Galactorrhea is a pathological efflux of milk in lactating women, lasting for five months after the feeding of the baby is discontinued. In non-breastfed women, milk is not allocated, but a milk-like discharge. The reason for this condition lies in the increased secretion of the pituitary hormone prolactin. Galactorrhea and amenorrhea tend to accompany each other.
Galactorrhea and amenorrhea - how are they related?
The galactorrhea is caused by the pituitary secretion of a large amount of the prolactin hormone. Simultaneously, prolactin suppresses the secretion of the gonadotropin-rizling hormone( GnRH) of the hypothalamus, the main task of which is stimulation of the secretion of gonadotropic hormones of the pituitary( STG) follicle-stimulating and luteinizing( FSH and LH).
The lack of THG affects the function of the ovaries. The lack of FSH does not allow the egg to ripen, enough estrogen is not produced, therefore the mucous membrane of the uterine cavity( endometrium) does not grow( there
Because of the absence of ovulation, the second phase of the menstrual cycle does not occur, since no yellow body normally secretes progesterone Progesterone is the norm and pathology .Constantly the same low( monotonous) level of secretion of female sex hormones leads to the fact that the monthly process of rejection of the endometrium, associated normally with a break in hormonal support, becomes impossible. This means that menstruation does not begin, that is, with a high content of prolactin in the blood, there comes a persistent amenorrhea.
Why prolactin secretion in the pituitary gland can increase
In the vast majority of cases, the cause of increased secretion of prolactin is a benign tumor of the pituitary gland prolactinoma. Therefore, with an increase in the content of prolactin in the blood, the presence of prolactinoma is primarily excluded.
In addition, the cause of an increase in the blood levels of prolactin can be a benign tumor of the pituitary somatotropinoma, which produces growth hormone in many respects similar to prolactin - it can suppress the secretion of GTG.Various tumors and diseases of the hypothalamus, as well as stresses can suppress the secretion of GnRH and adversely affect the function of the entire neurohormonal system.
Various diseases and tumors of the thyroid gland and adrenal glands can lead to hypersecretion of prolactin. Sometimes this stimulating function is performed by drugs with psychotropic action( aminazine, haloperidol), combined oral contraceptives( COCs), antiemetics( eg, cerucal).
During baby feeding Breastfeeding - personal choice breast reflex stimulation of prolactin secretion occurs. The syndrome of galactorrhea - amenorrhea in this case has a physiological character. It is often used for natural protection against unwanted pregnancy. But this protection is reliable only with regular breastfeeding. After the introduction of the first complementary food We introduce the lure - how not to be mistaken with the choice of products? ( at 5-6 months).
Sometimes, the same reflex stimulation of prolactin secretion occurs with inflammatory diseases of the mammary glands( mastitis), burns, operations on the mammary glands, shingles, and so on.
Some other diseases may also promote increased secretion of prolactin.
Signs of the syndrome of galactorrhea - amenorrhea
The main signs of the syndrome of galactorrhea - amenorrhea are the expiration of milk or milk-like fluid from the mammary glands and the absence of menstruation. Allocations from the nipples can be both copious and drip. The mammary glands can also change under the influence of prolactin: they often show signs of fibrocystic mastopathy.
Decreased secretion of sex hormones leads to suppression of sexual function: decreased sexual desire, there are atrophic changes( decrease in volume) in the uterus, ovaries and external genital organs. Mucous membranes of the genital organs become dry, which can disrupt sexual contacts and contribute to the development of urinary disorders.
Sometimes there is also obesity, male hair type, acne - all these are signs of high blood levels of male sex hormones.
Diagnosis and treatment
For amenorrhea of any origin, a blood test for hormones is mandatory. The high content of prolactin in the blood, with a low content of thyrotropin and thyroid hormones, and female sex hormones always causes suspicion of the presence of prolactinoma. To detect this tumor, X-ray studies of the brain, computer and magnetic resonance imaging are performed. Simultaneously, the area of the hypothalamus is also examined.
Treatment of the syndrome of galactorrhea-amenorrhea is usually conservative. Prescribe drugs that inhibit the secretion of prolactin, for example, parlodel. The operation is performed only in the case when the prolactinoma does not show sensitivity to the parlodel, as well as for large prolactinomas that compress the surrounding tissues.