinemia on reproductive function

Under the influence of prolactin, the sensitivity of the hypothalamus to estrogens decreases, as a result, the synthesis and release of GnRH, and as a consequence the level of FSH and LH, decreases;
In the ovaries, prolactin inhibits gonadotropin-dependent synthesis of steroids and reduces the sensitivity of the ovaries to exogenous gonadotropins.
An increase in prolactin reduces the secretion of progesterone by the corpus luteum.

The most common causes of hyperprolactinemia remain microprolactinomas (benign tumors of the pituitary gland, less than 1 cm in size) and pituitary hyperplasia. In most other cases, hyperprolactinemia plays a secondary role and is eliminated along with the elimination of the underlying pathology. Thus, normalizing the function of the thyroid gland in hypothyroidism, as a rule, immediately helps normalize the situation.

Manifestations of hyperprolactinemia

Symptoms of hyperprolactinemia, in addition to the steady increase in prolactin itself (several times more than normal), in women include:

1. Amenorrhea (no menstruation) - in approximately 15% of cases. Anovulation and cessation of menstruation are observed.
2. Galactorrhea (discharge from the nipples) is a pathological spontaneous leakage of milk from the mammary glands, unrelated to the process of feeding the child.
3. Hyperestrogenism – vaginal dryness, dyspareunia (painful sexual intercourse), decreased libido. Over a long period of time, osteoporosis may develop.
4. Deterioration of vision - is a consequence of an increase in the size of the pituitary tumor, which compresses the optic nerves.
5. Delayed sexual development (as a symptom of pituitary pathology, which can affect the production of PRL, TSH, STH) - it is also necessary to check the TSH level.
6. A combination of hyperprolactinemia with hyperandrogenism is possible - as a result of increased secretion of prolactin, the activity of the adrenal glands increases.

In addition, hyperprolactinemia can also occur in men. It leads to decreased libido and impotence.

Although galactorrhea is the most characteristic symptom of hyperprolactinemia, the prolactin level in half of the patients with galactorrhea is normal and the amount of discharge from the breast (from drops of colostrum when pressed to the spontaneous flow of milk) does not directly depend on prolactin numbers. This may be due to the fact that the hyperprolactinemia was transient but resulted in persistent galactorrhea.

Recent studies have shown that receptors for prolactin have been found in the zona reticularis of the adrenal cortex. Therefore, 30-40% of women with hyperprolactinemia have increased levels of adrenal androgens - DHEA and DHEA-S, and their level decreases during treatment with bromocriptine. In addition, the overproduction of androgens can be explained by the commonality of the hypothalamic regulation of the prolactin-secreting and ACTH-secreting functions of the pituitary gland. A decrease in the level of PSSG (sex hormone binding globulin (SHBG, SSSG, TESH)) is explained by the direct effect of prolactin on the liver, where they are synthesized.

Among other effects of prolactin, of interest is its diabetogenic effect, associated with the direct stimulating effect of prolactin on pancreatic cells, which can lead to to the development of peripheral insulin resistance, ovarian hyperandrogenism and the formation of PCOS.

In addition, prolactin promotes demineralization of bone tissue by suppressing the secretion of calcitonin, as well as reducing the synthesis of estrogen in the ovaries, so women with hyperprolactinemia are at risk of developing osteoporosis.

Diagnosis of the causes of hyperprolactinemia

After collecting anamnesis and detailed clarification of the patient’s complaints, the doctor should carry out the following diagnostic measures:

1. Blood sampling to determine the level of the hormone in the blood is carried out on days 5-8 of the cycle, from 9 to 12 am on an empty stomach (but not earlier than 3-4 hours after waking up), after sexual abstinence the day before. If a suspended level is detected, take it 3 times to eliminate errors. The upper limit of normal can be values ​​from 15 to 25 ng/ml (varies in different laboratories).

2. Determination of the level of thyroid hormones - a change in their level may indicate the presence of pathology in the area of ​​the pituitary gland where prolactin is produced. Hypothyroidism is characterized by changes in behavioral reactions (apathy, indifference, memory impairment), which is associated with a sharp decrease in metabolic processes in the central nervous system, resulting from a decrease in the concentration of thyroid hormones. There is also severe weakness, fatigue with impaired ability to work, swelling, dry skin, brittle nails and hair loss, constipation. Sometimes the first manifestation of hypothyroidism is spontaneous galactorrhea with various menstrual irregularities. The decisive role belongs to the study of blood hormones, in which there is an increase in TSH and a decrease in thyroid hormones - T3 and T4 against the background of increased or normal levels of PRL (prolactin).

3. Functional tests - Tests with metoclopromide and thyrotropin-releasing hormone (dopamine antagonists).
When metoclopromide is administered (10 µg into the blood with prolactin levels determined at 0, 15, 30, 60 and 120 minutes of the study), the prolactin level normally increases 10-15 times, while in pathology it is stable. With physiological hyperprolactinemia, the level continues to rise.
With the introduction of thyrotropin-releasing hormone (200-250 mcg simultaneously with measurement of prolactin levels at 0, 15, 30, 60, 120 minutes of the study), it is also possible to clarify the nature of hyperprolactinemia, since in the case of a hyperprolactinemia caused by other (non-pituitary) factors, the prolactin level is significantly higher than with prolactinoma, in which after the administration of thyroliberin the level of prolactin is lower.
It should be noted that these tests have lost their importance due to the advent of more advanced computer diagnostic methods.

