What is the first step in the workup of galactorrhea?

In patients presenting with galactorrhea, the first step in the workup is obtaining a pregnancy test. This is crucial because galactorrhea can be associated with a variety of conditions, and one of the most common and easily reversible causes is pregnancy. Elevated prolactin levels can be seen during pregnancy due to physiological changes, and identifying pregnancy allows for appropriate management and consideration of the galactorrhea in the context of the patient’s reproductive health.

If the pregnancy test is positive, the clinician can address the galactorrhea as a product of normal physiological changes during pregnancy and may choose to monitor rather than intervene further. A negative pregnancy test would then lead to further investigations, including measuring serum prolactin levels and reviewing medications, as hyperprolactinemia can stem from other etiologies such as medication effects, pituitary tumors, or hypothyroidism.

By starting with a pregnancy test, healthcare providers ensure that they do not overlook a potentially relevant and immediate cause of galactorrhea before moving on to other diagnostic steps.