Prolactin Levels: Why Am I Still Experiencing Milk Discharge? - Obstetrics and Gynecology

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Understanding prolactin levels and their implications can be quite complex, especially when it comes to the physiological processes that govern lactation and milk discharge. Prolactin is a hormone produced by the pituitary gland, and its primary role is to promote milk production in breastfeeding women. Elevated levels of prolactin, known as hyperprolactinemia, can lead to unintended milk discharge, even in individuals who are not pregnant or breastfeeding.

In your case, you mentioned that your prolactin level was initially 38 ng/mL, which is significantly higher than the normal range (typically less than 25 ng/mL for non-pregnant women). After treatment with bromocriptine (known as "國嘉" in your context), your prolactin levels have decreased to 6.1 ng/mL, which falls within the normal range. However, you are still experiencing some milk discharge when you apply pressure to your nipples.

There are several potential explanations for this phenomenon:
1. Residual Effects of Elevated Prolactin: Even after your prolactin levels have returned to normal, the body may still exhibit some residual effects from the previous elevated levels. Prolactin can stimulate the mammary glands to produce milk, and it may take some time for the glands to fully return to their baseline state after prolonged exposure to high levels of the hormone.

2. Physiological Response: The mammary glands can remain somewhat responsive to stimulation even after prolactin levels normalize. This means that physical stimulation, such as squeezing the nipple, can still trigger a small amount of milk discharge due to the sensitivity of the glands.

3. Other Hormonal Influences: Other hormones, such as oxytocin, can also play a role in milk ejection. If there are fluctuations in these hormones, it could lead to milk discharge even if prolactin levels are normal.

4. Cysts or Other Breast Conditions: You mentioned the presence of a 0.33 cm cyst near the areola. While this is likely benign, any breast condition can potentially influence milk production or discharge. It's essential to monitor any changes in the cyst and consult with your healthcare provider for further evaluation if necessary.

5. Psychological Factors: Sometimes, psychological factors such as stress or anxiety can influence hormonal levels and bodily responses. If you are particularly focused on the issue of milk discharge, it could inadvertently stimulate a response.

If the milk discharge continues or if you experience any other symptoms such as pain, changes in breast appearance, or any new lumps, it is crucial to follow up with your healthcare provider. They may recommend further imaging studies or hormonal evaluations to ensure that there are no underlying issues that need to be addressed.

In summary, while your prolactin levels have returned to normal, the mammary glands may still be reacting to previous hormonal levels or other factors. It is advisable to keep an open line of communication with your healthcare provider to monitor your condition and address any concerns you may have.