When a woman notices milky discharge from her nipples-without being pregnant or breastfeeding-it can be alarming. This condition, called galactorrhea, isn’t rare. About 1 in 4 women experience it at least once in their life, according to Mayo Clinic data from early 2025. What most people don’t realize is that this isn’t a disease on its own. It’s a signal. A red flag from your body saying something else is off-often tied to a hormone called prolactin.
What Exactly Is Galactorrhea?
Galactorrhea means milky nipple discharge that happens outside of pregnancy or nursing. It’s usually bilateral (both breasts), though about 1 in 4 cases affect just one side. The fluid isn’t watery or bloody-it’s thick, white, and can drip spontaneously or when the breast is squeezed. Unlike discharge linked to breast cancer (which is often bloody and from one duct), galactorrhea doesn’t typically come with pain, lumps, or skin changes. The key trigger? High levels of prolactin in the blood-what doctors call hyperprolactinemia. Normal prolactin levels for non-pregnant women range from 2.8 to 29.2 ng/mL. When levels climb above 25 ng/mL, it’s considered elevated. And when they hit 100 ng/mL or higher, there’s a strong chance a pituitary tumor (called a prolactinoma) is to blame. But here’s the twist: not everyone with high prolactin has symptoms. About 15-20% of women with mildly elevated levels feel perfectly fine. That’s why doctors don’t treat numbers alone-they treat people. If you’re not having missed periods, not struggling to get pregnant, and the discharge isn’t bothering you, sometimes the best move is watchful waiting.Why Does High Prolactin Cause Infertility?
Prolactin doesn’t just make milk. It also shuts down the reproductive system. When prolactin is too high, it suppresses two critical hormones: GnRH (gonadotropin-releasing hormone) and then FSH and LH (follicle-stimulating and luteinizing hormones). Without these, your ovaries don’t ovulate. No ovulation means no period-and no chance of pregnancy. This is why many women with galactorrhea also have amenorrhea (absent periods). Studies show that up to 90% of women with hyperprolactinemia-related infertility will start ovulating again once prolactin levels are brought back down. Dr. Richard S. Legro from Penn State College of Medicine confirmed this decades ago: dopamine agonists don’t just stop the discharge-they restore fertility in 80-90% of cases. It’s not just women. Men with high prolactin can have low libido, erectile dysfunction, and reduced sperm count. But because men don’t get galactorrhea as often, their symptoms are often missed until they’re tested for infertility.What Causes High Prolactin?
There are over a dozen possible causes. Here are the big ones:- Prolactinoma-a benign tumor on the pituitary gland. These are the most common cause of very high prolactin levels (over 100 ng/mL). Microprolactinomas (under 10 mm) make up 80% of cases and respond beautifully to medication.
- Medications-many common drugs raise prolactin. Antidepressants like SSRIs (sertraline, fluoxetine), antipsychotics (risperidone), and even some blood pressure pills (verapamil) can trigger it. Switching from sertraline to bupropion, for example, has helped many patients stop discharge entirely.
- Thyroid problems-low thyroid function (hypothyroidism) can cause prolactin to rise. That’s why every patient with galactorrhea gets a TSH test.
- Stress and physical triggers-chest wall irritation, intense exercise, or even a bad blood draw can spike prolactin temporarily. That’s why doctors often repeat the test after a calm, rested morning.
- Idiopathic-in about 1 in 3 cases, no cause is found. These patients often improve on their own within a year.
How Is It Diagnosed?
Diagnosis isn’t just about the discharge. It’s about connecting the dots. First, your doctor will:- Ask about your menstrual cycle, medications, and any breast trauma or nipple stimulation.
- Do a physical exam-checking for lumps, asymmetry, or signs of other hormonal issues.
- Order blood tests: prolactin, TSH, kidney function (since kidney disease can raise prolactin), and sometimes pregnancy testing.
What Are the Treatment Options?
Treatment isn’t one-size-fits-all. It depends on your symptoms, prolactin level, and whether you want to get pregnant. The go-to treatment? Dopamine agonists. These drugs mimic dopamine, the natural hormone that tells the pituitary to stop making prolactin. Two main drugs are used:| Drug | Dosing | Effectiveness | Side Effects | Cost (Monthly) |
|---|---|---|---|---|
| Cabergoline (Dostinex) | 0.25-1 mg, twice weekly | 83% normalize prolactin in 3 months | Nausea (10-15%), dizziness, fatigue | $300-$400 |
| Bromocriptine | 1.25-2.5 mg daily | 76% normalize prolactin in 3 months | Nausea (25-30%), vomiting, low blood pressure | $50-$100 |
What About the New Treatments?