4. Craniogram (x-ray of the skull in 2 projections) – thanks to this, it is possible to diagnose the sella turcica (the area where the pituitary gland is located in the sphenoid bone of the skull).

5. Examination of the fundus and visual fields is mandatory as part of the examination of women with hyperprolactinemia, especially in the presence of oligo- and amenorrhea. Changes in the vessels of the fundus and/or bitemporal narrowing of the visual fields to white, red, green and blue may indicate the presence of a pituitary tumor located above the sella turcica, suprasellar.

6. Computed tomography (CT) and magnetic resonance imaging (MRI) - today MRI is the method of choice for diagnosing pituitary gland pathology. CT scanning is not indicated for women planning pregnancy.

It is important to emphasize that CT and MRI, as well as craniography, make sense only if there is no previously diagnosed pathology in other organ systems, one of the symptoms of which is hyperprolactinemia.

Transvaginal echography helps in the differential diagnosis of PCOS. Hyperprolactinemia is characterized by multifollicular ovaries, which are characterized by normal size and volume with many follicles with a diameter of 4-8 mm, diffusely located in the stroma.

Laparoscopy is performed for women with hyperprolactinemia and infertility with a regular ovulatory menstrual cycle, since in this group of women an increase in PRL is not the cause of infertility and occurs secondary to various gynecological pathologies. During laparoscopy, the most common pathology is external endometriosis, chronic salpingitis, and adhesions in the pelvis.

Functional hyperprolactinemia is characterized by the absence of changes in the sella turcica on radiographs and CT scans increase in PRL level to 2000 mIU/l and positive functional tests. The menstrual cycle is regular in 32% of women, oligomenorrhea in 64%. Galactorrhea is detected in approximately 30% of patients. Hyperplastic processes of the endometrium and mammary glands are 2 times more common than with tumorigenesis of hyperprolactinemia. In 80% of patients, concomitant pathological processes are detected: PCOS, external endometriosis, inflammatory diseases and adhesions in the pelvis.

Pituitary microadenoma is characterized by the absence of changes on the radiograph and the presence of a space-occupying formation in the pituitary gland according to CT data. PRL level is 2500-10000 mIU/l, functional tests are negative. Menstrual irregularities such as amenorrhea in 80% of women, oligomenorrhea in 20%. The frequency of galactorrhea reaches 70%. Concomitant gynecological pathology occurs in 15% of cases. The effect of bromocriptine therapy is up to 85%.

Pituitary macroadenoma is characterized by pathological changes on the radiograph: increased size, double-contour bottom, signs of sclerosis, violation of the integrity of the contours and/or widening of the entrance to the sella turcica. CT scan shows areas of increased density in the area of ​​the pituitary gland. PRL level is above 5000 mIU/L. Functional tests are negative. Amenorrhea in 100% of women, galactorrhea in 96% of cases.

With an “empty” sella turcica, there is a discrepancy between clinical, radiological and hormonal parameters. At a PRL level of up to 3000 mIU/l, the sella turcica is not changed on an x-ray, but a CT scan shows a typical picture of an “empty” sella turcica. Functional tests are negative. Menstrual irregularities from oligomenorrhea to amenorrhea with or without galactorrhea.

Treatment of hyperprolactinemia

First of all, it is necessary to exclude primary hypothyroidism, the treatment of which is carried out with thyroid drugs under the supervision of a general endocrinologist (thyroid drugs are prescribed: thyroidin, L-thyroxine or thyrocomb); against the background of such treatment, the level of prolactin, as a rule, decreases. Treatment is usually long-term and under the control of blood hormones and the general well-being of the patient. During pregnancy, it is necessary to continue taking thyroid medications, since hypothyroidism is the cause of non-developing pregnancies and fetal malformations.

With functional hyperprolactinemia against the background of various gynecological diseases in women with infertility, treatment of the underlying disease should be a priority. After this, when planning pregnancy, small doses of parlodel (1.25-2.5 mg per day) can be prescribed under the control of blood prolactin and basal temperature. In women with PCOS, treatment with Parlodel is carried out against the background of ovulation stimulation at a dose of 1.25-2.5 mg per day and is discontinued upon pregnancy.

In case of hyperprolactinemia caused by microprolactinemia or pituitary hyperplasia, in patients who do not plan to have children in the future, in the absence of menstrual irregularities, observation is limited. If the menstrual cycle is disrupted in such women, hormone replacement therapy is indicated.

The main drug for the treatment of hyperprolactinemia is bromocriptine (Parlodel). It suppresses the secretion of prolactin by activating dopamine receptors and the release of dopamine. As a rule, 1.25 mg/day is prescribed, then every third week 1.25 mg/night is added, and every 4th week 1.25 mg/morning under the control of prolactin in the blood. Contraindicated for liver disease. Cancellation of the drug is possible after 2-3 years. Ultrasound monitoring is mandatory (6-12 months after normalization of prolactin levels). Ovulation is restored, as a rule, in the 4-8th week of treatment. For macroprolactinoma, bromocriptine can significantly reduce tumor size (up to 30% of the original). MRI in this case every 6 months, because education may increase again.

