Gynecomastia (sometimes with galactorrhea) can develop not only as an element of feminization due to the estrogenic effect on the male body, but also by another mechanism - when using drugs that act on the central nervous system. These medicines can also cause galactorrhea in women with or without menstrual irregularities. Therefore, in its main manifestations associated with the state of the mammary glands, this syndrome differs from the consequences of estrogenization, which justifies its independent consideration: it can occur in both sexes under the influence of other compounds with a pathogenetic mechanism different from estrogens and has its prototype in natural human pathology. .
Gynecomastia and galactorrhea have recently been observed relatively more frequently. due to the increasing and prolonged use of reserpine and phenothiazine drugs, and especially when combining these two groups of drugs. This effect seems to be stronger with phenothiazine drugs, probably due to the more frequent use of large doses, for example, in mentally ill patients, in whom a significant concentration of the substance in the body must be achieved to obtain a therapeutic effect. Nevertheless, there is no complete parallelism between the dose and the appearance of the syndrome, since galactorrhea can also appear after taking relatively small amounts of the drug, in particular in patients who have other abnormalities in the body that favor the onset of a neurohumoral disorder. In patients with uremia, Rabinowitz and Friedman observed the appearance of milk secretion after taking low doses of phenothiazine drugs (for example, 12 mg perphenazine per day). Among 200 mentally ill Sulman and Winnik treated with 75 to 300 mg of largactil per day, persistent or transient galactorrhea was observed in 25 women after two weeks of treatment, and at higher doses (350-400 mg of chlorpromazine per day), milk secretion appeared after the first 10 days. Since spontaneous galactorrhea can also occur in mental illness, the role of the drug is proved by the characteristic dynamics of the process: milk secretion stops with the cessation of treatment and naturally reappears with the resumption of medication, usually this time in a shorter period from the start of treatment.
The lactogenic effect of reserpine was established in experimental animals and was also observed in patients with severe hypertension or with mental disorders who were treated for a long time with relatively large doses. Unlike chlorpromazine, this effect was usually observed after several months of reserpine treatment. In some cases, the violation occurred with simultaneous treatment with reserpine and phenothiazine drugs, so that, in all likelihood, it was due to their summed action. Gynecomastia has been observed in isolated cases after prolonged treatment with mileran, isoniazid and other drugs, but, in all likelihood, the pathogenesis is not the same here, and, perhaps, disorders associated with the underlying pathological process also play some role.
To understand the pathogenesis of the syndrome, it should be borne in mind that the only adenohypophyseal hormone, the secretion of which is inhibited by the humoral pathway by the hypothalamus, is prolactin. Phenothiazine drugs and reserpine, in turn, acting on the central nervous system, can under certain conditions remove this inhibitory effect, which would release the secretion of prolactin by the adenohypophysis and would lead to the appearance of galactorrhea. Disturbed function of the hypothalamus under the influence of these drugs is also indicated by other detected abnormalities in the endocrine system, despite the fact that the results of studies conducted so far are rather contradictory and difficult to interpret in a certain pathophysiological aspect. For example, in some cases, a decrease in estrogen secretion was found with a reduced, normal or increased amount of follicle-stimulating hormone. In some cases, the secretion of HTG was five times higher than the initial level. Excretion of 17-ketosteroids was normal or temporarily reduced, in men even severely reduced at the end of treatment, while mild to significant stimulation of ACTH and corticosteroid secretion was found in experimental animals. The heterogeneous deviations in the adenohypophyseal function are explained by a partial drug blockade of the hypothalamus or various functional relationships with the mesoencephalic and higher brain structures. As a direct cause of dysfunction of the hypothalamus, blockade of the action or binding of serotonin to neuroglandic cells is considered.
In a small number of autopsies performed to date on women with phenothiazine-induced galactorrhea, neither macroscopic or histological changes in the endocrine glands nor morphologically perceptible lesions of the hypothalamus have been found.
Clinically, in the male, the syndrome is mild to moderate, usually bilateral, gynecomastia, sometimes with the separation (spontaneous or by squeezing) of a small amount of colostrum-like secretion; in some cases, there is also a suppression of libido. In a woman, galactorrhea begins with slight changes in the size and consistency of the mammary glands, sometimes with a feeling of tension and mild soreness. At the beginning, the secret can be obtained after squeezing, and later spontaneously; the amount can be very different - from very meager to quite plentiful, with macroscopic and chemical qualities of milk and colostrum. In some cases, galactorrhea is unilateral. Both prolonged continuous milk secretion and intermittent, independent of the menstrual cycle or appearing during the week preceding menstruation are described. Usually galactorrhea stops 2-3 weeks after stopping treatment, and sometimes after several months, to reappear after the resumption of treatment.
