The nipple can squeeze out water on the fifth day after medical abortion

After an unexpected pregnancy occurs, many women will choose to have an abortion. The current abortion procedure has developed into a painless technique. However, some people still choose medical abortion because they are worried and afraid of surgery. However, medical abortion depends on the specific physical condition of the pregnant woman. If you meet the requirements for medical abortion, you can do it. However, some women experience strange phenomena after having medical abortion. Why can water be squeezed out of the nipple on the fifth day after medical abortion?

This situation usually returns to normal in about 3-7 days. If the milk leak is severe, you can go to the hospital to get some milk-regulating medication. Remember not to squeeze it hard to avoid infection.

Galactorrhea is also known as amenorrhea-galactorrhea syndrome, milk leakage, and abnormal milk secretion syndrome. It is a phenomenon of spontaneous breast discharge that occurs in women in the non-puerperium period or six months after stopping breastfeeding, and is clinically characterized by lactation and amenorrhea. It is a pathological lactation during non-pregnancy period. There are three types according to the different objects of occurrence: Chiari-Frommel syndrome, in which patients are characterized by onset after delivery or weaning; Argone-Castillo syndrome, in which the onset is unrelated to pregnancy; and Forbes-Albright syndrome, in which patients have galactorrhea and pituitary tumors. The three types of diseases have different pathological characteristics, but all of them have the pathological characteristics of hypothalamic-pituitary dysfunction.

Causes

Abnormally elevated serum prolactin for various reasons can cause galactorrhea.

1. Hypothalamic lesions

Pathologies such as craniopharyngioma and inflammation affect the secretion of prolactin inhibitory factor (PIF), leading to increased PRL secretion.

2. Pituitary lesions

Pituitary tumor, empty sella syndrome.

3. Thyroid and adrenal gland diseases

Primary hypothyroidism, chronic kidney disease, adrenocortical insufficiency, chronic renal failure.

4. Polycystic ovary syndrome

5. Hormone drugs

People who take oral contraceptives may sometimes experience galactorrhea. Oral contraceptives generally contain estrogen and progesterone. The occurrence of galactorrhea may be related to the inhibition of the hypothalamus by estrogen or progesterone.

6. General medicine

Long-term use of antipsychotics, antidepressants, anti-epileptic drugs, antihypertensive drugs, anti-gastric ulcer drugs and opioid drugs, etc.

7. Chest wall lesions

For example, chest wall injury (including trauma, surgery, burns or herpes zoster, etc.) can also cause increased PRL secretion through reflex.

Clinical manifestations

1. Breast leakage

It is often manifested as bilateral nipple galactorrhea, the milk is white or light yellow, and spontaneous discharge can be seen by pressing the breasts and nipples, which can be in the form of jets or a small amount of milk when squeezed out. The chemical composition is between colostrum and mature milk, and sometimes is exactly the same as colostrum. In a few women whose lactation lasts for a very long time, blood may be mixed in the milk, which may be caused by intraductal papilloma.

2. Amenorrhea

It is often secondary amenorrhea, and the degree of amenorrhea is also different, manifested as infrequent menstruation or long-term amenorrhea. For those who have been menopausal for a long time, the vulva will atrophy and the uterus will be significantly reduced. For those with a short period of amenorrhea, the uterus is normal or shrunken.

3. Others

Some patients may experience symptoms such as infertility, headache, limb hypertrophy, and visual impairment.

examine

1. Blood prolactin measurement

The level of prolactin in the blood is measured by immunoassay. In most patients, the elevated prolactin level in the blood leads to dysfunction of the hypothalamus-pituitary-ovarian axis, which inhibits the function of pituitary gonadotropin, reduces the secretion of FSH and LH, and at the same time, the secretion of ovarian steroid hormone E2 is also significantly reduced, resulting in amenorrhea and milk leakage. If the prolactin level in the blood continues to rise, it often indicates the possibility of a pituitary tumor.

2. Other hormone measurements

FSH and LH values ​​are slightly lower than or equal to normal early follicular levels; E2 measurement is lower than or equal to ovulation levels; T3 and T4 are lower than normal, while TSH is higher than the normal range.

3. Excitation or inhibition test

The main purpose is to understand the reserve of hypothalamic-pituitary function. A significant increase in PRL indicates a high possibility of hypothalamic-pituitary dysfunction.