The use of bromocriptine is possible during pregnancy in short courses; breastfeeding is not contraindicated. It has been established that pregnancy during treatment with Parlodel in patients with pituitary microadenoma proceeds safely. During pregnancy, observation by a neurologist and an ophthalmologist is mandatory. The risk of developing a tumor during pregnancy can be avoided by pre-treatment with Parlodel for a year or more.

Therapy with the following drugs is possible: lisuride, terguride, cabergoline (1 mg per week) - longer action, metergoline and dihydroergocryptine - fewer side effects, but also lower efficiency. Prescription of drugs is carried out by a qualified endocrinologist.

Surgical treatment for hyperprolactinemia

If bromocriptine is ineffective, as well as persistent progression of the process (for example, visual field impairment), surgical treatment is indicated, which, unfortunately, does not exclude relapses of the disease. Surgical access is usually carried out through the nasal sinuses, with the removal of pathological tissue. The operation is carried out in a specialized hospital by a qualified team of surgeons, as serious complications are possible: injury to the internal carotid artery, meningitis, oculomotor nerve palsy, etc. In this case, if the decision is made to perform surgery, treatment with bromocriptine is stopped, because after it the tissue becomes denser and this complicates the intervention. A positive effect of surgical treatment is considered to be normalization of prolactin levels within 2 hours after surgery and the presence of ovulation in the next cycle.

Complications of hyperprolactinemia

1. It is possible to develop pituitary insufficiency, and as a consequence, insufficiency of the endocrine system organs - in this case, it may be necessary to use hormonal therapy aimed at correcting the insufficiency of one or another endocrine organ - adrenal glands, thyroid gland, etc.
2. Compression of the optic nerve - manifested by a decrease in visual fields, a sharp deterioration and loss of vision until the compressive effect of the tumor is eliminated.
3. Osteoporosis – with a long-term uncorrected process.
4. Possible malignancy of benign pituitary tumors.

Features of the state of hyperprolactinemia

It is difficult to choose a method of contraception in women who have undergone treatment for hyperprolactinemia and have completed their generative function, since the most popular estrogen-containing combined oral contraceptives, which increase prolactin, are contraindicated for them. In addition, there is evidence that an increase in prolactin is also observed against the background of an intrauterine device, which is associated with constant irritation of endometrial receptors. Based on the above, the method of choice is laparoscopic sterilization or oral contraceptives containing pure gestagens, as well as prolonged ones - Depo-Provera, the popularity of which is low due to side effects in the form of acyclic bleeding.

Hyperprolactinemia in men

We should touch upon this condition in a few words. Hyperprolactinemia occurs much less frequently in men, but in men the most common cause is pituitary macroadenomas. An increase in the level of prolactin in the blood, as a rule, is not much higher than 25-30 ng/ml. When the numbers reach 200, we can confidently speak about a tumor process. A serious sign is loss of visual fields - this may indicate tumor growth.
The most common clinical manifestations of hyperprolactinemia in men are: decreased libido and impotence, the cause of which is initially considered to be “psychogenic factors”, softening of the testicles, gynecomastia (breast swelling), osteoporosis.

Galactorrhea is the release of milk from the breast not associated with childbirth. It most often occurs when there is an excess of pituitary prolactin in the blood, but it can also be caused by a tumor process of the mammary gland. Usually accompanied by sexual dysfunction in men and women. To learn more about how galactorrhea manifests itself, which specialist should treat you, and what the doctor will recommend, read more in the article.

📌 Read in this article

Causes of pathological galactorrhea

The secretion of milk and similar fluid can normally only occur in women after childbirth. One of the physiological (not associated with diseases) options is neonatal galactorrhea. It is associated with an excess of prolactin and estradiol received by the child from the mother before birth. All other cases are pathological. They occur in a wide variety of diseases. In about half of patients, the causes remain unknown.

In men

Occurs 40 times less frequently than in women. More often associated with increased production of prolactin by the pituitary gland. It stimulates the appearance of milk-like discharge from the nipples. This condition is caused by a tumor, as well as mixed adenomas that also produce other hormones. The increase in prolactin in the blood can be influenced by the following diseases:

• congenital defect of formation (it normally inhibits the formation of prolactin);
• compression of the pituitary stalk by a tumor, its damage during brain surgery, traumatic brain injury, high intracranial pressure;
• dysfunction of the kidneys and liver involved in the transformation and excretion of the hormone;
• tumors of the lungs, intestines, capable of hormonal synthesis, VIPoma of the pancreas (its VIP hormone increases the release of prolactin);

Vipoma of the pancreas

• severe or frequently repeated stress overexertion;
• tumors, infections in the pituitary-hypothalamic region, circulatory disorders;
• chronic prostatitis;
• dysfunction of the adrenal cortex (), thyroid gland, excess;
• injuries, herpetic rashes in the mammary glands;
• chronic alcoholism.

In order for galactorrhea to manifest itself, in addition to excess prolactin, a special hormonal background is needed - low progesterone and increased estradiol.

Medicinal

The use of certain medications may:

• stimulate the formation of prolactin;
• enhance the effect of the hormone on the mammary glands;
• inhibit the release of dopamine;
• suppress the activity of dopamine receptors in the brain.

Drugs that can cause galactorrhea include:

• neuroleptics (for example, Haloperidol, Triftazin);
• antidepressants (Anafranil, Amitriptyline);
• drugs to lower blood pressure (Dopegit, Clonidine);
• gastric medications (Cerucal, Ranitidine, Cimetidine with long-term use in high doses);
• anticonvulsants (Finlepsin);
• anabolic steroids (Methandrostenolone).