In some cases (up to 62%), galactorrhea is accompanied by amenorrhea, which resembles the Argonz-Del Castillo syndrome, but without its characteristic decrease in FSH levels. The similarity between these syndromes corresponds to the hypothalamic origin of the disorders in both cases. With chlorpromazine amenorrhea, a hypoestrogenic colpocytogram is observed, but histologically normal endometrium. After stopping the medication, sometimes even after lowering the dose, the normal menstrual cycle is restored.
Syndrome of drug-induced gynecomastia and galactorrhea is mainly of theoretical interest; it is of no particular importance to patients, if we exclude the inconveniences of a more abundant milk secretion and, if present, menstrual disorders. This should be known in order not to attribute its symptoms to another process in the endocrine system. The only effective means of eliminating it is to reduce or stop treatment. For more intense tension or soreness in the breasts, a topical application of androgenic hormone ointment can be tried.
The main symptom is milky discharge, which is detected either on its own or with pressure on the nipples. They may be yellowish or greenish in color. The secret of a reddish color is not a sign of galactorrhea, but requires immediate examination.
Additional (not mandatory) symptoms:
- gynecomastia (breast enlargement);
- headaches;
- visual impairment (more often narrowing of the visual fields);
- acne (a skin disease accompanied by the formation of clogged pores (black dots) and inflammation of the sebaceous glands);
- problems in sexual life (decreased sexual desire (libido), erectile dysfunction (enlargement and tension of the penis during sexual arousal).
Forms
Galactorrhea can be:
- unilateral;
- bilateral.
- 1st degree which is characterized by drip secretion when pressing on the peripapillary region;
- 2 degree with jet secretion when pressed;
- 3 degree (spontaneous expiration of the secret).
Causes
- Pituitary pathology - transection of the pituitary stalk, a pituitary tumor that secretes (produces) prolactin.
- Bronchogenic cancer - arising from the tissues of the bronchi.
- - a condition characterized by a lack of hormones secreted by the thyroid gland.
- Taking certain drugs: tricyclic antidepressants, reserpine, verapamil, melidofa, phenothiazines, butyrophenones, opiates (including illegal opium preparations).
- The use of a large number of herbs: fennel, anise, nettle, fenugreek, thistle.
- Excessive stimulation of the nipples.
Diagnostics
- Analysis of the history of the disease and complaints (when discharge from the nipples appeared (on its own or with pressure), headaches, blurred vision, etc.).
- Analysis of the anamnesis of life (what medications are taken, are there any problems in sexual life).
- Inspection data - is there any discharge from the nipples, what color are they (milky, yellowish or greenish), the presence of seals, obesity, swelling, gynecomastia (enlargement of the mammary glands) is determined.
- Determination of the level of prolactin in the blood.
- Radiography of the brain, which allows, with tumors of the pituitary gland, to see an increase and change in the bottom of the Turkish saddle - the bone receptacle of the pituitary gland.
- Computed tomography (CT) (more sensitive than radiography, research method) and magnetic resonance imaging (MRI) of the brain - can detect small tumors.
- Determination of the level of thyroid hormones in the blood.
- X-ray of the lungs: used to look for a lung tumor that can cause galactorrhea.
- Consultation.
Treatment of galactorrhea
The main principle of treatment is the elimination of the cause of hyperprolactinemia (elevated levels of prolactin in the blood. Hyperprolactinemia can occur without galactorrhea. Therefore, hyperprolactinemia is not a synonym for galactorrhea, it is a symptom determined by the laboratory).
- Taking drugs that inhibit the secretion (production) of prolactin in the pituitary gland.
- Treatment of tumors (surgical removal; radiation therapy, which involves the use of ionizing radiation to destroy tumor cells).
- Treatment of an endocrine disease (for example, hypothyroidism - a condition of reduced levels of thyroid hormones).
- Correction of the intake of pharmacological agents (with drug galactorrhea caused by the intake of certain drugs - verapamil, antidepressants, oral contraceptives, etc.).
Complications and consequences
For each of the diseases that cause galactorrhea, there are complications.
- For pituitary tumors: loss of vision, cerebral hemorrhage, cerebral infarction (brain damage caused by the cessation of blood flow to its tissues).
- For bronchogenic cancer (): metastasis (spread of cancer cells to other organs with the formation of secondary tumors), death.
- For hypothyroidism (a condition caused by low levels of thyroid hormones): hypothyroid coma (confusion and loss of consciousness, low blood pressure, swelling of vital organs); diseases associated with the accumulation of fluid in the pericardial sac and pleural cavity (the cavity surrounding each lung).
Prevention of galactorrhea
Galactorrhea in men is most often associated with pituitary tumors, the causes of which are unknown, therefore, prevention as such does not exist.
