Nipple discharge in women
Nipple discharge in females is relatively common. It could be due to reasons that might not indicate any serious problems. Nipple discharge during pregnancy and after breastfeeding periods is a normal bodily function. But there are several cases where the nipple discharge can indicate a severe problems.
Nipple Discharge Causes in Women
Given below are a list of several common and uncommon causes of nipple discharge in women
Abnormal Causes (can indicate underlying condition)
- Pregnancy and breastfeeding
- Breast Cancer: along with nipple discharge, the symptoms might include a lump, bloody discharge, and chronic discharge
- Menstrual cycle: nipple discharge before periods is very common in women.
- Breast infections like mastitis.
- Hormonal/ Endocrine gland disorders.
- Birth control pills and other medication
- Galactoorrhea: a condition where the milk glands secrete milky discharge even when a woman is not pregnant. It can be due to medication or pituitary gland disorder.
- Regular breast stimulation: squeezing or breast stimulation is associated with a normal nipple discharge.
- Ectasia of the mammary gland: commonly seen in menopausal women. The condition is associated with Inflammation and blockage of mammary ducts.
Nipple Discharge Treatment in Women
The normal nipple discharge after pregnancy or breastfeeding gets resolved on its own in most cases. But in cases where it is persistent with other symptoms, consulting a doctor should be the priority.
A thorough diagnosis can better understand the causes behind the nipple discharge. Some of the common treatments are:
- Stopping the birth control pills or medications that are causing the discharge
- Infection treatment with antibiotic
- Cancer treatment
- Surgery for lum removal
- Hormonal therapy to treat hormone imbalances
- Removal of the infected or inflamed milk duct.
Diagnosis of nipple discharge
You should see a doctor if nipple discharge persists for more than one menstrual cycle or if any of the warning signs are present. Unless there are signs of infection, such as redness, swelling, and pus discharge, there is not much reason to worry but visit the doctor to be sure.
Your doctor will begin by questioning about the symptoms and medical history. The doctor then performs a physical examination that points to the cause of the discharge and the tests that may be required. Doctors ask about the discharge and other symptoms that may indicate a possible cause to help identify the cause.
Normal and abnormal nipple discharge
Normal nipple discharge occurs from both nipples, usually when they are squeezed or compressed. Some of its causes might be: –
- Pregnancy- clear discharge might be seen from the nipples during the early stages of pregnancy. Later this discharge becomes milkier.
- When breastfeeding is stopped or the weaning stage- even after a mother stops breastfeeding her child, milk-like discharge may be seen for a while.
- Stimulation- normal nipple discharge may take place under conditions such as stimulation, compression, etc. It can also occur during vigorous exercise or by wearing an uncomfortably tight bra.
Abnormal nipple discharge is usually from one breast and is spontaneous. It Does not require stimulation or compression., It cannot be determined whether the discharge is normal or abnormal by its color. However,a bloody nipple discharge is not normal.
Some of the causes of an abnormal nipple discharge may be: –
- Fibrocystic breast changes- the presence of fibrous tissue and a cyst is known as fibrocystic. Thickening or lumps may be seen in the breast tissue which is always not indicative of cancer. These fibrocystic changes not only cause pain but are also responsible for clear or colored nipple discharge.
- Galactorrhea- This is a milky discharge when the woman is not breastfeeding. This may be present due to tumors, certain medications, drugs, hormonal changes, etc.
- Infection- In the presence of an abscess or infection in the breast, the breast is warm, red, and sore. Pus discharge takes place. This is also known as mastitis. It can occur in both lactating as well as non-lactating women.
- Mammary duct ectasia- the nipples might appear greenish and thick. This occurs due to inflammation and a possible blockage of the ducts located under the nipples. It is the second most common cause of the abnormal discharge and is seen mostly in women who are nearing menopause.
- Intraductal papilloma- In this case, the discharge contains blood and is sticky. Noncancerous growth of the ducts of the mammary glands take place resulting in inflammation. This is the most frequent cause of abnormal nipple discharge.