Often the cause of fluid discharge from the nipples is the use of contraceptives, especially those containing a lot of estrogens. Galactorrhea, not associated with childbirth, is also detected with abrupt discontinuation of birth control pills.

For hypothyroidism

With normal prolactin

In some women with galactorrhea, examination reveals normal prolactin. In this case, the reaction of the mammary gland to its action may be changed. One of the reasons for high sensitivity is a long period of breastfeeding after childbirth, as well as cysts and tumor lesions of the mammary glands, and deformation of the ducts.

It should also be taken into account that the concentration of prolactin in the blood is not constant, so it is possible that one test does not reflect actual changes in the level of the hormone. When making a diagnosis, it is recommended to repeat it at different times of the day at least twice with an interval of 3 weeks.

Norm prolactin

Forms of galactorrhea

Fluid can be released from only one gland. This form is called unilateral, it is usually caused by a local inflammatory or tumor process. Hormonal types of galactorrhea are usually bilateral.

Depending on the severity, the following course options are identified:

Pituitary prolactin has an inhibitory effect on the formation of follitropin and lutropin. This leads to inhibition of the functions of the gonads.

Therefore, with galactorrhea, signs of testicular and ovarian dysfunction are also found:

• In men– enlarged mammary glands, sexual weakness, low level of sexual desire, decreased motility and sperm count, infertility.
• Among women– extended menstrual cycle (33 days or more), bleeding occurs for 1-2 days, scant, delays are possible. Heavy discharge appears only with hypothyroidism.

The absence of menstruation (amenorrhea) is so typical that they are often combined into one galactorrhea-amenorrhea syndrome. It usually occurs during emotional conflicts, stress, prolonged experiences, at the beginning of sexual activity, after childbirth, miscarriage, abortion, and surgery on the pelvic organs. In such cases, the manifestations are temporary and disappear after the general condition normalizes.

Women with persistent and prolonged forms of galactorrhea are often infertile and also experience the following symptoms:

• pain during sexual intercourse;
• low sex drive (frigidity) and lack of orgasms;
• increased growth of coarse hair around the nipples, along the midline of the abdomen;
• increased anxiety, irritability, tendency to depressive reactions;
• fatigue, low performance;
• pain in the heart area;
• swelling of the eyelids, legs;
• rapid weight gain.

Watch the video about increased prolactin in women:

The type of fluid released also matters. Milky or clear whitish discharge is characteristic of excess prolactin. During inflammatory processes, they can also have a brownish, greenish tint; they are extremely dangerous when bloody, since their appearance often indicates a malignant tumor.

Which doctor should I contact?

A mammologist deals with problems of lactation and the condition of the mammary glands. He prescribes a primary examination and, if necessary, refers you to a consultation with an endocrinologist or gynecologist. If there is a suspicion of the central nature of galactorrhea due to a disease of the pituitary gland or hypothalamus, then patients must be examined by a neurologist and an ophthalmologist.

Treatment of galactorrhea

The most successful therapy is aimed at eliminating the cause of galactorrhea. Medication and surgical techniques are used. In the dosage form, drug withdrawal is necessary.

Traditional methods at home

Herbal preparations will not help in the presence of a tumor process, inflammation of infectious or autoimmune origin. Their use is possible only with a normal level of prolactin in the blood to reduce its effect on the mammary glands and functional disorders (eg, stress, contraceptive withdrawal). For this use:

• cinquefoil root,
• cuff grass,
• comfrey root,
• raspberry leaf,
• peony root.

They are brewed at the rate of a tablespoon per glass of boiling water, kept in a water bath for 15 minutes and filtered. Take a third of a glass 3 times a day. After a month of use, you need a break for two weeks, and then, if necessary, the course continues, but it is better to use another plant.

There are also ready-made preparations on a natural basis - Cyclodinone, Prefemin and Mastodinone, Tazalok. Before starting to take herbs and dietary supplements, it is important to consult a doctor, since hormonal imbalance can cause the opposite effect.

Drugs for drug treatment

To reduce the formation of prolactin in the pituitary gland, the following agents are used:

• stimulating dopamine receptors - Alactin, Dostinex, Parlodel, Norprolac, their use helps even with pituitary tumors;
• dopamine precursor - Levodopa, increases the synthesis of a hormone that inhibits the formation of prolactin, is used for normoprolactinemic galactorrhea.

All these medications are taken under the control of blood tests. In the presence of pituitary prolactinoma, the course of treatment continues for at least 2 years. Patients undergo brain tomography at least once every 9-12 months.

If the cause of increased prolactin synthesis is a previously inactive pituitary tumor, then in exceptional cases Dostinex is used to correct hormonal levels under medical and laboratory supervision.

Possible complications without treatment

A mild degree of galactorrhea usually does not change the general condition of patients, but with heavy discharge, irritation of the skin of the nipple and the addition of a fungal or bacterial infection cannot be ruled out. The consequences of excess prolactin are much more serious. It disrupts the functioning of the reproductive system, which threatens:

• early menopause;
• destruction of bone tissue;
• increased levels of male hormones (increased hair growth);
• reduction in the size of the mammary glands, loss of their tone.

