Lactation occurs naturally in women after childbirth. However, lactation without pregnancy is characterized by milk discharge from breasts even if one is not pregnant or nursing. It is not uncommon for mothers to experience breast milk production and leakage even one year after weaning the baby. However, in some cases, lactation without pregnancy may be a side effect of certain medications or a symptom of a pituitary gland disorder. Read this post to learn about the symptoms, diagnosis, treatment, and prevention of lactation during pregnancy.
What Is Lactation Without Pregnancy?
Some women may have a milky discharge from the breast even in the absence of pregnancy. Such a condition is called galactorrhea, which is experienced by around 20-25% of women at some point in their life (1). It is common in women aged between 20 and 35 years. The milk secretion can be persistent or intermittent, abundant or scant, unilateral or bilateral. So what could cause lactation when you are not pregnant or have recently delivered a child? Find out next.
Why Do You Lactate When You Are Not Pregnant?
Several causes that can cause inappropriate milk discharge. We have categorized them into physiological and pathological reasons (2):
Physiological
In the case of amenorrhea (absence of a monthly period), galactorrhea is usually caused by hyperprolactinemia, a condition when the level of prolactin hormone in the blood increases and stimulates breast milk production. The amount of this hormone remains high post delivery, which is normal (2).
Nipple or breast manipulation during sex.
Psychosocial stress (3)
Pathologic
Disorders involving the hypothalamus or pituitary stalk. Suprasellar or sellar lesions of the pituitary stalk, which is also called ‘stalk effect,’ can lead to galactorrhea.
Tumors that include craniopharyngioma, germinoma, meningioma
Infiltrative disorders like histiocytosis, sarcoidosis
Rathke’s cleft cysts
Pituitary lesions like prolactinoma (that causes hyperprolactinemia), acromegaly
Chest wall lesions
Breast surgery
Burns
Spinal cord injury
Herpes zoster
Trauma
Systemic disease like hypothyroidism, renal insufficiency
Medication-induced hyperprolactinemia that includes antipsychotics, gastrointestinal motility medications (metoclopramide), antidepressants, antihypertensive medications (verapamil, methyldopa, reserpine), opioids, cocaine
Idiopathic hyperprolactinemia
Normoprolactinemic galactorrhea
Thyrotoxicosis
Few of the causes mentioned above are associated with certain symptoms, which you may watch out for.
Symptoms of lactation without pregnancy
Breast milk discharge in itself is a symptom of some other condition. Therefore, look for other symptoms to know the reason behind the inappropriate lactation (3): In the case of pituitary or hypothalamic disease:
Headaches Visual disturbances Temperature intolerance Seizures Disordered appetite Polyuria Polydipsia
In the case of hyperprolactinemia:
Decreased libido Infertility Oligomenorrhea Amenorrhea
In the case of hypothyroidism:
Tiredness Cold intolerance Constipation
In the case of thyrotoxicosis:
Nervousness Restlessness Increased sweating Heat intolerance, Weight loss despite increased appetite
If any of the symptoms mentioned above or a discharge other than the milky secretion from the nipples bother you, then make sure to see a doctor without delay. Early diagnosis and treatment can prevent the condition from worsening.
Diagnosis of lactation without pregnancy
The diagnosis for lactation without pregnancy includes a physical examination and a laboratory evaluation (3).
Physical examination:
General test: The doctor determines your height, weight, and vital signs and examines the chest for any infection, irritation, or trauma. The doctor will also look check for poor growth, gigantism/acromegaly, bradycardia, and tachycardia.
Examination of the breast: The breast is examined for discharge and nodules. In the case of discharge, it is essential to ascertain the nodules’ location and to determine if the secretion is through one duct.
Look for other signs: The doctor checks for other signs like visual field defect, cranial neuropathy, papilledema, goiter, dry skin, coarse hair, myxedema, and carotenemia.
Laboratory evaluation:
After the physical examination, the doctor may suggest a lab examination if there is still doubt regarding the nature of the discharge from the nipple. A microscopic examination of the fat globules in the discharge and an hCG test will be done to confirm pregnancy if any. If necessary, the doctor may recommend further tests to ascertain the serum prolactin level. If the serum prolactin level is more than 200mg per ml (200 mcg/l), it indicates prolactinoma, which can cause galactorrhea. In the case of elevated serum prolactin levels, and a suspected pituitary tumor, the doctor may suggest an MRI scan. Also, bone densitometry will be carried out if the patient is suspected of having osteopenia or osteoporosis. The next section tells you about the different treatment options for lactation without pregnancy. Keep reading.
How Is Lactation Without Pregnancy Treated?
The treatment for galactorrhea depends on the serum prolactin level. If the symptoms of hyperprolactinemia become bothersome, then the following medicines are given to the patient (3):
Dopamine agonists – It helps in suppressing the serum prolactin level, restoring the gonadal function, eliminating galactorrhea, and decreasing the size of the tumor. Bromocriptine (Parlodel) and cabergoline (Dostinex) are the FDA approved drugs used for this treatment.
Surgical interventions – It is rarely the choice of treatment and is considered only if the medicines fail. Doctors would consider transsphenoidal surgery, which is a preferred, conventional method. Stereotactic radiosurgery is another popular method used for treating the condition.
Radiotherapy – It is considered in patients with macroadenomas, who could not be treated using medicines of surgery.
If the patient has normal prolactin levels and the galactorrhea symptoms are not bothersome, then no treatment is suggested. But, the prolactin level will be periodically measured in such cases. The section below mentions the preventive steps to avoid any occurrence of lactation without pregnancy and breastfeeding.
Prevention Of Lactation If You Are Not Pregnant
Here are some steps you can follow to prevent galactorrhea (4):
Avoid wearing bras that irritate the nipple.
Avoid too much of breast stimulation during sex.
Practice meditation, yoga, or engage in physical activities to relieve stress.
Check for any lumps while doing a self-breast examination.
