Galactorrhea

  I have had milk coming from my breasts for the past few months.  I am the mother of three and nursed each child their first year, however,  my youngest has been weaned for over one year now.  
  I first noticed the condition when I felt a "letting down" of milk after a shower.  When I pressed on the nipples, milk came out.  One night, I experienced pain in one breast.  It was strong enough to wake me and keep me from sleeping.  The next morning, I called my doctor, who was out of town, and one of his associates advised me to stop caffeine intake and follow up with my own doctor.  As I told the nurse, I do not drink caffeinated drinks.  
  Since I had a pap smear check up a couple of months away, and no one seemed too alarmed, I waited until this month to talk to my OB/GYN about it.  I, also, told him that my migraine headaches have increased (I get them about 10 or more days a month now), I feel cold a lot (not normal),  and my menstrual cycles have changed.  My cycles are no longer at around 30 - 32 days but are 21 - 26 days and the blood flow seems to have increased.  
  My doctor took a blood sample to check my thyroid, TSH and prolactin levels.  All came back normal.  
  Next, I will have a mammogram (my second, they took a baseline just one year ago) in the breast that caused me pain.  My doctor says the cause could be a cyst.  However, I have only had pain in one breast, one time; and milk (not blood or anything green that might indicate cancer) is coming from both breasts.  I would have to have cysts in both breasts, wouldn't I?
  Some other possible causes don't seem likely.  I am not on birth control pills.  The only medications I take are Midrin and Imitrex (for the migraines).  According to the test, my thyroid is not underactive.  While I don't know about all brain diseases, I do not have a fever like someone with meningitis would.  Cysts under my aerolas are possible, but the doctor doesn't feel anything, and he's only doing a mammogram on one.  I don't know about a pituitary tumor, wouldn't the prolactin levels be high to indicate that?  
  Is there some other causes that I am not aware of?  What type of treatment can I expect?  What if the causes remain unknown?  How long can I expect to be treated or will this condition continue indefinitely?
      

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Galactorrhea, or milk production, is obviously a normal and desirable phenonmenon after childbirth. It occasionally can persist long after weaning, as in your case. As you have noted, milk production is not a characteristic of breast cancer.
I believe that your evaluation has been appropriate. Prolactin is the hormone released from the anterior pituitary that maintains milk production. Pathologic causes of prolactin production (for example, a benign condition of excessive pituitary growth called an adenoma) are invariably associated with elevated prolactin levels (often markedly so).
However, your breasts are obviously being stimulated by prolactin, even though the level is not elevated, since they are producing milk. This is entirely possible and even normal in a woman who has breastfed. Typically, levels of prolactin after several months of breastfeeding are in the normal range most of the day and are only elevated with nipple stimulation.  The bottom line is that the milk production you are experiencing is a variation of normal and should not be a cause of alarm. There should be no effect on your fertility or ability to ovulate/conceive since the prolactin level is normal. Although there are very effective, nonhormonal medications to treat galactorrhea, I would suggest not using them unless the prolactin level was markedly elevated, causing infertility or other symptoms, or if the milk letdown was particularly troublesome.
The best advice is to avoid stimulating the nipple if at all possible, much like the advice given to women after delivery who do not want to breastfeed. This includes avoiding jets of water contact such as in the shower. I would anticipate that the "problem" will resolve on its own with these measures.
The pain you are experiencing could be from a cyst or from a blocked milk duct (called a galactocele). A physical examnination or breast ultrasound should differentiate these conditions.
Hope this is helpful to you.