(1) Thyrotropin-releasing hormone test: 100-400 pg of TRH (thyrotropin-releasing hormone) is injected intravenously. 15-30 minutes later, the blood PRL level is measured to be 5-10 times higher than before the injection, and the TSH level is increased by 2 times, but it does not increase in patients with pituitary tumors.

(2) Chlorpromazine stimulation test: After intramuscular injection of 25-50 mg of chlorpromazine, prolactin increases 1-2 times within 60-90 minutes and continues for 3 hours. A positive test result indicates hyperprolactinemia, but it does not increase in pituitary tumors.

(3) Levodopa suppression test: Oral administration of 500 mg of levodopa will significantly reduce blood prolactin levels within 2 to 3 hours. If there is no obvious decrease, it is likely a pituitary tumor.

4. Medical imaging examination

Pituitary x-rays or magnetic resonance imaging (MRI) to detect small pituitary tumors.

5. Eye examination

Find out whether there are any changes in the fundus or visual field caused by compression of intracranial tumors.

diagnosis

1. Medical history

Pay attention to the course of the disease. If the patient is postpartum or weaned, or is a woman who has never been pregnant, pay attention to whether she has a history of taking related medications, such as chlorpromazine, reserpine, or oral contraceptives.

2. Physical examination

Pay attention to the presence of breast or chest wall lesions, signs of acromegaly or Cushing's syndrome, pelvic masses, or genital atrophy.

3. Auxiliary examination

The cause of galactorrhea can be clarified by measuring thyrotropin-releasing hormone, testing pituitary function, pituitary X-ray or magnetic resonance imaging (MRI), etc.

Differential Diagnosis

This disease needs to be differentiated from random lactational amenorrhea and lactational uterine atrophy caused by nipple stimulation. The disease may persist until menopause.

treat

1. Stop taking related drugs

For example, lactation caused by reserpine, chlorpromazine, perphenazine or meprobamate (Meprobamate) usually returns to normal, menstruation resumes, and galactorrhea stops 2 to 7 months after stopping the drug. Galactorrhea caused by oral contraceptives often cannot heal itself after stopping the medication and requires adjustment of the menstrual cycle. If normal menstruation can be restored, lactation will often gradually disappear.

2. Medication

(1) Thyroxine: Patients with primary hypothyroidism should be given thyroxine replacement therapy, and their lactation will then stop and menstruation will resume.

(2) Bromocriptine: used to treat galactorrhea caused by pituitary adenoma and unexplained galactorrhea. Relapse may occur after discontinuation of medication or after the end of pregnancy, and the medication may still be effective when taken again. It should be noted that during the use of this medication, once pregnancy is diagnosed, the medication should be stopped immediately to prevent fetal malformations.

(3) Levodopa: Levodopa can be used for those whose disease is not caused by pituitary tumors. Most patients recover after one and a half months of medication, and galactorrhea disappears after one and a half to two months. Symptoms may reappear after stopping the medication.

(4) Gonadotropin therapy: It can enhance ovarian function and restore the physiological function of the hypothalamus-pituitary-ovarian axis. One tube/day for 7 to 10 days is used. A vaginal exfoliated cell smear examination or cervical mucus crystal examination is performed every day to check for sufficient estrogen effects, or blood or urine estrogen is measured until it reaches 300pg/ml or 50ng/24h respectively, proving that the follicles have reached maturity. Then 2000U of human chorionic gonadotropin (HCG) is given for 2 to 3 consecutive days to promote ovulation.

(5) Clomiphene: It can fully restore the function of the hypothalamic-pituitary-ovarian axis and induce ovulation. It should be taken starting from the 5th day of the natural or artificially induced menstrual cycle, once a day for a total of 5 days.

(6) Vitamin B6: It can stimulate PIF and inhibit PRL secretion. It can be used for a long time, but it has not yet been widely adopted.

3. Surgery

It is suitable for patients with giant adenoma showing symptoms of intracranial compression, ineffective treatment with bromocriptine, giant adenoma, etc.

4. Radiation therapy

Suitable for patients with non-functional hypothalamic-pituitary tumors who have not responded to drug or surgical treatment.

prevention

Paying attention to rest, combining work and rest, living a regular life, and staying optimistic are very helpful in preventing diseases. Pay special attention to breast hygiene and choose appropriate underwear; in addition, you should have regular breast examinations to try to detect the disease in its early stages and treat it as soon as possible.