Watch the video about nipple discharge and what the color tells you:

A growing prolactinoma of the pituitary gland, if left untreated, can lead to loss of vision, as well as compression of brain tissue. If the hormone level remains elevated for a long time, this can lead to the following complications:

• tumor processes of the mammary gland, including cancer;
• disorders of fat metabolism - obesity, blockage of blood vessels with cholesterol plaques;
• changes in carbohydrate metabolism - prediabetes, .

Galactorrhea is manifested by fluid discharge from the nipples, which is not associated with childbirth. It occurs in women and men most often against the background of excess pituitary prolactin. Provoking factors include tumors, inflammatory and vascular disorders of the brain, hormonal imbalance, and the use of medications. Accompanied by sexual dysfunction. To identify the cause, a comprehensive examination is needed. Drug and surgical treatment are prescribed.

Pathological discharge of milk-like fluid from the mammary glands is called galactorrhea. The condition occurs more often in women, rarely in men. It almost always has a hormonal nature, so treatment for galactorrhea is carried out with drugs of the pituitary group.

Discharge can be observed constantly or only after stimulation of the nipples. However, normally they should not exist at all, with the exception of natural conditions: lactation, breastfeeding.

What fluid is released during galactorrhea?

Milk-like fluid is milk, colostrum, or other nipple discharge that contains some amount of human milk. If they do not contain this substance, the color is different from purulent, serous, bloody contents, these may be other pathologies. However, the amount of milk in nipple discharge may be so small that it can only be determined through testing.

For any discharge from the nipples, even clean, transparent in appearance, in a non-pregnant or non-lactating woman, you should consult a doctor. The sooner the pathology is determined, the more effective the treatment will be, and the less cost it will require.

Features of the pathology

Galactorrhea is considered pathological in the following conditions:

- in a non-pregnant woman

- after breastfeeding for more than 5 months.

The condition is considered normal during pregnancy, breastfeeding and after the end of feeding, if milk fluid is observed for no more than 5 months. Pathology manifests itself in both mammary glands, but can also be detected in only one of them.

Symptoms of the disease appear as follows:

1. Complete absence of menstruation or menstruation becomes irregular, with long delays. This condition is called galactorrhea-amenorrhea syndrome, and it is caused by the deficiency or absence of luteinizing and follicle-stimulating hormones. Respectively: LH and FSH.

2. Visual impairment. In particular: the color fields have been narrowed. Peripheral vision may remain normal or progressively worsen.

3. Excessive hair growth in the chin and décolleté (in particular, the mammary glands). Acne on the face.

4. Pathology can be observed during a normal menstrual cycle. The woman does not notice any symptoms, and does not pay attention to the cooling towards intimacy, lack of libido and does not consider it a sign of illness. The distinctive symptom in this case will be intense acne. And also: swelling of the skin due to the accumulation of fluid in it (maceration).

Galactorrhea and concomitant amenorrhea

The most common type of this pathology is galactorrhea-amenorrhea syndrome with menstrual irregularities. They can lead to the cessation of menstruation during childbearing years. The same applies to nipple discharge, which manifests itself to varying degrees as follows:

- spontaneous, abundant

- only with stimulation

- minor, not detected by a woman.

Causes of pathology

Disturbances in the hypothalamic-pituitary system or in the functioning of the thyroid gland are the main causes of the development of pathology. It is most often caused by:

- intraductal papilloma of the mammary gland

- diseases of the pituitary gland, for example, sarcoidosis

– pituitary tumors (glioma, meningioma, chondroma, adenoma)

- increased secretion of prolactin (responsible for lactation during pregnancy).

Adenoma: a common cause of the disease

Most often, galactorrhea-amenorrhea is caused by a tumor process in the pituitary gland. This is almost always a benign tumor (adenoma) that can be easily treated with medication. It is rarely necessary to use surgical methods. Adenoma is distinguished by size: small (microadenoma) and large, respectively, macroadenoma.

Non-pathological factor: medication use

In addition to pathological ones, there are external causes that lead to galactorrhea. In these cases, it is enough for a woman to remove the provoking factor from her life for the disease to recede. This condition includes, for example, taking medications. Namely:

1. Drugs that block dopaminergic receptors: Triftazin, Trimeprazine, Molipdon.

2. Antidepressants: Amitriptyline, Diazepam, Doxepin.

3. Hormonal and contraceptive drugs: Premarin, Nolvadex, Medroxyprogesterone.

Treatment of milky discharge from nipples

Treatment of galactorrhea syndrome is based on determining the pathological factor. First, the doctor finds out: what caused the changes in the hormonal system? If this is a pathology of brain activity of a hormonal nature, and this is how galactorrhea is formed in most cases, medications are prescribed. They lead to the disappearance of small tumors and effectively reduce the size of large tumors.

Medication

The patient is treated by an endocrinologist and a gynecologist. Drugs prescribed after diagnosis of a hormone-dependent pituitary tumor, as well as for elevated prolactin levels:

— Parlodel

— Serocriptine

— Bromergon

— Dostinex

When treatment is not carried out

If the symptoms are minor and/or the tumor is microscopic, treatment may not be prescribed. Sometimes discharge from the mammary gland stops on its own. This is typical for conditions when tests are normal:

- prolactin 4-22.8 ng/ml (in non-pregnant, non-lactating women)

— prolactin 35-385 ng/ml (in pregnant women more than 8 weeks pregnant)

— cortisol 20-230 mcg/l or 145-630 nmol/l

— dehydroepiandrosterone (DHEA) 2660-11200 nmol/l

- thyroxine (T4) 100-120 nmol/l, in pregnant women - 120-140 nmol/l, in premenopause - 80-100 nmol/l.