- this is a pathological secretion of milk from the mammary glands, which is not associated with the process of feeding a child. It occurs in men and women of different ages and is more often associated with hyperprolactinemia. The causes of galactorrhea can be systemic diseases, pathology of the hypothalamic-pituitary system, or side effects of certain drugs. When diagnosing, hormone levels are determined, ultrasound of the pelvic organs, MRI of the brain are performed. Treatment depends on the cause of galactorrhea. Drugs that block the production of prolactin are used, and for tumors, surgery and radiation therapy.
ICD-10
N64.3 Galactorrhea not associated with childbearing
General information
Galactorrhea is more common in women than in men, observed both in reproductive age and at the threshold of menopause. During the neonatal period, it is diagnosed with the same frequency in girls and boys, but in this case it is a manifestation of physiological adaptation and passes without treatment. In 67% of cases with galactorrhea, the level of prolactin is increased, but there is no direct relationship between the appearance of milk and the degree of increase in the hormone. Most women with galactorrhea have menstrual irregularities, and 70% have infertility.
Causes
Galactorrhea is a pathological symptom, it appears without connection with the lactation process after childbirth, it can occur in nulliparous women. Hormone releases occur during sexual intercourse, during physical exertion, stress and sleep, but they do not lead to galactorrhea. The causes of a pathological increase in the level of the hormone and the appearance of milk are:
- Hypothalamus lesions. Hyperprolactinemia and galactorrhea against its background develops with tumors of the hypothalamus. The reason may be traumatic brain injury undergone brain surgery, encephalitis. In rare cases, galactorrhea is a consequence of radiation damage to the hypothalamus.
- Endocrine Syndromes. Galactorrhea, which is accompanied by hyperprolactinemia, occurs when polycystic ovary syndrome. Milk secretion may begin in patients with hypothyroidism, Cushing's syndrome and acromegaly.
- Pathology of the adrenal glands or kidneys.Tumors of the adrenal glands, in which the production of estrogen increases, cause an increase in prolactin, which leads to galactorrhea. In renal failure, the excretion of prolactin is impaired, it remains circulating in the blood and causes galactorrhea.
- Iatrogenic factors. Galactorrhea develops against the background of taking drugs that affect the secretion and metabolism of dopamine, reduce its reserves in the central nervous system, or stimulate the serotonergic system. Such effects have anticonvulsants, antidepressants, neuroleptics, amphetamines, opiates, including cocaine , heroin.
- Malignant tumors. Prolactin can be secreted not only in the brain. Its synthesis occurs in some malignant tumors. This is most often observed in bronchogenic carcinoma, hypernephroma.
Pathogenesis
In humans, prolactin secretion is controlled by a complex neuroendocrine mechanism involving the central and peripheral nervous systems. Dopamine, somatostatin, gamma-aminobutyric acid, gastrin and some other peptides inhibit the release of prolactin. The stimulating factors are oxytocin, TSH, GnRH, melanocyte-stimulating hormone, serotonin, opiates, insulin, estrogens, and androgens.
The main inhibitory factor is dopamine. With a decrease in its influence, an increase in the release of prolactin into the blood occurs. Due to prolonged stimulation of lactotrophic cells in the pituitary gland, they first hyperplasia, and then micro- and macroadenomas occur. Under its influence, the synthesis of gonadotropin-releasing hormone is disrupted, the release of FSH and LH is reduced. In a woman against the background of galactorrhea, the menstrual cycle changes by type amenorrhea developing infertility.
The extragenital influence of prolactin leads to a violation of carbohydrate metabolism, promotes the conversion of glucose into fats and the development obesity. Many have insulin resistance. The production of dihydroandrostenedione is stimulated, women form hyperandrogenism with its characteristic symptoms. Endocrine disorders lead to the development of osteopenia.
Classification
For the occurrence of galactorrhea, it is necessary that the increase in the level of the hormone occurs with a simultaneous decrease in estrogens. The appearance of breast milk sometimes appears several years earlier than menstrual irregularities, in half of the patients these symptoms develop simultaneously. The degree of galactorrhea is determined depending on the amount of milk secreted:
- 1 degree. A woman has single drops of a liquid resembling milk, with strong pressure on the nipple.
- 2 degree. With gentle pressure, large drops or a stream of milk flow out.
- 3 degree. Milk is secreted spontaneously without external influence.
Symptoms
The main symptom of galactorrhea is the appearance of milk from the mammary glands. The amount of discharge depends on the severity of the disease. The menstrual cycle is interrupted. Menstruation becomes rare, short, blood loss decreases. Gradually develops amenorrhea. Trying to get pregnant for a year and no longer bring results. Many women report symptoms of estrogen deficiency in the form of vaginal dryness, decreased libido.
