Dear Doc:

I had a miscarriage in 2003 and until this day whenever I squeeze my breast I see some watery substance like milk coming out; but it is not white like the real breast milk. The pregnancy was three-months-old. Could it be that I'm still producing breast milk?

Another query I have is that I am feeling a pain in my left side. I went to see the doctor once and she said that it was a bladder infection and I was treated for that. But I am still feeling the pain, even as I type, and it's really hurting me. What do you think could cause this pain?

- Puzzled

Dear Puzzled,

Elevated prolactin level is usually the underlying cause of inappropriate lactation. Prolactin is a hormone produced by the pituitary gland in the brain. Excessive production of prolactin may be due to enlargement of the gland. There may be a slight enlargement resulting in a microadenoma or excessive enlargement resulting in a macroadenoma.

When the gland is significantly enlarged, this may result in visual disturbances because of compression of the optic nerve to the eyes. Additionally, some drugs may also stimulate prolactin secretion, thus causing milk production which is unrelated to pregnancy. These drugs include antipsychotics (used to treat some psychiatric disorders, such as schizophrenia), antidepressants, antihypertensives such as Reserpine and methyldopa, anti-anxiety agents and other drugs such as estrogen and phenobarbitone.

It is not impossible to have milk in the breast secondary to pregnancy loss at three months' gestation. It is, however, important for you to be examined and have your prolactin level done. High prolactin levels can also contribute to suppression of ovulation and subsequent infertility. The treatment of this condition is usually very effective and quite simple. You should avoid squeezing the breast, as excessive stimulation may cause the milk production to continue. If the milk secretion becomes excessive and fertility is desired, then either bromocriptine (Parlodel) or Dopergin tablets are usually effective in decreasing the prolactin level and suppressing the milk production.

Regarding your other concern, the pain that you experience in your left side may be as a result of one several conditions. An ovarian cyst or an inflamed fallopian tube is quite possible. You need to be examined by your gynaecologist and probably have a pelvic ultrasound done to confirm the underlying cause.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Email your health queries to Dr Mitchell at mclymonti@jamaicaobserver.com or write to Dear Dr Mitchell, c/o all woman, Jamaica Observer, 40-42 1/2 Beechwood Avenue, Kgn 5.

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