Last update Jan. 5, 2024

Hypergalactia; Hyperlactation

Low Risk

Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

Hypergalactia or hyperlactation is the excessive production of breast milk, with a volume greater than that necessary for the infant to grow normally. There may be physical and social discomfort, fullness and pain in the breast, frequent milk leakage, duct obstruction, vasospasm and mastitis. Infants may have choking, breast refusal, excessive weight gain or weight loss.... All of these can lead to cessation of lactation.

The causes of hypergalactia can be due to hyperstimulation of the breast, idiopathic (of unknown cause) or due to hyperprolactinemia, whether or not due to prolactinomas.

There is no good quality evidence on the best treatment of hypergalactinemia. The following progressive actions are recommended in a stepwise fashion. (Johnson 2020, Trimeloni 2016):

  1. Make milk let-down more difficult: breastfeed supine (face up); use nipple shields.
  2. Avoid hyperstimulation (caused by pumping and/or very frequent feedings) by breastfeeding from one breast alternating with the other in hourly blocks of 3 to 6 hours (block feeding). (van Veldhuizen 2007)
  3. Avoid taking pharmacological or herbal galactogogues (domperidone, metoclopramide, sulpiride, fenugreek...), 
  4. Take infusions of various plants traditionally prescribed to reduce milk production such as peppermint, sage, parsley, jasmine flowers, chasteberry.
  5. Taking medications that can decrease milk production, such as Pseudoephedrine 30 to 60 mg once or twice a day or combined contraceptives containing at least 20 mg of estradiol.
  6. Take dopaminergic medication that inhibits prolactin: 
    1. Cabergoline 0.25 mg, repeating after 3 days if no improvement; can be increased to 0.5 mg after 3 days 
    2. Bromocriptine 0.25 mg per day for 3 days.

HYPERPROLACTINEMIA and PROLACTINOMES

Breastfeeding does not pose a risk of prolactinoma growth, nor does it increase the recurrence of hyperprolactinemia, whether or not due to micro or macro prolactinomas (Aguayo 2014, Auriemma 2013, Shahzad 2012, Bronstein 2005). Remission of prolactinomas after pregnancy and lactation is frequent (Domingue 2014). There is consensus from expert societies that prolactinomas, micro or macro, do not contraindicate breastfeeding (Casanueva 2006). If they give compression symptomatology they can be treated with dopaminergic agonists. (Aguayo 2014)

Successful and prolonged lactation has been described in more than 30 cases of hypergalactia-prolactinoma-hyperprolactinemia treated with a daily dose of 2.5 to 5 mg of bromocriptine without adverse effects in the infants. (Liu 2018, Verma 2006, Cheng 1996, Canales 1981, Peters 1985)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Hypergalactia; Hyperlactation is also known as


Group

Hypergalactia; Hyperlactation belongs to this group or family:

References

  1. Johnson HM, Eglash A, Mitchell KB, Leeper K, Smillie CM, Moore-Ostby L, Manson N, Simon L; Academy of Breastfeeding Medicine.. ABM Clinical Protocol #32: Management of Hyperlactation. Breastfeed Med. 2020 Mar;15(3):129-134. Abstract Full text (link to original source)
  2. Liu X, Liu Y, Gao J, Feng M, Bao X, Deng K, Yao Y, Wang R. Combination Treatment with Bromocriptine and Metformin in Patients with Bromocriptine-Resistant Prolactinomas: Pilot Study. World Neurosurg. 2018 Jul;115:94-98. Abstract
  3. Trimeloni L, Spencer J. Diagnosis and Management of Breast Milk Oversupply. J Am Board Fam Med. 2016 Abstract Full text (link to original source) Full text (in our servers)
  4. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015 Jan 20;144(2):73-9. Abstract
  5. Domingue ME, Devuyst F, Alexopoulou O, Corvilain B, Maiter D. Outcome of prolactinoma after pregnancy and lactation: a study on 73 patients. Clin Endocrinol (Oxf). 2014 Abstract
  6. Auriemma RS, Perone Y, Di Sarno A, Grasso LF, Guerra E, Gasperi M, Pivonello R, Colao A. Results of a single-center observational 10-year survey study on recurrence of hyperprolactinemia after pregnancy and lactation. J Clin Endocrinol Metab. 2013 Abstract Full text (link to original source) Full text (in our servers)
  7. Shahzad H, Sheikh A, Sheikh L. Cabergoline therapy for macroprolactinoma during pregnancy: a case report. BMC Res Notes. 2012 Abstract Full text (link to original source) Full text (in our servers)
  8. van Veldhuizen-Staas CG. Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeed J. 2007 Aug 29;2:11. Abstract Full text (link to original source)
  9. Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf). 2006 Aug;65(2):265-73. Abstract Full text (link to original source)
  10. Verma S, Shah D, Faridi MM. Breastfeeding a baby with mother on Bromocripine. Indian J Pediatr. 2006 Abstract
  11. Bronstein MD. Prolactinomas and pregnancy. Pituitary. 2005;8(1):31-8. Review. Abstract
  12. Cheng W, Zhang Z. [Management of pituitary adenoma in pregnancy]. Zhonghua Fu Chan Ke Za Zhi. 1996 Abstract
  13. Peters F, Geisthövel F, Breckwoldt M. Serum prolactin levels in women with excessive milk production. Normalization by transitory prolactin inhibition. Acta Endocrinol (Copenh). 1985 Abstract
  14. Canales ES, García IC, Ruíz JE, Zárate A. Bromocriptine as prophylactic therapy in prolactinoma during pregnancy. Fertil Steril. 1981 Abstract

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