With galactorrhea, headaches are often disturbing; in the presence of pituitary macroadenoma, visual disturbances occur. There are also cerebellar-vestibular, oculomotor, pyramidal, chiasmal disorders. They are the first signs of neurological pathologies. Many patients with galactorrhea tend to depression, depressed mood, memory declines, increased fatigue worries.
Women develop obesity, reduce body weight with the help of diets or physical activity does not work. Insulin resistance can develop over time type 2 diabetes. Hyperandrogenism leads to hirsutism, an increase in greasiness of the skin and hair, the appearance of acne. There is also an acceleration of bone resorption, which is manifested by pain in the legs, develops osteoporosis.
Complications
Left untreated, galactorrhea can cause permanent infertility. The danger is the effect of hyperprolactinemia on metabolic processes. Obesity over time leads to an increased risk of developing cardiovascular diseases, brain accidents. Osteoporosis in advanced form is the main cause pathological bone fractures that are difficult to treat.
The influence of elevated prolactin on the risk of hyperplastic processes of the reproductive organs is also noted. Studies show that chronic galactorrhea increases the likelihood breast cancer. But there is evidence that proves the opposite, that prolactin blocks the genes that are responsible for cancer aggression.
Diagnostics
Examination for galactorrhea is aimed at excluding organic changes in the structure of the brain. A gynecologist takes part in the diagnosis. Mandatory endocrinologist consultation, and for differential diagnosis with tumors of the hypothalamus, a profile examination and examination is performed by a neurosurgeon. The following diagnostic methods are used:
- Gynecological examination . In women, a gynecological examination is mandatory to exclude pregnancy. With galactorrhea, the external genital organs are not changed, the uterus and appendages are palpated with a normal size. When squeezing the nipple, milk comes out.
- Laboratory research. For hyperprolactinemia, a single detection of a hormone level above 500 mU / l is sufficient. The levels of FSH, LH and estradiol in galactorrhea are minimally acceptable or reduced below normal. TSH, T4, ACTH, 17-OPG, IGF-1 are being studied for differential diagnosis of the causes of galactorrhea.
- Gynecological ultrasound . With galactorrhea, the size of the uterus and ovaries may be normal. In women with polycystic ovaries, they are enlarged, there is a large number of follicles, with hyperprolactinemia, the size of the ovaries is not changed, but the number of follicles may increase.
- brain MRI . Necessary for visualization of the pituitary gland. With a macroadenoma, a tumor formation is diagnosed, which can compress other brain structures and give appropriate symptoms.
- Laparoscopy . It is used for suspected polycystic ovaries to clarify the disease. Surgical treatment can be carried out at the same time. Polycystic ovaries are characterized by a large number of follicles under a dense white capsule.
Treatment
The goal of treating galactorrhea is to normalize hormone levels and restore fertility. Methods of treatment are diverse and depend on the causes of the disease. In tumor processes, preference is given to surgical methods of therapy. With galactorrhea secondary to other diseases, treatment of the underlying cause of hyperprolactinemia is necessary.
Conservative therapy
Drug treatment of galactorrhea is aimed at suppressing the synthesis of prolactin, restoring the normal level of sex hormones. Women are observed at the gynecologist of the antenatal clinic, hospitalization in the gynecology department or endocrinology only needed for invasive diagnostics. The following groups of drugs are used:
- dopamine agonists. They act on dopamine receptors in the brain, inhibit the synthesis and release of prolactin. Preference is given to cabergoline, bromocriptine acts non-selectively, therefore it has a large number of side effects.
- Thyroid hormones. Levothyroxine sodium is prescribed for diagnosed hypothyroidism. In cases of persistent elevated prolactin and galactorrhea during treatment, dopamine agonists are additionally used.
- Antiandrogens. Used for polycystosis, which caused galactorrhea. Assign combined oral contraceptives with a pronounced antiandrogenic effect. They should include cyproterone, chlormadinone, dienogest or drosperinone.
- Ovulation stimulants. After the hormone decreases to normal levels and the galactorrhea stops, the cycle should be restored, menstruation begins. If ovulation does not occur, use clomiphene citrate or letrozole to stimulate it.
Surgery
Surgical treatment is carried out in the Department of Neurosurgery. It is indicated for the ineffectiveness of drug therapy or its intolerance, increased intracranial pressure, signs of compression of the chiasm. Removal of the tumor required with its progressive growth, the appearance of liquorrhea. Dopamine agonists should not be used in patients with mental disorders, this causes an exacerbation of the underlying disease. Macroadenoma of the pituitary gland is not operated.
Radiation therapy
Forecast and prevention
With galactorrhea, the prognosis is favorable for general health and reproductive function. With timely treatment, the menstrual cycle is normalized, ovulation is restored, and pregnancy can be planned. Prevention of galactorrhea consists in a timely visit to a doctor for any endocrine disorders, the prevention of traumatic brain injuries, and infectious diseases. Stress, nervous disorders can lead to galactorrhea, so it is recommended to prevent the occurrence of these conditions.