Medicine is moving forward. In January 2025, the FDA approved a new extended-release version of cabergoline called Cabergoline ER. It’s taken just once a week instead of twice. Phase 3 trials showed 89% effectiveness-slightly better than the standard version. Novartis is also testing a new drug in phase 2 trials: a selective prolactin receptor blocker. Instead of lowering prolactin, it blocks its action at the breast. This could be a game-changer for patients who can’t tolerate dopamine agonists or have side effects from long-term use. In 2024, Mayo Clinic started integrating endocrine and breast specialists into one clinic. Before, patients waited 8 weeks for a full workup. Now, it’s down to 3.5 weeks. That kind of teamwork matters.What’s the Outlook?
The good news? Prolactin disorders are among the most treatable endocrine conditions. Most people see dramatic improvement within months. For those trying to conceive, success rates are high. One patient on BabyCenter wrote: “I conceived naturally 4 months after starting cabergoline. I never thought it was possible.” Even idiopathic cases-where no cause is found-often resolve on their own. About 30% of these patients stop having discharge within a year without any treatment. The key is not to panic. Galactorrhea is scary, but it’s rarely cancer. And while medication side effects can be annoying, they’re usually temporary. If one drug doesn’t work, another might.
When to See a Doctor
Don’t wait if you have:- Milky discharge and no period for 3+ months
- Discharge that’s bloody, clear, or only from one breast
- Headaches, vision changes, or unexplained fatigue (signs of a pituitary tumor)
- Difficulty getting pregnant and abnormal discharge
Real Patient Experiences
- “After 3 months on cabergoline 0.5 mg twice a week, my discharge stopped and my period returned after 18 months of absence.” - u/HealthyHope2023, Reddit - “I switched from sertraline to bupropion. The discharge vanished in two weeks.” - MyHealth Alberta forum - “Bromocriptine made me so sick I almost quit. Cabergoline? No nausea. Just relief.” - Healthgrades review - “I was told it was stress. But when I got tested, my prolactin was 180. Tumor was tiny. Now I’m pregnant.” - BabyCenter postWhat to Expect Long-Term
Most patients stay on medication for 1-2 years. After that, doctors may try to wean off slowly-if prolactin stays normal and symptoms are gone. About half of patients can stop without relapse. Others need to stay on low-dose cabergoline long-term, especially if they have a tumor. Regular follow-ups are key. Blood tests every 3-6 months at first, then yearly. MRI scans every 1-2 years if you had a tumor. The global market for hyperprolactinemia drugs is growing fast-projected to hit $1.8 billion by 2029. That’s because more women are speaking up, more doctors are testing, and better drugs are coming. The bottom line: galactorrhea isn’t just about milk. It’s about your hormones, your fertility, your peace of mind. And with today’s tools, it’s rarely a dead end. It’s a detour-and one that can lead right back to health.Can galactorrhea happen in men?
Yes, though it’s rare. Men with high prolactin can develop breast discharge, but it’s much less common than in women. More often, men experience low libido, erectile dysfunction, or reduced sperm count. When galactorrhea does occur in men, it’s almost always linked to a prolactinoma or medication side effects. Testing prolactin levels is critical in men with unexplained infertility or sexual dysfunction.
Is galactorrhea a sign of breast cancer?
Usually not. Galactorrhea is milky, bilateral, and not linked to lumps or skin changes. Breast cancer-related discharge is typically bloody, from one breast, and occurs in only 5% of galactorrhea cases. However, any non-milky, unilateral, or spontaneous discharge should be evaluated with imaging (mammogram or ultrasound) to rule out cancer. Don’t assume it’s benign-get it checked.
Will I need surgery for a prolactinoma?
Rarely. Over 90% of small prolactinomas shrink or disappear with dopamine agonists like cabergoline. Surgery is only considered if the tumor is large (macroadenoma), doesn’t respond to medication, or causes vision problems. Even then, medication is often tried first. Radiation is reserved for cases that don’t respond to either drugs or surgery.
Can stress cause high prolactin?
Yes. Stress, intense exercise, or even an improper blood draw can temporarily raise prolactin by 10-20 ng/mL. That’s why doctors often repeat the test after a calm morning with no breast stimulation. If your level is borderline (say, 35 ng/mL), they’ll retest before jumping to treatment. Don’t panic over one high reading.
How long does it take for prolactin levels to drop after starting medication?
Prolactin levels usually drop within the first 1-2 weeks of starting cabergoline or bromocriptine. Symptoms like discharge and missed periods often improve in 4-8 weeks. For fertility, ovulation can return in as little as 4 weeks, though it may take up to 3-6 months for regular cycles to fully resume. Full tumor shrinkage can take 6-12 months.
Are there natural ways to lower prolactin?
There’s no proven natural cure. Some supplements like vitamin B6 or chasteberry (vitex) are marketed for hormonal balance, but no strong evidence supports their use for hyperprolactinemia. The only reliable treatments are medication and, in rare cases, surgery. Trying unproven remedies can delay effective care. Always talk to your doctor before starting any supplement.