Nipple Discharge: Signs & Possible Causes

Types of Nipple Discharge

There are many types of nipple discharge based on color, texture and consistency of the fluid:

• Milky white: This might be linked to hormone changes or high levels of prolactin, a hormone in your body.
• Clear or watery: This might be linked to hormone changes or high levels of prolactin, a hormone in your body.
• Yellow or green: This color could suggest an infection.
• Brown or bloody: This may indicate an injury, a harmless growth or in rare cases, cancer.
• Thick and sticky: This is often related to a condition called duct ectasia and is more common in older women.

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 it can rarely be a sign of breast cancer. It's important to find out what's causing it and 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 nipple discharge. The mother's hormones cause this before birth. It should be gone in 2 weeks.

Cancers such as Paget's disease can also cause nipple discharge.

Nipple Discharge Symptoms

Along with the fluid, nipple discharge can also be indicated by the following symptoms:

• Breast pain or tenderness
• Swelling or lumps in the breast
• Redness or warmth may indicate infection
• Itching or irritation around the nipple
• Changes in nipple appearance, like inversion or scabbing

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.

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 and 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 may:

• 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
• Receive 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.

How to Stop Nipple Discharge?

Wondering how to prevent nipple discharge? Here are some practical tips:

• Avoid squeezing or stimulating the nipples, as this can worsen the discharge
• Wear a supportive bra to reduce irritation
• Reduce stress as it can affect hormone levels
• Review your medications with your doctor
• Maintain good breast hygiene