- Carcinoma – papillary carcinimas orany carcinoma near the nipple area.
- Hormonal disorders- Hypothyroidism, prolactinemia, pituitary adenoma
Evaluation of nipple discharge
Evaluation starts with ascertaining whether the nipple discharge is pathologic or physiologic. If the discharge contains blood, is spontaneous, and is associated with a mass, then it is pathologic. They are mostly confined to one duct. Physiologic discharge, on the other hand, involves many ducts & may be both sides. The fluid, in either case, might be clear, white, or greenish.
Physiologic discharge is often self limiting when irritation of the nipple is avoided, as it usually takes place due to stimulation. Intraductal papilloma and duct ectasia are most commonly causes of pathologic nipple discharge which may also lead to cancer. A mammogram is more useful than cytology. A magnified view of the retro areolar region helps identify its pathology. Surgical evaluation should be referred to all patients irrespective of the discharge type.
Pathologic nipple discharges needs treatment unlike galactorrhea as they are not indicative of breast cancer or primary breast pathology. It may be due to the use of oral contraceptives, hormonal disbalance, or trauma in the chest walls. Hence, in the case of galactorrhea, surgical duct excision is not recommended.
When to see a doctor
- A lump is present in the breast
- When nipple discharge lasts for more than four weeks outside of pregnancy and lactation, a doctor should be consulted within a week in such a case.
- The color of the nipple or skin is changing
- You experience breast pain
- Blood is present in the discharge
- Discharge is spontaneous, from only one breast
A doctor should also be consulted when the nipple discharge does not resolve The doctor will ask you to go through certain tests to diagnose the discharge. Some of these tests may include: –
- Laboratory analysis of the discharge
- Blood tests
- Mammogram or/and ultrasound of one or both breasts
- MRI of breast
- A brain scan
- May need a biopsy
Some of the following tests will be required to be done: –
- Biopsy- It is a test where a small sample of tissue from the suspected area will be sent to the laboratory for study.
- Ductogram- The images of the milk ducts inside the mammary glands are taken using mammography and a contrast medium that is injected.
- Ultrasound- Sound waves are used to create images inside the patient’s breast.
The treatment of nipple discharge depends on the type of discharge. Once it is evaluated, the doctor decides on a suitable method to treat it. Some of the treatments for treating non-cancerous discharges are: –
- If the discharge has been caused by a certain medication, an alternative medication is suggested.
- Removal of the lumps
- Removal of all or certain parts of the ducts
- Use of medicated creams
If the diagnosis points towards cancer, then the treatment is done accordingly.
How to Prepare before nipple discharge?
- Take careful note of all your symptoms, even if they appear unrelated to the reason for your appointment.
- Examine critical personal information, such as major life stresses or recent life changes.
- Make a list of all of your medications, vitamins, and supplements.
- Make a list of questions to ask, highlighting the ones that are most important to you.
- Avoid breast stimulation to reduce or eliminate nipple discharge. Avoid stimulating the nipples and wear clothing that creates a lot of friction on your nipples.
- Breast pads absorb and prevent nipple discharge from penetrating your clothing.
What to expect from a doctor during nipple discharge?
Your doctor will make an evaluation based on:
- Whether the discharge originates in one or both breasts
- What color is the discharge?
- How long has it lasted?
- Whether it happens on its own or only when the nipple is stimulated
- Women are also asked if they have had disorders or take drugs that can increase prolactin levels, as well as whether they have a lump or breast pain.
If the discharge does not occur spontaneously, the area around the nipples is gently pressed to induce one. You will be checked for enlarged lymph nodes in the armpits and above the collarbone.
Blood tests to measure prolactin and thyroid-stimulating hormone levels are performed if doctors suspect a hormonal disorder is the cause. Ultrasound, mammography, and other tests may be required at times.
Both men and women should see a doctor if they suspect abnormal nipple discharge. Infection or breast cancer diagnosed and treated at an early stage have better outcomes.