If the factor provoking the disease is eliminated, you need to wait 1 month and then donate blood. In this case, the analysis will be more accurate. An ultrasound of each breast is also necessary. If the discharge remains, you need to submit the fluid for cytological analysis.

Taking Parlodel

Parlodel is prescribed for the treatment of galactorrhea syndrome, regardless of the presence of a tumor (adenoma) of the pituitary gland. Patients take the drug for any pathology of the hypothalamic-pituitary origin. The medicine blocks the release of the hormone prolactin into the blood and also inhibits its secretion by the pituitary gland. The standard dose of the drug is 2.5-5 mg/day.

The peculiarity of treatment with Parlodel is its constant use. If a woman stops drinking it, galactorrhea will appear again. This disease refers to recurrent pathologies when the drug is discontinued.

The discharge of milk or milky fluid from the nipples of the mammary glands, not associated with the lactation period, is termed galactorrhea. In most cases, it is diagnosed in women, both those who have given birth and those who have not had children.

Galactorrhea is not an independent pathology; it usually occurs as a result of certain diseases.

What is galactorrhea

Abnormal galactorrhea is said to occur if colostrum is formed in the mammary glands during periods not associated with pregnancy. Pathology occurs in 1-4% of female patients, and much less frequently in men.

In most cases, the disease is temporary, it does not pose any danger and stops on its own. But the abnormal production of an unusual secretion in the mammary glands can also be the main sign of serious diseases that require specific treatment.

Therefore, when detecting discharge from the nipples, an examination is necessary, especially in cases where the disease is combined with other changes in well-being.

Classification

Galactorrhea is divided into bilateral and unilateral. During the pathology, three degrees are distinguished:

• FIRST DEGREE. Characterized by the squeezing out of milk drop by drop when pressing on the nipple;
• AT SECOND DEGREE. Pressure leads to a stream of milk;
• THIRD DEGREE. Set if discharge occurs continuously without external stimulation.

ICD 10 code

In the international classification of diseases, pathological galactorrhea is designated by code O92.6.

Idiopathic type of galactorrhea

The reason for the abnormal secretion of milk from the mammary glands may not be precisely determined during the examination. In this case, galactorrhea is defined as idiopathic.

Increased milk secretion sometimes occurs due to hypersensitivity of breast tissue to prolactin, even if the secretion of the hormone is at normal levels.

Galactorrhea in men

Pathology in male patients often occurs due to testosterone deficiency (hypogonadism). The disease occurs with gynecomastia (engorgement and increase in the size of the mammary glands), and may be accompanied by a decrease in sexual desire and sexual dysfunction.

Galactorrhea in children

The pathology occurs in newborn babies. The appearance of milky fluid from the breast is caused by an increased level of prolactin in the blood of a pregnant woman.

Hormones easily penetrate the placenta, begin to circulate in the baby’s blood and after birth cause galactorrhea and enlarged glands. The condition is temporary and not dangerous for the child; it goes away on its own after a few weeks.

What is lactation

Lactation is the physiological formation and subsequent excretion of milk in the female mammary glands. Fluid production occurs in the glandular structures of the organ under the influence of several hormones:

• Somatotropin (GH) or otherwise growth hormone;
• Adrenal cortex hormone cortisol;
• Insulin;
• Thyroxine;
• Estrogens.

But still, prolactin has the main effect on milk secretion. Its production in normal times is suppressed by dopamine, a biologically active substance secreted by the hypothalamus.

By the end of pregnancy, the secretion of dopamine stops almost completely, so prolactin becomes tens of times greater, which enhances the process of milk formation. In the last weeks, colostrum begins to be released from the mammary glands, and after childbirth, milk.

When breastfeeding, the receptors in the nipples are irritated, and in response to this, more prolactin begins to be produced.

After stopping breastfeeding, milk may be released in small quantities for another 5-6 months. This is considered normal and does not require correction.

Causes of pathological galactorrhea

As has already been clarified, the formation of milk and its excretion from the milk ducts is regulated by a complex of hormones produced by the pituitary gland, ovarian tissues, pancreas and thyroid glands.

The nervous system also takes an active part in the process. Therefore, with abnormal galactorrhea, the cause of the disease must be sought at one of these levels.

Diagnosis does not always help to identify the causative factor. In this case, they speak of an idiopathic form of the disease, in which the formation of milk is most likely associated with the increased sensitivity of the mammary gland tissue to prolactin, which is produced in normal quantities.

Among the main causes of pathological galactorrhea are diseases of the pituitary gland and hypothalamus, disorders of hormone metabolism, severe damage to the liver and kidneys.

Pathologies of the hypothalamus

The hypothalamus is a small structure in the diencephalon endowed with dozens of functions. Damage to the hypothalamus occurs due to brain injuries, tumors, inflammatory processes, sarcoidosis, neurotuberculosis.

Pathological processes in the hypothalamus lead to the development of neuroendocrine disorders, which in turn can manifest as abnormal changes in water-salt and fat metabolism, hyper- and hypothyroidism.

Damage to the hypothalamus often causes a decrease in the secretion of dopamine, a hormone that inhibits the production of prolactin. Without restraining factors, the volume of prolactin in the body increases, which leads to the formation of secretion in the ducts of the mammary gland.

