Galactorrhea, also known as inappropriate lactation, refers to milk discharge from the breasts when a woman is not breastfeeding. It can occur in women, men, and even infants. Galactorrhea is not a disease itself but rather a symptom of an underlying condition. Determining what is causing galactorrhea is key to finding appropriate treatment and estimating how long it may last.
What causes galactorrhea?
There are several potential causes of galactorrhea including:
- Hormonal imbalances – Elevated prolactin levels stimulate milk production. Conditions like hypothyroidism, pregnancy, and pituitary tumors can raise prolactin levels.
- Medications – Antidepressants, anti-psychotics, opiates, and high blood pressure medications may cause galactorrhea as a side effect.
- Breast stimulation – Nipple stimulation from sexual activity, breast exams, coarse fabrics rubbing on nipples, or other physical stimulation of the breasts can trigger milk discharge.
- Pituitary disorders – Tumors on the pituitary gland can overstimulate prolactin production.
- Chest wall irritation – Shingles and other conditions that irritate nerves in the chest wall can cause galactorrhea.
- Illegal drugs – Use of heroin, methadone, marijuana, and cocaine has been associated with galactorrhea.
- Other medical conditions – Hypothyroidism, liver disease, and kidney disease may contribute to high prolactin levels.
- Unknown causes (idiopathic) – Sometimes the cause of galactorrhea cannot be identified.
Identifying whether an underlying medical condition, medication, breast stimulation, or other factors are contributing to galactorrhea will provide insight into how long it may last.
How long does medication-induced galactorrhea last?
Many medications can cause galactorrhea as a temporary side effect. These include:
- Antidepressants like amitriptyline, duloxetine, fluoxetine, paroxetine, sertraline, venlafaxine
- Antipsychotics like risperidone, haloperidol, clozapine
- Blood pressure medications like methyldopa, verapamil, nifedipine
- Opiates like methadone, morphine, codeine
- H2 blockers like cimetidine and ranitidine
In most cases, galactorrhea caused by medications lasts only while the drug is being taken. It typically resolves within days to weeks after discontinuing the medication. However, in rare cases, medication-induced galactorrhea may persist for months after stopping the drug before eventually resolving.
Tips for managing medication-related galactorrhea
- See your doctor about switching to an alternative medication that is less likely to cause galactorrhea.
- Take medications as prescribed to minimize side effects.
- Use breast pads to manage milk leakage until galactorrhea resolves.
- Avoid stimulating breasts unnecessarily to prevent triggering milk discharge.
- Monitor for changes after stopping the medication and follow up with your doctor if galactorrhea persists beyond a few weeks.
How long does pregnancy and breastfeeding related galactorrhea last?
It’s normal for women to experience milky discharge from the breasts during pregnancy and after recently giving birth while breastfeeding. This causes galactorrhea but is considered a normal process. Galactorrhea typically lasts in these situations:
- During pregnancy – Begins around the 2nd trimester and can last throughout the remaining pregnancy, though it may be intermittent and come and go.
- Postpartum while breastfeeding – Can occur for weeks to months after giving birth while breastfeeding.
- After weaning from breastfeeding – May initially last for up to 6 months after weaning as the breasts adjust.
Occasionally, prolactin levels remain elevated after pregnancy and breastfeeding ends, leading to prolonged galactorrhea. See your doctor if galactorrhea lasts beyond 6 months after weaning from breastfeeding.
How long does pituitary gland related galactorrhea last?
The pituitary gland in the brain produces prolactin, the hormone that stimulates breast milk production. Pituitary disorders like tumors, inflammation, injury or other abnormalities can cause elevated prolactin and galactorrhea that persists beyond normal postpartum timeframes. Pituitary adenomas or prolactinomas are benign tumors that secrete excess prolactin. In women, signs like galactorrhea may prompt diagnosis. In men, larger tumors may be found incidentally.
How long pituitary-induced galactorrhea lasts depends on the specific cause and whether it is treated:
- Prolactinoma – Galactorrhea typically resolves within a few months if the tumor is treated with medication or surgically removed. Without treatment, it may continue indefinitely.
- Pituitary enlargement or inflammation – Galactorrhea usually resolves within weeks to months if the underlying cause (such as infection) is treated.
- Pituitary injury – Head trauma or pituitary apoplexy (stroke) can damage the gland. Resulting galactorrhea may be permanent if the damage cannot be repaired.
Monitoring prolactin levels over time and evaluating for any changes with MRI scans of the pituitary can help guide prognosis and treatment.
How long does idiopathic galactorrhea last?
In up to a third of cases, no specific cause of galactorrhea is found after evaluation. This is termed idiopathic galactorrhea. By definition, the duration is unpredictable in these instances. Idiopathic galactorrhea may resolve spontaneously or it may come and go indefinitely depending on individual circumstances.
If there are no bothersome symptoms, monitoring over time may be appropriate. Hormone testing at periodic intervals can help assess if prolactin levels change. Seeking treatment is reasonable if galactorrhea is frequent or disruptive to quality of life.
When should you seek medical treatment for galactorrhea?
See your doctor if you experience any of the following:
- Galactorrhea that persists beyond 6 months postpartum
- Galactorrhea accompanied by headache, vision changes, menstrual issues
- Bloody nipple discharge
- Single nipple discharge (not both sides)
- Galactorrhea in an infant
- Persistent galactorrhea associated with irritability, anxiety, changes in sex drive
Evaluation will help determine if there is an underlying cause requiring treatment. Even if there is no specific cause found, medication options are available to manage bothersome prolactin-induced galactorrhea.
Treatment options for persistent galactorrhea
Treatments that may help stop ongoing bothersome galactorrhea include:
- Medications like bromocriptine and cabergoline to lower prolactin levels
- Treating underlying conditions like thyroid disorders or withdrawing any medications linked to galactorrhea
- Surgical treatment for large pituitary tumors causing substantial prolactin elevation
- Estrogen therapy may relieve nipple discharge in some postmenopausal women
- Wearing breast pads and avoiding nipple stimulation to manage breast leakage
With appropriate treatment, galactorrhea caused by sustained high prolactin levels may resolve within several weeks to months in many instances. This can help restore normal hormone balance and breast function.
What is the outlook for galactorrhea?
The prognosis for galactorrhea depends greatly on the underlying cause:
- Medication-related – Usually resolves within weeks of discontinuing the medication.
- Pregnancy or breastfeeding – Resolves spontaneously after giving birth and weaning from breastfeeding.
- Pituitary disorders – Has an excellent outlook with proper treatment but may recur if the tumor returns.
- Idiopathic – No way to predict duration though it may stop spontaneously.
Transient galactorrhea with a known trigger like medications or pregnancy generally has a good prognosis. Permanent galactorrhea may occur with irreversible pituitary gland injury. With appropriate monitoring and treatment, bothersome galactorrhea can often be effectively managed.
Conclusion
In summary, the duration of galactorrhea depends largely on the underlying cause. Identifying contributing factors is necessary to estimate potential duration and guide appropriate treatment. While galactorrhea can understandably cause distress, keep in mind it is not harmful for health. Prompt evaluation and management can provide relief in many cases.