Contrary to the opinion of many, galactorrhea is not a disease, but a kind of symptom, or a condition in which there is a release from the mammary mammary glands of a liquid similar in composition to milk or colostrum.
Literally, the term "galactorrhea" is translated from Greek as "leakage of milk." Most often, it is a sign of an incorrect ratio of hormones in the body, but the participation of other developmental factors is not excluded.
Galactorrhea syndrome develops as a consequence of increased levels of prolactin in the bloodstream. More often, this syndrome is diagnosed in the fair sex, but there are cases when children or men get sick.
Galactorrhea-amenorrhea syndrome
The combined syndrome of galactorrhea-amenorrhea refers to pathological conditions in which, against the background of the release of breast milk, there are no periods and infertility is diagnosed. The cause of this syndrome is hyperprolactinemia, which, in turn, can be caused by tumor processes in the pituitary gland, disorders in the hypothalamus, primary hypothyroidism, psychotrauma, prolonged treatment with certain medications.
We can also talk about a similar syndrome if amenorrhea and milk secretion are present in a woman who has stopped breastfeeding her baby (we are talking about the so-called Chiari-Frommel syndrome).
ICD-10 code
N64.3 Galactorrhea not associated with childbearing
O92.6 Galactorrhea
Epidemiology
With galactorrhea, milk is secreted from the ducts of the mammary glands - and this condition is in no way connected with the stage of lactation. The volume and severity of discharge can be different - from the detection of small spots on a bra or clothes, to a more intense expiration.
The pathological condition is unilateral or bilateral, and it is diagnosed mainly in women of reproductive age. However, men are also no exception - they have galactorrhea, although much less frequently.
According to statistics, the expiration of milk in women outside the period of feeding the baby occurs in 20% of the fair sex, aged 25 to 40 years. In men, pathology is diagnosed in 0.07% of cases.
, , , , ,
Causes of galactorrhea
The root causes of the development of galactorrhea can be:
- malignant, benign tumor processes affecting the pituitary gland;
- chaotic medications such as hormonal drugs, sedatives, antidepressants, narcotic analgesics, cardiovascular drugs;
- tumor processes affecting the hypothalamus, or the structure of the limbic system;
- insufficient function of the thyroid gland;
- disorders in the work of the adrenal glands;
- liver disease (especially chronic forms of pathologies);
- mechanical damage, trauma, burns, operations that caused damage to the sensitive fibers of the sympathetic and parasympathetic nervous system;
- tumor processes affecting the spinal structures;
- hyperstimulation of the nipple area (with frequent sexual contact, when using tight underwear, with allergies, etc.);
- after operations affecting the conducting spinal tract;
- bronchogenic cancer process;
- Itsenko-Cushing's disease, Addison's disease;
- taking medicines or folk remedies based on fennel, anise, nettle leaf, fenugreek.
Risk factors
Several factors are known that do not in themselves cause galactorrhea, but contribute to its occurrence. These factors include:
- Stein-Leventhal syndrome (PCOS, accompanied by galactorrhea and amenorrhea);
- cystic skid;
- uterine choriocarcinoma;
- inflammatory processes in the tissues of the mammary glands.
Galactorrhea is normal if observed within five months after the end of the lactation period. If the discharge is present for six months or more, then the presence of a pathology can be suspected.
Discharge in infants during the neonatal period is also considered a relative norm: this condition is associated with the concomitant influence of hormones that have passed to the baby from the mother. This phenomenon goes away on its own and does not require any treatment.
It is worth noting that in approximately every second patient it is not possible to establish the cause of the appearance of galactorrhea, even after all diagnostic measures have been carried out. In such a situation, a term such as "idiopathic galactorrhea" is indicated in the diagnosis.
, , , ,
Pathogenesis
Pathological galactorrhea most often becomes the result of diseases that are associated with impaired work of the hypothalamus (inflammation, trauma), or the pituitary gland (malignant and benign tumors, "empty Turkish saddle").
Increased synthesis of prolactin provokes the development of swelling, swelling and pain in the mammary glands. Vegetative signs may appear: migraine-like pain in the head, swelling of the limbs, discomfort in the abdomen. The constant elevated level of prolactin becomes a chronic stimulating stimulus for the mammary glands, which causes the development of galactorrhea as a symptom. The root cause can be a large number of pathologies and pathological conditions.
, , , , , , , , ,
Symptoms of galactorrhea
The basic symptom, which determines the name of the pathology, is the outflow of a different volume of milk, or colostrum from the milk duct. Allocations can be observed constantly, or only occasionally. Their color can also be different - from a translucent whitish to a yellow-greenish hue.