Pathology may indicate a syndrome referred to as Chiari-Frommel. An increase in the secretion of prolactin by pituitary tissues leads to the blocking of the release of follicle-stimulating hormone, that is, the follicles in the ovaries cease to mature.

Therefore, with Chiari-Frommel syndrome, pathological lactation is complemented by amenorrhea. Women may complain of headaches, blurred vision, hirsutism (excess hair growth), weight loss or gain, and insomnia.

Pituitary gland lesion

Excessive secretion of prolactin can be caused by a benign tumor of the pituitary gland - prolactinoma (microadenoma). It is more often detected in women.

Prolactinoma is a hormonally active formation, in most cases it does not lead to compression of nerve endings. It manifests itself as galactorrhea, absence of menstruation, infertility, symptoms of hyperandrogenism - excessive hair growth, acne. Hyperprolactinemia may be accompanied by osteoporosis.

In rare cases, a microadenoma transforms into a macroadenoma, which leads to compression of the nerve pathways passing near the pituitary gland. The main symptoms include headaches, visual impairment, apathy, etc.

Hyperprolactinemia can be caused by acromegaly, Addison's disease, Itsenko-Kushimng syndrome, hypothyroidism, metastases of malignant tumors of the mammary glands and lungs, and endocrine neoplasia.

Thyroid hormone metabolism disorder

Galactorrhea sometimes accompanies primary hypothyroidism, a pathology in which increased stimulation of the thyroid gland by the pituitary thyroid-stimulating hormone (TSH) does not lead to increased production of prolactin.

Increased secretion of TSH leads to hyperprolactinemia and, accordingly, galactorrhea. Hypothyroidism is also manifested by apathy, increased drowsiness, excessive hair loss, and the appearance of edema.

Increased production of TSH also causes hyperthyroidism, which occurs with tachycardia, sudden weight loss, and ophthalmopotia. In hyperthyroidism, galactorrhea occurs less frequently than in hypothyroidism.

Disturbances in estrogen metabolism

Hyperprolactinemia is characteristic of polycystic ovary syndrome and is detected in a third of cases during the development of this disease. The main reason for increased secretion of prolactin is a decrease in the effect of dopamine on pituitary tissue.

This causes disturbances in the formation of follicles and an imbalance in the production of hormones by the ovaries. Increased secretion of estrogen further enhances the formation of prolactin.

Galactorrhea also occurs with estrogen-producing formations of the adrenal glands. In men, abnormal milk secretion develops due to testosterone deficiency and is accompanied by gynecomastia and decreased potency.

Metabolic disorders

Galactorrhea can be caused by:

• Cirrhosis and other severe liver diseases. With liver failure in the cells of the organ, the inactivation of hormones is disrupted, and the level of prolactin in the blood increases;
• Renal failure, in which the elimination of hormone metabolites from the body slows down.

Prolactin production may not be pituitary, but ectopic. The hormone is produced during the formation of hypernephroma and bronchogenic sarcoma.

Other causes of galactorrhea

Other possible causes of abnormal milk production in the mammary glands include:

• Treatment with a number of medications. First of all, these are contraceptive pills, but the disease can also be provoked by taking antihypertensive drugs, antidepressants, tranquilizers;
• Excessive stimulation of the mammary glands. Occurs when wearing tight bras, with increased sexual activity, with irritation of the breast due to skin rashes, piercings;
• Damage to nerves in the chest and back;
• Spinal cord injuries;
• The influence of stressful situations;
• Severe forms of mastitis.

In newborns, increased secretion of milk-like liquid from the nipples is sometimes associated with the intake of lactogonic herbs by a nursing woman.

Symptoms

The main symptom of galactorrhea is the release of milk-like liquid from the juices, which can be unilateral or bilateral. The color of the secretion ranges from light transparent to rich milky. Fluid is released from the glands both spontaneously and when the nipples are stimulated.

Slight unilateral secretion production periodically appears in most healthy women; this is considered normal in the absence of other symptoms.

The secretion of galactorrhea from the mammary glands should not be bloody or greenish. Discharge with this shade indicates serious diseases that require careful diagnosis and treatment.

Abnormal nipple discharge may be accompanied by:

• Maceration of the area around the nipples;
• Enlargement of the mammary glands, their engorgement;
• Traces of discharge on underwear.

Determining the primary causes of galactorrhea is mandatory if the pathology is accompanied by:

• Amenorrhea;
• Visual impairment;
• Headaches;
• Drowsiness or, conversely, insomnia;
• Depression.

Periodically or constantly occurring abnormal secretion of milk from the mammary glands in the absence of pregnancy is a good reason to consult a doctor. The diagnosis will help to timely identify the causes of the disease that require specific treatment.

Which doctor should I contact?

If signs of galactorrhea appear, you can make an appointment with:

• Endocrinologist;
• Gynecologist;
• Gynecologist-endocrinologist;
• Mammologist;
• Reproductologist.

Any of the specialists will conduct an examination and prescribe diagnostic procedures, based on the results of which it will be possible to decide which specialist’s help the patient needs.

Diagnostics

The diagnosis is established on the basis of examination, collection of medical history, laboratory and instrumental examination methods.

During the examination, the doctor must verify the presence of discharge by pressing on the mammary gland. The released secretion must be taken for analysis. Palpation of the glands also allows you to detect compactions, painful areas, and bumps.

