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Unexpected Breastmilk Production

Galactorrhea and unexpected milk production

So, maybe you’ve weaned from breastfeeding, a process that may have seemed like it has taken quite some time. It might also seemlike everything returning to ‘pre-baby state’ is also taking its time. So, leaking after weaning is normal, right?

Generally, prolonged leaking (less than 6 months) after weaning is not considered a concern, unless the breasts produce high quantities of milk for a long period of time. Any stimulation, i.e., friction from clothing, breast examination or frequent stimulation during intercourse, etc. can continue to cause milk production after weaning. However, if your breasts remain swollen, hard and/or painful for months following weaning – it would be wise to seek advice from your health professional.

The spontaneous bilateral secretion of milk from the breast (not associated with lactation) is called Galactorrhea. It is not a disease, but could be a symptom of an underlying hormonal imbalance or health condition causing increased prolactin levels. It is commonly found to be caused by benign (non-cancerous) lesions, however can rarely be caused by malignant conditions and therefore deserves investigation.

 

Other possible medical conditions causing excessive milk production after weaning:

Subsequent pregnancy or recent miscarriage
Primary hypothyroidism (rarely)
Pituitary, Uterine or ovarian tumours (more common cause)
Chronic kidney failure secondary to increased prolactin levels
Some medications such as oral contraceptives and antidepressants
Fibrocystic breasts

When to seek further advice from a professional:

You start producing milk and you have never been pregnant(this can occur in men also!)
You are still producing milk 6 months or more following total weaning from breastfeeding
You have breast discharge that doesn’t appear to be ‘milk’. I.e., discoloured, sticky, bloody or purulent (contains pus – generally due to mastitis or an abscess)

 

 

References:
Aziz, K., Shahbaz, A., Umair, M., Sharifzadeh, M. and Sachmechi, I., 2018. Hyperprolactinemia with Galactorrhea Due to Subclinical Hypothyroidism: A Case Report and Review of Literature. Cureus,.
Freeman, M., Kanyicska, B., Lerant, A. and Nagy, G., 2000. Prolactin: Structure, Function, and Regulation of Secretion. Physiological Reviews, 80(4), pp.1523-1631.
Huang, W. and Molitch, M., 2012. Evaluation and management of galactorrhea. 85th ed. American Family Physician, pp.1073-1080.
Lazopoulos, A., Krimiotis, D., Schizas, N., Rallis, T., Gogakos, A., Chatzinikolaou, F., Tsiouda, T., Zarogoulidis, P., Sarafis, P., Kamparoudi, P., Paliouras, D. and Barbetakis, N., 2019. Galactorrhea, mastodynia and gynecomastia as the first manifestation of lung adenocarcinoma. A case reportRespiratory Medicine Case Reports, 26, pp.146-149.
Melmed, S., Casanueva, F., Hoffman, A., Kleinberg, D., Montori, V., Schlechte, J. and Wass, J., 2011. Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 96(2), pp.273-288.
Menon, P., Thunga, G., Nambiar, S. and Khera, K., 2015. Atypical presentation of metoclopramide-induced galactorrhea. Journal of Pharmacy Practice and Research, 45(4), pp.437-439.
Nebhinani, N., 2013. Sertraline-induced galactorrhea: case report and review of cases reported with other SSRIs. General Hospital Psychiatry, 35(5), pp.576.e3-576.e5.
Nebhinani, N., Suthar, N., Pareek, V. and Suman, D., 2018. Galactorrhea with antidepressants: A case series. Indian Journal of Psychiatry, 60(1), p.145.
Ruhela, S., Sahu, I., Ruhela, M. and Ola, R., 2020. Domperidone induced galactorrhea: rare presentation of a common drug. International Journal of Basic & Clinical Pharmacology, 9(11), p.1735.
Vroonen, L., Daly, A. and Beckers, A., 2019. Epidemiology and Management Challenges in Prolactinomas. Neuroendocrinology, 109(1), pp.20-27.

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