Question: I am an 18 year old woman and I have a situation. I am secreting milk from both my breasts for about a month now. I have not had a baby. I am sexually active. Please help me doctor.
Answer: The condition you are describing is called Galactorrhea which is secretion of milk from one or both breasts not associated with child birth or nursing.
If it involves both sides, minimal in amount, painless and associated with manipulation of breast it is more likely physiological.
However it can be associated with a number of causes and might be an early symptom of a problem. It is important to see a doctor.
Let us look at the normal anatomy and physiology behind breast milk secretion to understand this problem better.
The milk secreting cells in the anterior pituitary gland are called lactotrophs.. Prolactin is secreted by the anterior pituitary gland which promotes milk secretion. The pituitary gland is controlled by hypothalamus which is connected to pituitary gland by a stalk. The hypothalamus secretes Dopamine which inhibits the secretion of Prolactin from anterior pituitary. This is regulated by nerve stimulation.
Any interruption of the signal between the hypothalamus and anterior pituitary gland lead to disorders in the secretion of prolactin and hence milk secretion.
The anterior pituitary also secretes a number of substances which regulate the secretion of growth hormone, thyroid hormone and steroid hormones.
Causes of Galactorrhea:
1. Most important cause which needs immediate attention is a tumor of the pituitary gland (master gland in the brain).
It is a slow growing tumor hence symptoms are not obvious.
Galactorrhea is one of the symptoms. Problems with vision i.e. restriction in the visual field is a late symptom.
2. Other systemic diseases which invade the brain stem can also present the same way.
Infiltrative disease – Sarcoidosis
Metastatic cancer - Usually older age, symptoms of cancer including weight loss, loss of appetite and symptoms related to the primary organ involved will be present.
3. Head trauma can lead disruption in the nerve stimulation.
4. Drugs: Inhibits the effect of dopamine secreted by hypothalamus.
Most common medications include:
Anti Depressants (e.g. Prozac, Luvox, Depakote)
5. Hypothyroidism – As mentioned above the anterior pituitary secretes TSH which stimulates the thyroid hormone secretion and prolactin. Decreased functioning of thyroid gland leads to increased TSH and hence increased prolactin.
6. Others causes:
Chronic kidney disease
Injury to chest
7. Idiopathic – Even after extensive evaluation the cause may not be found. However regular follow up with a doctor is needed as sometimes with time the disease may become apparent.
How to diagnose:
The first thing to do is to be examined by a doctor.
To look for any abnormal breast swelling, nipple abnormalities, changes in skin, movement of the breast and gland swelling under the arm.
The most important blood work would be to check your prolactin level and check your thyroid hormone.
If both of them are normal usually it is nothing to worry if otherwise you are healthy.
If prolactin is elevated then you would nee an MRI of your brain.
Is there a treatment option:
Remember Dopamine has an inhibitory effect on the prolactin. In patients with high prolactin, drugs which have a dopamine like effect can be given. They are just like any other pills.
E.g. Bromocriptine, Cabergoline.
If they find a tumor in your brain depending on the size treatment varies.
If it is small and less than 1 cm and no other symptom the above medication works.
If greater than 1 cm in size and associated with visual field problems or resistant headaches then surgical option to be considered.
Radiation may be considered but results are not favorable when compared to surgery.
What is my chance of getting Galactorrhea on Birth control pills?
The newer birth control pills do not have much estrogen to influence the secretion of prolactin. The risk of developing hyper prolactinemia is comparable to normal women.
Does it affect my chance of being pregnant?
The best option would be treat the hyper prolactinemia and try conception later.
After treatment of increased prolactin if you have problems getting pregnant then you may need ovulation induction drugs like clomiphene citrate.
Will the treatment method affect my chances of conception?
If the tumor is small usually it would not have much effect. But is the tumor is small its better to treat the tumor and when wait for your doctors approval before trying to conceive.
Among the pills bromocriptine is safer and time tested.
The surgery is done through the nose and it is an endoscopic surgery. It is less invasive and has fewer complications.
Points to remember:
- Younger age
- Minimal milk secretion
- Bilateral breast
- No other systemic problems
- Not using any over the counter or prescription medications
- Not associated with pain
- No breast abnormality
If the above points are true, then you are less likely to have a problem. But the best option to get checked by a doctor.By seeing a doctor, you can be assured if your prolactin and thyroid hormone levels are normal.