During the questioning you need to establish:

• Duration of galactorrhea;
• Circumstances conducive to its development;
• Past injuries;
• Presence of endocrine, gynecological diseases in the anamnesis, pathologies of the thyroid gland;
• Main complaints. The nature of galactorrhea is established, that is, fluid flows from the mammary glands spontaneously or spontaneously, whether other changes in the body are disturbing;
• Cyclicity of critical days.

After the initial examination, the patient is sent for laboratory tests:

• A blood test for prolactin in women is taken on days 5-8 of the cycle;
• Tests for thyroid hormones and sex hormones;
• Biochemical analysis to exclude severe pathologies of the liver and kidneys.

Of the instrumental research methods used:

• Mammography;
• Computed tomography if there is a suspicion of disturbances in the functioning of the hypothalamus and pituitary gland;
• Ultrasound of the mammary glands, pelvic organs.

Based on the test results, consultation with a neurosurgeon, ophthalmologist, neurologist, or endocrinologist may be required. The diagnosis is made after accurately determining the cause of galactorrhea.

Principles of treatment

Complete elimination of galactorrhea is impossible unless the underlying cause of the pathology is established. The treatment regimen is selected based on the diagnostic results obtained. First of all, it is necessary to eliminate the cause or minimize its negative impact on the body.

When the disease develops as a result of taking medications, they are discontinued and replaced with those that do not contribute to increased production of prolactin.

If hormone-dependent tumors are detected, the patient is prescribed:

• Parlodel;
• Bromergon;
• Serocriptine;
• Dostinex.

IMPORTANT: All medications are taken as prescribed by a doctor.

These drugs inhibit the production of prolactin, which allows normalization of the functioning of the mammary glands. For growing pituitary tumors, conservative therapy is not always effective, so surgical removal of the tumor and chemotherapy are prescribed.

If galactorrhea is a consequence of disorders of the thyroid gland, then treatment of the underlying disease is required. With the idiopathic type of pathology, the woman is usually monitored and recommended to repeat examinations every few months.

Treatment of galactorrhea in pregnant women

The secretion of milk-like liquid from the glands of a pregnant woman is not considered an abnormal condition. After conception, hormonal changes occur, the level of oxytocin and prostatitis increases - hormones, under the influence of which the process of milk maturation in the mammary glands begins.

In some pregnant women, galactorrhea occurs several weeks before childbirth, and sometimes in the first months of pregnancy. There is no need to panic about this, but the doctor should be aware of changes in the mammary glands.

If necessary, additional examinations are prescribed. The diagnosis of hyperprolactinemia during pregnancy is not made, since prolactin is always elevated during this period.

Hyperprolactinemia is not an obstacle to planning a child. But before conceiving, a woman must undergo all examinations and, if necessary, receive a course of treatment. The gynecologist monitoring the pregnant woman must be aware of the diagnosis, this is necessary in order to prescribe the appropriate tests and diagnostic procedures in a timely manner.

Traditional treatment

Abnormal galactorrhea in most cases develops due to malignant and benign formations and hormonal imbalance in the body. It is impossible to eliminate such disorders using folk methods, but herbal recipes can be used as an addition to the main therapy.

Before using them, you should consult a doctor, since not all grandmother’s treatment methods have a positive effect on hormonal levels.

When treating galactorrhea, the use of herbs with hormonal properties can help; they help normalize hormone levels.

Herbal medicines:

Phytoestrogens contain basil, periwinkle, hogweed, mint leaves, yarrow, sorrel and parsley root, Robert's geranium (leaves). You can prepare decoctions from these plants by mixing them together. It is better to use recipes that contain no more than 3-4 plants, since multi-component infusions and decoctions increase the likelihood of adverse reactions.

In addition to the main treatment, men with galactorrhea are recommended to take Adam's root alcohol tincture or drone homogenate internally. They increase testosterone levels and reduce prolactin secretion.

Complications and prevention

With pathological galactorrhea, the development of life-threatening complications cannot be ruled out. With pituitary tumors, as they progress, vision deteriorates and there may be hemorrhage with infarction of the meninges.

Hypothyroidism often ends in hypothyroid coma without treatment. In malignant neoplasms, metastases spread throughout the body.

There is no specific prevention of abnormal galactorrhea. The likelihood of pathology can be reduced if a woman wears appropriately sized underwear and performs self-examination of the mammary glands no more than once a month. Timely treatment of endocrine and gynecological diseases is also important in the absence of pathological discharge from the nipples.

Galactorrhea with normal prolactin levels

In some cases, an increase in prolactin is not detected during laboratory diagnostics, but galactorrhea continues to be a concern. The mechanism of development of this phenomenon has not been fully established, but a number of doctors associate it with ductectasia.

This term refers to the dilation of the ducts in the mammary gland, which occurs as a result of mastopathy and tumors of the mammary glands.

Galactorrhea and pregnancy planning

With elevated prolactin levels, anovulation and amenorrhea occur. That is, there are no conditions conducive to conception. Women with established hyperprolactinemia must first undergo a course of therapy and only after that plan a pregnancy.

Galactorrhea does not worsen your health and does not reduce your ability to work. But if you notice the appearance of secretions from the mammary glands, you should observe the changes occurring for several weeks and pay attention to other symptoms.

Repeated pathology can cause quite serious diseases, so the examination should not be delayed.