From the Guidelines
Galactorrhea, or milky nipple discharge, is a condition that requires evaluation to determine its underlying cause, which can range from hormonal imbalances to breast lesions. The term "galactorrhea" itself refers to the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Treatment of galactorrhea depends on addressing its underlying cause. If the discharge is due to elevated prolactin levels, dopamine agonist medications like cabergoline (0.25-1 mg twice weekly) or bromocriptine (2.5-15 mg daily) are typically prescribed to normalize hormone levels, as noted in various studies 1. For medication-induced galactorrhea, discontinuing the causative drug (such as antipsychotics, certain antidepressants, or antihypertensives) may resolve the condition. If a pituitary tumor (prolactinoma) is present, dopamine agonists are the first-line treatment, with surgery reserved for medication-resistant cases. Hypothyroidism-related galactorrhea requires thyroid hormone replacement therapy. For idiopathic galactorrhea with normal prolactin levels, observation may be appropriate if the discharge is not bothersome. Regardless of cause, patients should undergo appropriate imaging (usually MRI of the pituitary) and laboratory testing to rule out serious underlying conditions, as suggested by recent guidelines 1. Key points to consider in the management of galactorrhea include:
- Identifying and treating the underlying cause
- Use of dopamine agonists for prolactinoma or elevated prolactin levels
- Discontinuation of offending medications
- Thyroid hormone replacement for hypothyroidism
- Observation for idiopathic cases with normal prolactin levels
- Appropriate imaging and laboratory testing to rule out serious conditions. Given the complexity and potential seriousness of the underlying causes of galactorrhea, a thorough evaluation and tailored treatment approach are essential, as emphasized by recent studies 1.
From the FDA Drug Label
Among patients with galactorrhea, this symptom disappeared in 73% of those treated with cabergoline compared with 56% of those treated with bromocriptine. The treatment for galactorrhea or milky discharge is a dopamine receptor agonist such as cabergoline.
- Galactorrhea is a symptom that can be treated with cabergoline, with a disappearance rate of 73% in patients treated with this medication 2.
From the Research
Definition and Treatment of Galactorrhea
Galactorrhea, also known as milky discharge, can be caused by various factors including hyperprolactinemia, hypothyroidism, renal insufficiency, pregnancy, and nipple stimulation 3.
Causes of Galactorrhea
- Hyperprolactinemia, often induced by medication or associated with pituitary adenomas or other sellar or suprasellar lesions 3
- Hypothyroidism 3, 4
- Renal insufficiency 3
- Pregnancy or breast-feeding 4
- Nipple stimulation 3
- Drug therapy, such as duloxetine, a serotonin-noradrenaline reuptake inhibitor (SNRI) 5
Treatment Options
- Dopamine agonists, such as bromocriptine or cabergoline, are usually the treatment of choice for patients with hyperprolactinemic disorders 3, 6
- Discontinuation or replacement of medications causing hyperprolactinemia 3
- Surgery or radiation therapy may be required in rare cases, such as pituitary adenomas 3
- Transecting the mammary ducts may be an option for persistent galactorrhea 4
- Central duct excision may be performed for surgically significant discharges 7