What is Nipple Discharge?
Nipple discharge is any fluid or other fluid that comes out of your nipple. You may need to squeeze the nipple to get the fluid out, or it may seep on its own. Nipple discharge is common during your childbearing years, even if you are not pregnant or breastfeeding.
Discharge from the nipple or fluid from the breasts can be very alarming, but it is normal in many women. So normal that when famous breast surgeon Susan Love, MD, conducted a study in which gentle suction was applied to women's breasts, 83% of women - old, young mothers, non-mothers, previously pregnant, never pregnant - had had some flow.
There are many different presentations of nipple discharge, as well as many potential causes. While precancers and cancers may be to blame, they rarely are. However, if you are worried,
consult your gynecologist.
Color and uniformity, among other things, can help determine what might be due to the concern.
Causes of Nipple Discharge
Sometimes the discharge from your nipples is okay and will improve on its own. You are more likely to have a nipple discharge if you have been pregnant at least once.
A discharge from the nipple is most often not cancer (benign), but rarely it can be a sign of breast cancer. It is important to find out what is causing it and to seek treatment. Here are some reasons for nipple discharge:
- Pregnancy
- Recent breastfeeding
- Rub the area with a bra or t-shirt
- Breast injury
- Breast infection
- Inflammation and blockage of the breast ducts
- Small breast growth that is not usually cancer
- Severe
hypothyroidism
(hypothyroidism )
- Fibrocystic breast (normal lumps in the breast)
- Use of certain medications such as birth control pills or antidepressants
- Use of certain herbs, such as anise and fennel
- Enlargement of the milk ducts
- Intraductal papilloma (benign tumor in the milk duct)
-
Chronic kidney disease
- Use of illicit drugs, including cocaine, opioids, and marijuana
Sometimes babies can have a nipple discharge. This is caused by the mother's hormones before birth. It should be gone in 2 weeks.
Cancers such as Paget's disease can also cause nipple discharge.
Diagnosis of Nipple Discharge
The doctor's decision to make a diagnosis will depend on your age and any other symptoms or results of the physical exam. Possible tests may include:
Cytology
A sample of the discharge can be evaluated under a microscope in the laboratory to observe the cells present. Although it can show cancer cells, a negative cytologic examination cannot rule out cancer.
Blood tests
A serum prolactin level is often established if a milky discharge occurs in a person who is not pregnant or has not been pregnant. A thyroid test (TSH) may also be done.
If prolactin levels are high without a clear cause, brain magnetic resonance imaging (MRI) or computed tomography (CT) may be done to check for a pituitary microadenoma, a benign tumor of the pituitary gland that can be treated with drugs that lower prolactin levels.
Ultrasound
An ultrasound exam, which uses sound waves, is a common test to look for abnormalities in the area behind the nipple and areola. It can be used to identify conditions such as papillomas, although a biopsy is often still needed.
Ductogram
A ductogram is a test that involves injecting a dye to assess the milk ducts. While useful in some cases, this test, along with screening tools like root canal lavage and ductoscopy, are not readily available.
Biopsy
A breast biopsy may be needed to test for a lump near the nipple, including a skin biopsy if Paget's disease is suspected.
Treatment of Nipple Discharge
Once the cause of your nipple discharge is found, your healthcare professional may recommend ways to treat it. You can:
- Need to change any medication that caused the discharge
- Remove lumps
- Have all or part of the breast ducts removed
- Get creams to treat skin changes around your nipple
- Receiving medication to treat a health problem
If all of your tests are normal, you may not need treatment. You should have another mammogram and another physical exam within a year.
When to visit a Doctor
A discharge from the nipple is rarely a sign of breast cancer. But it could be a sign of an underlying condition that needs treatment.
If you are still having your period and your nipple discharge does not resolve on its own after your next menstrual cycle and occurs spontaneously, make an appointment with your doctor to have it evaluated.
If you are past menopause and have spontaneous nipple discharge from a single duct into a single breast, see your doctor immediately for evaluation.
In the meantime, be sure to avoid nipple stimulation, including frequent discharge checks as stimulation can cause persistent nipple discharge
Citations
Cytology of abnormal nipple discharge- https://www.bmj.com/content/311/7003/486.short
Nipple discharge- https://search.proquest.com/openview/46991c892811fdaea973a2596d46280d/1?pq-origsite=gscholar&cbl=49079