Pathology may be accompanied by other signs that are dependent on the causative disease:
- headaches like migraines;
- blurred vision;
- deterioration in the condition of the skin;
- tachycardia;
- a sharp change in body weight, in one direction or another;
- libido disorder.
In girls, the monthly cycle may be disturbed at the same time, discomfort may appear in the vagina. Excessive hair growth in the limbs, face, chest is also characteristic.
If galactorrhea develops in men, then the following first signs become typical:
- violation of potency;
- gynecomastia (swelling of the mammary glands);
- deterioration of health, fatigue, pain in the head.
For newborn babies, any symptoms other than direct discharge are not typical.
Galactorrhea in adolescents
A liquid that looks like milk can sometimes be released with the advent of puberty. This refers to the age of 12 to 16 years. As a rule, a hormonal surge becomes a provoking factor, since no disturbances in the formation of glandular tissues are usually found.
Other factors in the development of galactorrhea in adolescents can be:
- taking medicines, medicinal plants;
- the formation of tumors affecting the pituitary gland, hypothalamus;
- decreased performance of the thyroid gland;
- elevated levels of cortisol against the background of disorders in the work of the adrenal glands;
- pathology of the reproductive sphere, kidneys, liver;
- disorders in the spinal cord.
To accurately determine the cause, it is necessary to diagnose and consult with individual specialists.
Galactorrhea in men
Adult men can also have problems with the outflow of milk from the mammary glands. This pathology is called male hypogonadism and is associated with a lack of testosterone in the body. In addition to galactorrhea, other signs are also observed:
- dulling of sexual desire;
- erectile dysfunction;
- enlargement and swelling of the mammary glands.
It is also impossible to exclude the possibility of the influence of other factors, such as taking medications, the presence of tumors, thyroid pathologies, spinal cord injuries, etc.
Galactorrhea and gynecomastia
The outflow of milk fluid from the mammary glands is not in all cases accompanied by their swelling. Gynecomastia is often either absent or present, but in a mild or moderate form. Enlargement of the glands is more often found in men: it is usually bilateral, there is inhibition of libido.
In women, galactorrhea is manifested by a slight increase in the volume and density of the glands. In some cases, the patient feels some tension and mild soreness. With a unilateral lesion, milk secretion is prolonged, without definite interruptions, or periodic. The latter usually does not depend on the phase of the monthly cycle, or occurs a few days before menstrual bleeding.
Galactorrhea and pregnancy
At the stage of preparation for pregnancy, galactorrhea must be cured. Based on the fact that the flow of milk from the breasts is associated with an increase in the secretion of prolactin, such an imbalance can become an obstacle to the conception of a baby, and in the future may jeopardize the normal course of the pregnancy itself.
If galactorrhea was discovered already during gestation, then such a condition cannot be called critical. The body of a woman is actively preparing for the birth of a baby - including the hormonal system is preparing for this. As the due date approaches, the synthesis of hormones such as prolactin and oxytocin increases, so for many women, milk begins to flow well in advance of the onset of labor.
However, the expectant mother must definitely notify the doctor if she has milky discharge from her breasts. After all, it is impossible to completely exclude the possibility of developing pathology during pregnancy. Therefore, additional analyzes are not excluded.
Forms
Taking into account the severity of galactorrhea, the following stages of pathology are distinguished:
- Mild stage - a droplet outflow of a characteristic liquid is observed only when the peripapillary zone is squeezed.
- The middle stage - the liquid flows out in a trickle when the peripapillary zone is squeezed.
- Severe stage - fluid from the milk ducts expires spontaneously.
If the outflow is observed from one gland, then they speak of a unilateral lesion, and if from two glands, they speak of a bilateral lesion.
The types of pathology are also determined depending on the etiological factor:
- galactorrhea associated with lactation;
- galactorrhea unrelated to lactation;
- physiological galactorrhea (takes place during the bearing of the baby).
Galactorrhea not associated with childbearing is not an independent disease. It develops as a result of any pathological processes inside the body - for example, due to endocrine disorders, oncology, or against the background of frequent and excessive stimulation of the nipple area.
Another type of galactorrhea pathology occurs occasionally with normal prolactin. In a similar situation, they often point to an idiopathic - that is, an unidentified cause of galactorrhea. Provoking factors in this case can be enlarged milk ducts, mastopathy, tumor processes in the mammary glands.
, , , , , , ,
Complications and consequences
Since galactorrhea is only a condition that has its own root causes, the likelihood of developing certain complications depends precisely on the initial pathology:
- With tumor processes affecting the pituitary gland, there is a great danger of loss of vision, hemorrhage in the brain tissue, and ischemic stroke.
- With tumor processes in the breast, there is a possibility of the spread of cancer cells with the formation of secondary malignant foci.
