Galactorrhea (unexpected milk production) and other nipple discharge

July 28, 2011. Posted in: Supply worries

By Kelly Bonyata, BS, IBCLC

Per Breastfeeding and Human Lactation (Riordan, 2004, p. 80), “Small amounts of milk or serous fluid are commonly expressed for weeks, months, or years from women who have previously been pregnant or lactating.” The amount is most often very small, however, and spontaneous flow (leaking) generally stops within 2-3 weeks. Mothers who have breastfed for a longer duration may be able to express milk for a longer time after weaning. Any stimulation, e.g. checking to see if milk is still there, frequent breast self-exams, friction from a bra , stimulation during intercourse, etc., can cause further production.

If you stop producing milk after weaning and then start again, it could be due to a new pregnancy (or a recent miscarriage).

Schedule a visit with your physician if…

  • you are still producing a significant amount of milk at 6 months after weaning or re-start milk production spontaneously (not associated with pregnancy).
  • you start producing milk and have never been pregnant.
  • you have breast discharge that does not appear to be milk. Discharge may be multicolored and sticky (color is generally green; this is usually a benign condition called duct ectasia), purulent (containing pus; this is generally due to mastitis or an abscess), clear/watery, yellow/serous, pink/serosanguineous or bloody/sanguineous.Per Breastfeeding: a guide for the medical profession (Lawrence & Lawrence, 2005, p. 602), “Most nipple discharges are caused by benign lesions, and many do not require surgical intervention. They could, however, represent a malignant condition and deserve careful investigation. Nipple discharges associated with lactation have a different etiologic incidence profile, but are no less significant.” Per Monica Morrow, MD in “The Evaluation of Common Breast Problems” (2000), “Nipple discharges are classified as pathologic if they are spontaneous, bloody or associated with a mass. Pathologic discharges are usually unilateral and confined to one duct.”

Per Breastfeeding: a guide for the medical profession (Lawrence & Lawrence, 2005, p. 570), “Galactorrhea is characterized by spontaneous milky, multiduct, bilateral nipple discharge. It is thought to result from increased prolactin production, either by the pituitary or by removal of hypothalamic inhibition.” It is not usually a serious problem, but you should always have your health care provider check it out carefully. Galactorrhea can have various causes:

  • Any type of frequent breast stimulation can induce lactation. Other types of nerve stimulation can also cause galactorrhea, including chest surgery/trauma/burns, herpes zoster that affects the chest wall or chronic emotional stress. Per Lawrence & Lawrence (2005, p. 571), “In susceptible women, a visit to the doctor, stress, a pelvic examination, venipuncture, or surgical procedures can produce elevated serum prolactin” which can result in galactorrhea.
  • Galactorrhea can be a side effect of certain drugs including some H2 blockers (cimetidine/Tagamet), oral contraceptives, metoclopramide (Reglan), sulpiride, psychotropic medications (SSRIs, tricyclic antidepressants, benzodiazepines, phenothiazines, thioxanthenes), antihypertensives (methyldopa/Aldomet, reserpine/Serpasil, verapamil/Calan, atenolol), rauwolfia alkaloids, theophylline, marijuana, opiates or amphetamines. It has also been seen as a copper IUD side effect. See also:
  • Pituitary tumors are the most common pathologic cause of galactorrhea. The most common type of pituitary tumor is a prolactinoma – this is a benign (non-cancerous) tumor. Hypothalamic lesions or disfunction, or pituitary stalk lesions can also cause galactorrhea.
  • Rarely, galactorrhea is a side effect of primary hypothyroidism or thyrotoxicosis.
  • Galactorrhea is sometimes associated with chronic renal failure due to elevated prolactin levels.

References and additional information

Normal prolactin levels in breastfeeding mothers @ KellyMom.com

Is leaking after weaning normal? by Anne Smith, IBCLC

Galactorrhea. Patient information from the American Academy of Family Physicians.

Nipple discharge – abnormal from MedlinePlus

Nipple discharge in women: Secretions often more alarming than dangerous from MayoClinic.com

Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: 570-573, 602-605.

Riordan J. Breastfeeding and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett, 2004: 80.

Leung AK, Pacaud D. Diagnosis and Management of Galactorrhea. Am Fam Physician. 2004 Aug 1;70(3):543-50.

Serri O, Chik CL, Ur E, Ezzat S. Diagnosis and management of hyperprolactinemia. CMAJ. 2003 Sep 16;169(6):575-81.

Morrow M. The Evaluation of Common Breast Problems.Am Fam Physician. 2000 Apr 15;61(8):2371-8, 2385.

Related Posts Plugin for WordPress, Blogger...