“My periods stopped and now there’s milk — am I pregnant?”

The triad of amenorrhoea, galactorrhoea and a markedly raised prolactin (pregnancy-negative) is hyperprolactinaemia — work it up structured rather than leaping to "brain tumour". Confirm with a repeat prolactin and exclude the common reversible causes: pregnancy, primary hypothyroidism, renal impairment, and especially DRUGS (dopamine-blockers — antipsychotics, metoclopramide, domperidone), which here is the easily-missed cause hiding in a private "anxiety pill" started shortly before her periods stopped — though it does not explain her visual symptoms. Screen for macroadenoma red flags (headache, visual-field loss from chiasmal compression) with formal visual fields, and arrange pituitary MRI and endocrine referral. The examinable hidden agenda is twofold: the stated brain-tumour fear, and the deeper, less-voiced FERTILITY fear ("am I broken?") as she and her partner consider trying — plus shame about undisclosed private medication. Deliver honest, mostly-reassuring information (hyperprolactinaemia is highly treatable; prolactinomas usually respond to dopamine agonists; fertility usually recovers once prolactin normalises), take a complete non-judgemental drug history, don’t stop a needed psychiatric drug abruptly, and safety-net visual symptoms as urgent.