- In hypothyroidism, hypothyroid coma, accumulation of fluid in the pericardium or pleural cavity can be observed.
If galactorrhea is caused by a hormonal imbalance, then for a woman this can result in infertility, or a violation of the processes of bearing a baby.
These complications develop mainly in advanced cases. Therefore, in order to prevent them, it is necessary to be examined in a timely manner and begin treatment of the underlying disease.
, , ,
Diagnosis of galactorrhea
As a rule, diagnosing galactorrhea syndrome is not difficult: it is much more difficult to determine the cause of this condition. Therefore, all complex diagnostic procedures are aimed at determining the root cause of the syndrome.
The first stage of diagnosis includes:
- questioning and examining the patient (the doctor finds out all the circumstances under which the pathology arose);
- examination and palpation of the mammary glands;
- for women, a pregnancy test.
- Analyzes are the next diagnostic stage, which includes:
- general blood test;
- tests for the level of hormones in the blood;
- blood chemistry.
Instrumental diagnosis depends on which disease is suspected. So, the doctor may prescribe:
- computer or magnetic resonance imaging of the skull;
- chest x-ray;
- mammography;
- ultrasonography, ultrasound of the mammary glands and reproductive organs;
- biopsy - if indicated.
Consultations of narrow specialists may be required: endocrinologist, gynecologist, mammologist, surgeon.
, , , , , ,
Differential Diagnosis
Differential diagnosis should be carried out with the following pathologies:
- primary hypothyroidism (hyperproduction of thyroliberin);
- sclerocystic ovarian syndrome;
- congenital hyperplasia of the adrenal cortex;
- tumor processes;
- iatrogenic conditions (taking contraceptives, sedatives, antipsychotics, drugs Dopegit, Cerucal, Reserpine, Cimetidine, as well as frequent hyperglycemic episodes in patients with type I diabetes);
- chest injuries, mechanical irritation;
- fibrocystic mastopathy;
- various somatic pathologies.
Treatment of galactorrhea
The main therapy for galactorrhea is aimed at eliminating the root cause of this condition - for example, at normalizing the content of prolactin.
- Prescribed drugs that slow down the secretory activity of the pituitary gland
- Surgical treatment is prescribed, or radiation treatment, if we are talking about tumor processes.
- If there are violations of the thyroid gland, then endocrine pathology is treated.
- Correct nutrition, lifestyle, reconsider the feasibility of taking medications by the patient that could cause galactorrhea.
|
Dosage and administration |
Side effects |
Precautionary measures |
|
|
Bromocriptine |
Take 2.5-7.5 mg per day, depending on the situation. |
Rare manifestations: dyspepsia, lowering blood pressure, headaches. |
The drug is not combined with alcohol, it is not used with a tendency to low blood pressure. |
|
pergolide |
Take 50-250 mcg per day. The exact dosage is determined by the doctor. |
Sometimes - pain in the head, dizziness, lowering blood pressure, dyspepsia. |
The drug is not combined with neuroleptics, metoclopramide. |
|
Cabergoline |
The treatment regimen is prescribed individually. The amount of the drug should not exceed 3 mg per day. |
Decreased blood pressure, peripheral vascular spasm, convulsions, muscle weakness, depression, insomnia. |
The drug is not combined with macrolide antibiotics. |
|
Mastodinon |
Take 30 drops or a tablet twice a day, for 3-4 months. |
Rarely - allergies, dyspepsia. |
With oncology of the mammary glands, the drug is not used. |
|
Cyclodinone |
Take 40 drops or one tablet in the morning, for 3-4 months. |
Allergy. |
The drug is not used during pregnancy. |
vitamins
Most of the processes in the mammary glands proceed under the direct influence of hormones. In this case, any change in the hormonal balance causes a response from the breast. Vitamins are also involved in similar mechanisms. For example, vitamin A has an antiestrogenic effect, reducing the risk of proliferation of epithelial tissue.
Vitamin A in the form of pharmaceutical preparations can be taken, but with great care. Excess retinol can accumulate, which increases the load on the liver. For this reason, it is safer to supplement with beta-carotene, a provitamin A.
With galactorrhea, 50 thousand IU of vitamin A are prescribed per day for several months.
Tocopherol is an antioxidant that has a complex effect on the body. In particular, this vitamin potentiates the production of progesterone, improves fat metabolism, normalizes the monthly cycle and weakens the signs of premenstrual syndrome.
With galactorrhea, tocopherol is taken in an amount of 50-100 mg daily, for several months.
Ascorbic acid also performs the functions of an antioxidant, and also simultaneously potentiates the action of other antioxidants, providing them with protection from destruction. In addition, ascorbic acid perfectly stimulates the immune system in the body. Dosages of vitamin C for galactorrhea are determined individually.
