Galactorrhea

Diagnosis

Finding the underlying cause of galactorrhea can be a complex task because there are so many possibilities.

Testing may involve:

• A physical exam, during which your doctor may try to express some of the fluid from your nipple by gently examining the area around your nipple. Your doctor may also check for breast lumps or other suspicious areas of thickened breast tissue.
• Analysis of fluid discharged from the nipple, to see if fat droplets are present in the fluid, which can help confirm the diagnosis of galactorrhea.
• A blood test, to check the level of prolactin in your system. If your prolactin level is elevated, your doctor will most likely check your thyroid-stimulating hormone (TSH) level, too.
• A pregnancy test, to exclude pregnancy as a possible cause of nipple discharge.
• Mammography, ultrasound or both, to obtain images of your breast tissue if your doctor finds a breast lump or observes other suspicious breast or nipple changes during your physical exam.
• Magnetic resonance imaging (MRI) of the brain, to check for a tumor or other abnormality of your pituitary gland if your blood test reveals an elevated prolactin level.

If your doctor suspects that a medicine you're taking might be the cause of galactorrhea, he or she might instruct you to stop taking the medicine for a short time to assess this possible cause.

Treatment

When needed, galactorrhea treatment focuses on resolving the underlying cause.

Sometimes doctors can't determine an exact cause of galactorrhea. Your doctor might recommend treatment anyway if you have bothersome or persistent nipple discharge. A medication that blocks the effects of prolactin or lowers your body's prolactin level could help eliminate galactorrhea.

Underlying cause	Possible treatment
Medication use	Stop taking medication, change dose or switch to another medication. Make medication changes only if your doctor says it's OK to do so.
Underactive thyroid gland (hypothyroidism)	Take a medication, such as levothyroxine (Levothroid, Synthroid, others), to counter insufficient hormone production by your thyroid gland (thyroid replacement therapy).
Pituitary tumor (prolactinoma)	Use a medication to shrink the tumor or have surgery to remove it.
Unknown cause	Try a medication, such as bromocriptine (Cycloset, Parlodel) or cabergoline, to lower your prolactin level and minimize or stop milky nipple discharge. Side effects of these medications commonly include nausea, dizziness and headaches.

Lifestyle and home remedies

Often, milky discharge associated with idiopathic galactorrhea goes away on its own, particularly if you can avoid breast stimulation or medications that are known to cause nipple discharge.

To lessen breast stimulation:

• Try not to overdo it when touching your nipples during sexual activity
• Avoid squeezing, pinching or otherwise manipulating your nipples
• Wear clothing that minimizes friction between the fabric and your nipples

Preparing for your appointment

You're likely to start by seeing your family doctor or gynecologist. However, you may be referred to a breast health specialist instead.

What you can do

To prepare for your appointment:

• Take note of all your symptoms, even if they seem unrelated to the reason for which you scheduled the appointment.
• Review key personal information, including major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you take.
• Write down questions to ask, noting which are most important to you to have answered.

For galactorrhea, possible questions to ask your doctor include:

• What's likely causing my symptoms?
• Are there any other possible causes?
• What kind of tests might I need?
• What treatment approach do you recommend for me?
• Is there a generic equivalent for the medicine you're prescribing me?
• Are there any at-home remedies I might try?

What to expect from your doctor

Your doctor may ask you questions, such as:

• What color is your nipple discharge?
• Does nipple discharge occur in one or both breasts?
• Do you have other breast signs or symptoms, such as a lump or area of thickening?
• Do you have breast pain?
• How often do you perform breast self-exams?
• Have you noticed any breast changes?
• Are you pregnant or breast-feeding?
• Do you still have regular menstrual periods?
• Are you having trouble getting pregnant?
• What medications do you take?
• Do you have headaches or vision problems?

What you can do in the meantime

Until your appointment, follow these tips to deal with unwanted nipple discharge:

• Avoid breast stimulation to reduce or stop nipple discharge. For instance, avoid stimulating the nipples during sexual activity. Don't wear clothing that causes a lot of friction on your nipples.
• Use breast pads to absorb nipple discharge and prevent it from seeping through your clothing.