Breast milk production is often seen as a sign of motherhood, but when it occurs in women who are not pregnant or nursing a baby, it may indicate an underlying health condition.
Known as galactorrhea, experts say this condition is linked to high levels of prolactin (hyperprolactinemia), a hormone that regulates milk production and could affect a woman’s menstrual cycle, fertility, and overall health if left unchecked.
Speaking with PT Health Watch, Lewis Aituma, a senior resident in Obstetrics and Gynaecology, Secretary of the Nigerian Medical Association (NMA), Edo Central Zone, and a member of the West African College of Surgeons, explained that prolactin is one of the body’s essential hormones.
Mr Aituma said it is produced by special cells called lactotrophs in the anterior pituitary gland located in the brain.
While prolactin rises during pregnancy to prepare for the unborn child’s nutrition, breast milk production in a woman who is neither pregnant nor breastfeeding is abnormal.
“Breast milk production in the non-pregnant state connotes a pathologic event ongoing,” Mr Aituma said.
Cause, effects on reproductive health
According to Mr Aituma, several conditions can stimulate prolactin release outside of pregnancy.
These include the use of certain drugs such as anti-ulcer medications, antidepressants, psychiatric medications, and some blood pressure medicines like methyldopa.
Other triggers are recurrent breast suckling or fondling during sexual intercourse, prolactin-producing tumours in the brain, low thyroid hormone levels, chronic kidney or liver disease, and chronic alcohol use.
The American Society for Reproductive Medicine (ASRM), in its publication Reproductive Facts, also notes that chest wall irritation, stress, and certain herbal remedies such as fenugreek, fennel seeds, and red clover can trigger prolactin release.
The consequences of hyperprolactinemia go beyond breast discharge. High prolactin levels suppress the brain hormone responsible for triggering menstruation.
This disruption may cause irregular or scanty menstrual flow and, in severe cases, a complete cessation of periods.
“For this same reason, it can impair the fertility chances of the woman as these women are often not ovulating due to the condition,” Mr Aituma explained.
ASRM noted in its publication that about a third of women in their childbearing years with irregular periods and otherwise normal ovaries have the condition. It is also estimated that 90 per cent of women with galactorrhea have elevated prolactin levels.
Symptoms, diagnosing the condition
Mr Aituma noted that while many women with high prolactin levels may not experience obvious symptoms, about 70 per cent will notice abnormal breast milk discharge, which may come from one or both breasts.
Others may face irregular menstrual cycles, inability to conceive, or complications linked to pituitary tumours.
Women with prolactin-secreting tumours in the brain, for instance, may experience persistent headaches and visual disturbances. In men, hyperprolactinemia can lead to galactorrhea, reduced sexual desire, erectile dysfunction, and infertility.
According to Mr Aituma, diagnosis usually begins with a blood test, and the normal prolactin levels should be 25-30 ng/ml; if higher than this, it could be suggestive of hyperprolactinemia. To avoid misleading results, the test is often done after fasting and while the patient is calm.
He said if a brain tumour is suspected, further imaging such as a CT scan or MRI of the brain may be required. A physical examination may also help identify breast discharge or other obvious signs.
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Treatment options
Mr Aituma explained that treatment depends on the underlying cause, noting that medical and surgical options are available, but management should always be guided by a physician.
Medications typically used are those that antagonise prolactin release from the anterior pituitary gland, such as bromocriptine and cabergoline. These drugs are usually given at low doses and gradually adjusted.
Treatment may last up to 12 months in cases where hormone levels are very high. During this period, regular monitoring of prolactin levels is important to track progress.
He noted that surgery may be necessary for patients with prolactin-secreting tumours that cause persistent headaches or vision problems, adding that lifestyle adjustments, including reducing alcohol intake and addressing stress, can also be beneficial in such cases.
Mr Aituma emphasised the importance of awareness, early diagnosis, and timely treatment for this condition, which affects both fertility and overall reproductive health.