Physiotherapy treatment
Patients in whom galactorrhea is associated with fibrous pathologies, cysts or tumor processes are undesirable to practice physiotherapy, and this is especially true for warming procedures and compresses. Such a warning is associated with the stimulation of metabolic reactions in the disturbed zone, which can cause the development of adverse effects. There is no direct danger to the mammary glands during physiotherapy, but the procedures can cause deterioration and aggravation of pathological processes.
Let's face it, with galactorrhea, medical specialists very rarely write out a referral for physiotherapy. Ignoring this type of treatment is primarily due to the fact that physiotherapy often involves thermal and stimulating effects, which is highly undesirable in galactorrhea. For the same reason, women are not recommended to visit the sauna, or stay in the sun for a long time.
The use of ultrasound, electrophoresis, shock wave therapy, mud therapy is allowed only in situations if this will really contribute to the successful elimination of the disease.
Alternative treatment
When it comes to folk treatment of galactorrhea, here experts advise paying attention to plants containing phytohormones. Such herbs will help stabilize the hormonal system and restore the body as a whole.
- The periwinkle plant regulates prolactin levels, so it can stop galactorrhea. At the same time, periwinkle is able to cure both men and women. In the evening pour 2 tbsp. l. herbs 0.5 l of boiling water, cover the container with a warm scarf and leave to infuse until the morning. All the resulting infusion should be drunk over the next day - about 150 ml three times a day in between meals. By the evening, a new portion of the remedy is brewed - and so the treatment is carried out for 1-2 weeks.
- Sage is used to eliminate galactorrhea in a woman who has completed breastfeeding, but milk continues to be secreted. There are many recipes for using sage. For example, you can simply swallow half a teaspoon of ground sage in the morning (before meals) with warm water or tea. You can prepare an infusion: 1 tbsp. l. plants are brewed in 250 ml of boiling water, drunk at a time instead of tea. Such a drink should be consumed 2-6 times a day, depending on the severity of the pathology.
- Sorrel - or rather, the root of the plant, is crushed, poured with drinking water at room temperature (1:20) and insisted overnight. In the morning, the drug is brought to a boil, after which it is removed from the fire, cooled and filtered. Drink 3 tbsp. l. medicines three times a day after meals.
- Freshly picked jasmine flowers are fixed on the mammary glands and held for an hour. The procedure is repeated 2-3 times a day. Jasmine narrows the milky channels and helps stop galactorrhea.
- Collect 100 g of walnut leaves, 50 g of gerbil grass, geranium leaves and lemon balm. Pour in a thermos 1 ½ tbsp. l. collection of 0.7 liters of boiling water, insist overnight. In the morning, the drug is divided into three parts, each of which is drunk after the next meal. The duration of treatment may vary, depending on the intensity of the symptoms.
- Collect 100 g of basil herb and parsley rhizomes, 50 g of mint leaves, sage and periwinkle. Brew 2 tsp. mixture in 0.7 liters of boiling water, insist 10-15 minutes, filter. Take 1 glass between meals.
- Collect 100 g of sorrel rhizome, 50 g of mint leaves, thyme, yarrow, and 25 g of boron uterus. Before going to bed, pour 30 g of a mixture of 0.7 liters of water at room temperature. In the morning, the drug is brought to a boil over a fire, cooled, filtered. Drink throughout the day. The course of such therapy lasts 2-3 weeks.
- Allium sativum - helps to eliminate galactorrhea after the end of the breastfeeding period.
- Calcarea carbonica 6, 12 - improves the condition of swollen mammary glands with the release of watery milk.
- Cyclamen europeum - eliminates galactorrhea in girls or women, in the absence of pregnancy.
- Crocus sativus - relieves the condition of the so-called "false pregnancy".
- Mercurius solubilis - can cure galactorrhea in males, or in girls during menstruation.
- Phytolacca decantra 3 - stops galactorrhea associated with the development of inflammatory processes in the mammary glands.
- stress, excessive experiences;
- Unhealthy Lifestyle;],
Homeopathy
Homeopathic treatment can be connected if various tumor processes have not become the cause of galactorrhea. If the tumor is excluded, then you can try the action of the following homeopathic remedies:
Dosages of drugs are determined individually, taking into account the constitutional characteristics of the patient. Side effects during treatment are extremely rare, due to small dilutions of drugs.
Surgery
The surgeon's help is resorted to only in exceptional cases. It is believed that even in the presence of tumor processes, the operation is not always advisable: most tumors, including pituitary adenoma, respond well to drug treatment. If a patient is diagnosed with a macroadenoma that does not respond well to medication, then it is possible to contact a surgeon.
Prevention
To prevent galactorrhea, you need to systematically take tests and undergo preventive examinations. You should also, if possible, exclude such factors that can provoke hormonal failure in the body:
