Not pregnant but lactating? Startling effects of a common pill

A woman came into my clinic, visibly concerned: her breasts had started leaking milk, even though she was neither pregnant nor breastfeeding. Understandably, this led her to fear the worst.
As she described the issue, she absentmindedly massaged her neck, wincing from what seemed like lingering pain. This caught my attention. When I asked about the neck pain, she mentioned that her orthopedist had been treating her.
Though she didn’t think it was related to her current issue, I began to wonder if there might be a connection.

I asked if she was on any medication for the neck pain. She reluctantly shared her prescription, which included a common combination: an anti-inflammatory for pain and

Pantoprazole-Domperidone

(Pan D), typically used for treating gastritis or acid reflux, especially in patients taking painkillers as these can be harsh on the stomach.
Then, the pieces of the puzzle began to fall into place.
Domperidone, one of the drugs she was taking, is known to raise prolactin levels, a hormone responsible for milk production. When

prolactin levels

rise unexpectedly, it can cause galactorrhea — the medical term for milk secretion in women who are not pregnant or breastfeeding.

Galactorrhea can stem from various causes such as pituitary tumours or thyroid imbalances. However, in many cases, it’s simply a side effect of medications like Domperidone. These drugs, often prescribed alongside antacids like Pantoprazole or Omeprazole, can spike prolactin levels, triggering milk secretion. It’s a side effect we occasionally encounter, especially when we treat gastrointestinal issues and pain simultaneously.
I explained to her that the Pantoprazole-Domperidone combination was likely the cause of her symptoms. She seemed relieved, though still cautious, as I reassured her that this wasn’t a sign of something more serious, like a tumour.
Discontinuing the Domperidone would likely resolve the issue, so I recommended switching to plain Pantoprazole for her gastritis management. A few weeks later, she returned for a follow-up, her anxiety replaced by relief. The milk secretion had stopped completely after she stopped the medication.
The case brought home the fact that sometimes, less is more. Reading the patient’s body language alongside their lab reports can help doctors see what sophisticated X-ray machines cannot. In the age of AI-powered diagnostics, the instance was a reminder to look for the root cause of an alarming symptom in the patient’s medicine cabinet.
Dr Pranjali Gadgil is a breast surgeon at Jupiter Hospital in Pune
As told to Umesh Isalkar