Q: Hello good evening ma’am. I’m a medical student. I have an issue that’s been bothering me for a while now. 2 years ago when I was 20 I noticed a discharge from my breasts, I complained to my brother-in-law who is an endocrinologist. He did some examinations and that was it….recently I started to have migraine during my period and he said I had menstruation-induced migraine. He gave some medications for it. Until recently, I forgot about the discharge from my breasts so, I checked and noticed it was still there. …I did some research and realized it might be a result of hyperprolactinaemia. So my fear is…I learnt it could cause infertility. I’m not married though and not sexually active but I’m worried….I don’t want to have issues when I do get married….and I forgot to add….The discharge is colorless and bloodless….Thank you
A: Hi dear. Thanks for writing in. The greatest problem(s) that doctors and other medical professionals have is that of over-diagnosing themselves! So, I suggest that instead of doing more self-diagnosis, you actually make an appointment to see the endocrinologist in the teaching hospital where you are studying.
Having said that, I’ll attempt to unpack some of the symptoms you describe.
Headaches during menstrual periods are referred to as menstrual or hormonal migraines and are due to a drop in the level of estrogen, a hormone. For a headache to be classified as this, it would happen anytime between about 2 days before a menstrual period to about 3 days after the first day of menstrual period. Some of these women find relief during pregnancy as the level of estrogen rises.
To pre-empt this, you can take pain relievers that are also anti-inflammatory like ibuprofen at the start of the period or even about a few days before the start of an expected period until the bleeding stops. If you’re asthmatic or have peptic ulcer disease, this drug is not a safe choice for you.
It is possible that the breast discharge is associated with the headache as can happen in prolactinomas, but they could be separate issues.
Causes of breast discharge include:
- Stimulation of the nipples during sexual foreplay or even pressing the nipple by people who are worried about the nipple discharge or friction between fabric and nipple can lead to nipple discharge.
- Breast abscess/infection
- Injury to the breast
- Cancer of the breast
- Use of some medications
- Hormone imbalance which can lead to production of prolactin even when one is not lactating. This results in women who are not pregnant having milky fluid come out of their breasts when they are not breastfeeding or even in women who have never been pregnant. This is called galactorrhea (pronounced gulactoria). This is not a disease on its own but a symptom of a problem. The hormone, prolactin is usually produced in these cases.
This milky fluid can be expressed by pressing or it can spontaneously come out on its own. It can affect one or both breasts and usually there are no blood stains involved. Sometimes, the cause of this discharge may not be known but some causes could be some medications, some drugs like cocaine, spinal cord injuries, some birth control pills, stress and even excessive stimulation during sexual intercourse. Galactorrhea can also happen in men and new born babies! In new born babies this can happen if the mother has a high level of estrogen which crosses over into the baby and stimulates the formation of breast tissue and sometimes, some milky white discharge.
If you notice this, please visit your doctor who may try to express this discharge to study. The discharge may also be clear, bloody or even tinged yellow. These need further evaluation and the presence of lumps should also be checked for. The level of prolactin will also be assessed. This may, however, be normal in people who are overly sensitive to prolactin. In this class of people, prolactin level is normal but there is still milky discharge from the nipples.
To determine cause, the doctor may do a scan, take tissue sample to examine (biopsy) etc. Treatment depends on cause. If due to pregnancy or breastfeeding, it will eventually stop. If due to stimulation, the discharge will continue as long as the stimulation is present. If due to injury, it will also stop with healing. If the discharge is due to medication, stopping the medication is sufficient to bring this to a stop or switch to something else under the supervision of your physician (doctor). If there is a tumour producing prolactin (this condition is associated with complaints of headache when they are large), drugs can be taken to shrink it or surgery can be done. If no cause is found, drugs that reduce prolactin level are prescribed. Remember, that you could be pregnant and so a pregnancy test may not be out of place.
In the meantime, breast pads can be worn to prevent the embarrassing leaks from staining clothes, limit manipulation of breasts either by self-breast examination or during sexual activity and try not to wear clothes in which there would be friction between the nipples and the material.
The first challenge is confirming a diagnosis and then dealing with the cause. I suggest that you deal with that first and then sort out other issues, if need be, afterwards.
All the best!
Have a good weekend 😀