Medicines for Galactorrhoea

What it is

Galactorrhoea is a milky discharge from one or both nipples that is not related to breastfeeding. It can occur in women who are not pregnant or breastfeeding, and, occasionally, in men. It is usually caused by a raised level of the hormone prolactin, which stimulates milk production. Prolactin can be raised for several reasons: certain medicines (a common cause, including some for mental health, nausea and blood pressure), a small benign tumour of the pituitary gland (a prolactinoma), an underactive thyroid, nipple stimulation, stress, and other conditions; sometimes no specific cause is found. As well as the discharge, raised prolactin can cause irregular or absent periods and reduced fertility in women, and reduced sex drive or, in men, erectile problems. Because galactorrhoea usually reflects an identifiable and treatable cause, it is worth assessing rather than ignoring — particularly to check the prolactin level and look for the reason.

How it is treated

Assessment focuses on identifying the cause. A doctor will ask about medicines, periods and other symptoms, examine as needed, and arrange blood tests — importantly checking the prolactin level, and often thyroid function and a pregnancy test. If prolactin is raised, further tests (such as a scan of the pituitary gland) may be arranged to look for a cause like a prolactinoma. Treatment then depends on the cause: reviewing or changing a responsible medicine (with the prescribing doctor), treating an underactive thyroid, or, for a prolactinoma, treatment with medicines that lower prolactin (which are very effective). Where nipple stimulation is the cause, reducing this helps. Where no serious cause is found and prolactin is normal, reassurance and simple measures may be all that is needed. The reassuring message is that galactorrhoea usually has an identifiable, treatable cause, and assessing it — particularly the prolactin level — guides the right treatment.