Galactorrhea

Galactorrhea or galactorrhoea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing.

Contemporary Maternal-Newborn Nursing Care defines galactorrhea as "nipple discharge."

Causes
It can be due to dysregulation of certain hormones or local causes such as excessive nipple stimulation. Hormonal causes most frequently associated with galactorrhea are hyperprolactinemia and thyroid conditions with elevated levels of TSH or TRH hormones.

Lactation requires the presence of estrogen, progesterone and prolactin, and the evaluation of galactorrhoea includes eliciting a history for various medications or foods (methyldopa, opiates, antipsychotics, as well as licorice) and for behavioral causes (stress, and breast and chest wall stimulation), as well as evaluation for pregnancy, pituitary adenomas (with overproduction of prolactin or compression of the pituitary stalk), and hypothyroidism. Adenomas of the anterior pituitary are most often prolactinomas. Overproduction of prolactin leads to cessation of menstrual periods and infertility, which may be a diagnostic clue. Galactorrhoea may also be caused by hormonal imbalances owing to birth control pills.

Galactorrhoea is also a side effect associated with the use of the second-generation H2 receptor antagonist Cimetidine (trade name: Tagamet). Galactorrhoea can be also caused by anti-psychotics that cause hyperprolactinemia by blocking dopamine receptors responsible for control of prolactin release. Of these, risperidone is the most notorious for causing this complication. Case reports suggest proton-pump inhibitors have been shown to cause Galactorrhoea.

Neonatal Milk
Neonatal milk or witch's milk is milk secreted from the breasts of many newborn infants. It is caused by a combination of the effects of maternal hormones before birth, prolactin and growth hormone passed through breast feeding and the postnatal pituitary and thyroid hormone surge in the infant. Witch's milk is more likely to be secreted by infants born at full term, than by prematurely-born infants. Breast milk production occurs in about 5% of newborns and can persist for two months though palpable breast buds can persist into childhood.

There is usually no treatment necessary; however, redness, tenderness, or fever may be a sign of mastitis and may require antibiotics. Blood from the nipples is nearly always benign and associated with the normal growth of the ducts, rather than mastitis. Removing the milk from the breasts can prolong milk production and is considered necessary in some cultures. While breastfeeding may also contribute to prolonged milk production and breast enlargement, temporary or permanent weaning is not recommended.

In folklore, witch's milk was believed to be a source of nourishment for witches' familiar spirits.