Lactation-amenorrhea syndrome, also known as milk regurgitation-amenorrhea syndrome, refers to a pathological state characterized primarily by lactation and amenorrhea. Strictly speaking, it is not a specific disease but rather a syndrome that can be caused by various underlying conditions, yet shares common clinical features.

bubble_chart Etiology

1. Hypothalamic tumors or dysfunction, diseases of the hypothalamus and adjacent areas, such as encephalitis, craniopharyngioma, pinealoma, etc.
2. Pituitary diseases, such as pituitary tumors, hyperpituitarism, partial empty sella syndrome, etc.
3. Primary hypothyroidism.
4. Improper medication, such as excessive use of sedatives.
5. Neural stimulation, such as chest surgery, burns, herpes zoster on the chest and back, etc.

bubble_chart Auxiliary Examination

Prolactin Stimulation Test

1. Thyrotropin-releasing Hormone Test (TRH test): In normal women, a single intravenous injection of 100–400 μg TRH results in a 5–10-fold increase in PRL and a 2-fold increase in TSH within 15–30 minutes. No increase is observed in cases of pituitary tumors.
2. Chlorpromazine Test: Chlorpromazine inhibits norepinephrine uptake and dopamine conversion via receptor mechanisms, thereby promoting PRL secretion. In normal women, intramuscular injection of 25–50 mg leads to a 1–2-fold increase in blood PRL levels within 60–90 minutes, lasting for 3 hours. No increase occurs in pituitary tumors.
3. Metoclopramide Test: This drug acts as a dopamine receptor antagonist, enhancing PRL synthesis and release. In normal women, intravenous injection of 10 mg results in a more than 3-fold increase in PRL within 30–60 minutes. No increase is observed in pituitary tumors.

1. L-Dopa Test: This drug is a dopamine precursor, which is converted to DA by decarboxylase, thereby inhibiting PRL secretion. In normal women, oral administration of 500 mg leads to a significant decrease in PRL within 2–3 hours. No decrease occurs in pituitary tumors.
2. Bromocriptine Test: This drug is a dopamine receptor agonist that strongly inhibits PRL synthesis and release. In normal women, oral administration of 2.5–5.0 mg results in a ≥50% decrease in PRL within 2–4 hours, lasting for 20–30 hours. Functional HPRL and PRL adenomas show marked decreases, while GH and ACTH exhibit smaller reductions compared to the former two.

bubble_chart Diagnosis

The lactation-amenorrhea syndrome is generally divided into three types, with the diagnostic points as follows:

1. Chiari-Frommel syndrome: Occurs postpartum, often caused by improper breastfeeding or prolonged nipple stimulation, leading to dysfunction of the hypothalamic-pituitary-ovarian system. No pituitary tumor is present. Blood levels of prolactin are elevated, while follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are reduced. It is usually transient but may persist for several years. After recovery, it often recurs during subsequent pregnancy.
2. Argonz-delCastillo syndrome (idiopathic galactorrhea syndrome): Occurs during non-pregnancy lactation periods, primarily due to hypothalamic-pituitary dysfunction. Factors such as surgery, trauma, anesthesia, or psychological stress can trigger it. No pituitary tumor is present. Hypothalamic-pituitary function tests show positive results for excitation or inhibition. Some cases may resolve spontaneously after removing the causative factors, but many patients experience prolonged symptoms that require medical treatment for recovery.
3. Forbes-Albright syndrome: Occurs during non-pregnancy lactation periods, usually caused by a pituitary tumor. Due to tumor compression, ocular fundus changes or visual field narrowing may occur. Pituitary sella turcica examination reveals the tumor. Symptoms will not alleviate unless the pituitary tumor is surgically removed.

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bubble_chart Treatment Measures

This disease is often caused by relatively clear disease causes leading to an increase in promoting lactation hormone levels, thereby resulting in the occurrence of lactation-amenorrhea syndrome. Therefore, the treatment principle should emphasize disease cause therapy.

1. For cases caused by pituitary tumors such as pituitary microadenomas or other tumors related to prolactin secretion, surgical removal should be performed if surgical conditions still exist. If surgery is not suitable, radiotherapy, chemotherapy, and Chinese medicine treatment can be considered.
2. For cases where promoting lactation hormone levels are elevated due to various medications, once the diagnosis is confirmed, the relevant drugs should be discontinued immediately. Symptoms often resolve spontaneously after discontinuation.
3. For cases where promoting lactation hormone levels are elevated due to dysfunction of the hypothalamic-pituitary-ovarian axis, appropriate drug therapy should be administered to regulate the functional state of this system, thereby reducing promoting lactation hormone levels and restoring normal ovulation and menstruation. For example, bromocriptine primarily acts on pituitary cells that secrete promoting lactation hormone, reducing its secretion; levodopa mainly affects the hypothalamus, decreasing promoting lactation hormone by enhancing the action of prolactin-inhibiting factors. The dosage and administration of medications must strictly follow medical advice. Menstruation may resume within one to several months of treatment, but side effects such as nausea, vomiting, and vertigo may occur.
4. For cases caused by hypothyroidism, oral thyroid hormone therapy is recommended, with dosage and administration following medical advice.
5. Chinese medicine treatment can effectively regulate the functional state of the hypothalamic-pituitary-ovarian axis, reducing promoting lactation hormone secretion levels. It not only improves symptoms but also adjusts the body's internal environment, avoiding the side effects of Western medicine. For those with qi and blood deficiency, the approach should focus on tonifying qi and nourishing blood, using modified Ginseng Nutrient-Nourishing Decoction. For those with liver qi stagnation, the method should involve soothing the liver and regulating qi, regulating qi and resolving stasis, using modified Peripatetic Powder combined with Peach Kernel, Carthamus and Four-Ingredient Decoction. The application of Chinese medicine treatment must be based on a clear diagnosis. If organic sexually transmitted diseases such as pituitary tumors are detected, surgical treatment should be pursued as early as possible to avoid delaying the optimal treatment window.