Galactorrhea
Basics
Description
- Milky nipple discharge not associated with lactation, defined as >1 year after pregnancy or cessation of breastfeeding.
- Does not include serous, purulent, or bloody nipple discharge
- System(s) affected: endocrine/metabolic, nervous, reproductive
Pediatric Considerations
Can occur in infants secondary to maternal estrogen exposure
Pregnancy Considerations
Milk production often begins during the second trimester; milk leakage that occurs during pregnancy is not pathophysiologic galactorrhea.
Epidemiology
- Predominant age: 15 to 50 years (reproductive age), most commonly ages 20 to 35 years
- Third most common breast complaint in women
Incidence
Marked variability reported
Prevalence
Approximately 20–25% of women experience galactorrhea in their lifetime.
Etiology and Pathophysiology
- Oxytocin stimulates the anterior pituitary to secrete prolactin, which induces lactation.
- Prolactin secretion is inhibited by dopamine produced in the hypothalamus.
- Galactorrhea results either from prolactin overproduction or loss of inhibitory regulation by dopamine.
- Physiologic galactorrhea can be due to pregnancy, nipple stimulation, nipple piercing, exercise, or sexual activity.
- Hyperprolactinemia can be due to overproduction by malignancy or mass effect, most commonly prolactinoma.
- Hyperprolactinemia secondary to systemic diseases:
- Hypothyroidism
- Chronic renal failure (reduced clearance of prolactin leading to elevated serum levels)
- Cirrhosis
- Adrenal insufficiency
- Medications/substances:
- Cardiovascular (α-methyldopa, reserpine, verapamil, spironolactone)
- GI (domperidone, metoclopramide)
- Herbal (anise [licorice], barley, blessed thistle, fenugreek seed, fennel, goat’s rue)
- Illicit (cocaine, marijuana)
- Antimicrobials (isoniazid, protease inhibitors)
- Opioids
- Psych/neuro (neuroleptics, antipsychotics, stimulants, SSRIs, tricyclic antidepressants, MAOIs)
- Reproductive (estrogens, copper IUD)
- DMARDs (azathioprine)
General Prevention
- Avoid frequent nipple stimulation.
- Avoid medications that can suppress dopamine.
Commonly Associated Conditions
- Commonly associated with hypothyroidism, chronic kidney disease, hypogonadism, and pituitary adenoma
- Rarely associated with adrenal insufficiency, chest wall conditions/trauma, post-breast reduction surgery, acromegaly
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Citation
Domino, Frank J., et al., editors. "Galactorrhea." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688531/all/Galactorrhea.
Galactorrhea. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688531/all/Galactorrhea. Accessed November 21, 2024.
Galactorrhea. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688531/all/Galactorrhea
Galactorrhea [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688531/all/Galactorrhea.
* Article titles in AMA citation format should be in sentence-case
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