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Agalactia – Causes, Symptoms and Treatment

Agalactia is the complete absence of milk production after childbirth. It can make breastfeeding impossible and requires medical evaluation and care.

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Things worth knowing about "Agalactia"

Agalactia is the complete absence of milk production after childbirth. It can make breastfeeding impossible and requires medical evaluation and care.

What is Agalactia?

Agalactia refers to the complete absence of breast milk production following childbirth. The term derives from the Greek words a (without) and gala (milk). Unlike hypogalactia, where milk production is merely reduced, agalactia means that no breast milk is produced at all. This is a rare but clinically significant disorder of lactation that requires prompt medical attention.

Causes

Agalactia can result from a variety of organic and functional causes:

Hormonal disorders: A deficiency of prolactin, the primary hormone responsible for milk production, is a common cause. This can result from damage to the pituitary gland, such as in Sheehan syndrome (pituitary infarction following severe postpartum hemorrhage).
Medications: Certain drugs such as dopamine agonists (e.g., bromocriptine) or antihistamines can suppress milk production.
Anatomical causes: Congenital malformations of the mammary gland, scar tissue from surgery, or severe burns can destroy glandular tissue.
Psychological stress: Intense emotional stress or trauma can disrupt the hormonal regulation of lactation.
Preterm birth: In cases of premature delivery, the onset of milk production may be significantly delayed or absent.
Primary agalactia: In rare cases, the mammary gland is insufficiently developed from birth (hypoplastic breast tissue).

Symptoms

The hallmark of agalactia is the complete absence of milk let-down after delivery. Common signs include:

No breast engorgement or warmth after delivery
The newborn shows persistent hunger cues and fails to gain adequate weight
No colostrum (first milk) in the days immediately following birth
Dry diapers in the newborn, indicating insufficient fluid intake

Diagnosis

Diagnosis is typically made clinically by a midwife or physician. The following investigations may be carried out:

Hormone analysis: Measurement of prolactin levels in the blood
Imaging: Ultrasound or MRI of the pituitary gland if a hormonal cause is suspected
Newborn weight monitoring: Regular weight checks to assess adequate feeding
Medical history: Review of pre-existing conditions, medications, and obstetric history

Treatment

Treatment depends on the underlying cause and may include:

Lactation-stimulating measures: Frequent nursing attempts, breast pumping, and warm compresses can help stimulate milk production.
Medical therapy: In selected cases, physicians may prescribe domperidone or other galactagogues to increase prolactin levels.
Treatment of underlying conditions: If Sheehan syndrome or a pituitary tumor is identified, targeted treatment is essential.
Lactation counseling: Professional support from a lactation consultant or midwife is highly recommended.
Supplemental feeding: If breastfeeding is not possible, the infant must be fed with appropriate infant formula to ensure adequate nutrition.

When to See a Doctor

Parents should seek immediate medical attention if the newborn is not receiving sufficient nutrition in the first days after birth, is losing significant weight, or shows signs of dehydration. Early diagnosis and treatment are critical for the well-being of both mother and child.

References

World Health Organization (WHO): Infant and young child feeding. Fact Sheet, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
Lawrence RA, Lawrence RM: Breastfeeding: A Guide for the Medical Profession. 8th Edition. Elsevier, Philadelphia 2016.
Neville MC et al.: Lactogenesis: The Transition from Pregnancy to Lactation. Pediatric Clinics of North America, 2001; 48(1):35-52.

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