Diagram of the female body
Recommended health screenings
What Are The Worrying Signs Of Nipple Discharge?
Firstly it needs to be said that the vast majority of women who experience discharge from the nipple do not have breast cancer. But that doesn't let you off the hook - if your nipple is discharging, make an appointment to see your doctor.
When the signs are worrying:
• Discharge from one nipple only.
• Blood-stained discharge (see pictures).
• Persistent discharge.
• You are aged over 40 and have a lump in your breast.
Why Are My Nipples Leaking?
Both nipples leaking: Milky discharge from both breasts can occur from stimulation, tight clothing or even exercise. Up to 2 years after pregnancy, women will often have a milky discharge on hearing a baby cry or on touching the nipple area - that's normal. Medicines that you are taking can sometimes cause the problem too, for example cimetidine, which is an ulcer medicine, some antidepressants (Risperdal), the oral contraceptive pill, some over-the-counter anti-nausea medications (metoclopramide) and blood pressure medications like verapimil or methyldopa. Additionally over-use of cough syrups with codeine can cause nipple discharge in some women.
Prolactin: A prolactinoma is a growth in the pituitary gland in your brain that causes an excess of the hormone prolactin (literally meaning 'pro lactation'). This hormone is normally produced after childbirth. A milky discharge from both nipples when you are not pregnant or nursing can be a sign that you have a prolactinoma; it may also be accompanied by headache, visual problems and irregular or absent periods. Doctors call this milky discharge galactorrhea when it's unrelated to breastfeeding.
One nipple leaking: It is possible that you have an intraductal papilloma. Don't panic - these are benign (non-cancerous) little growths in the milk duct system and can cause a milky (sometimes bloody) discharge from one breast. The milk ducts can also become inflamed, which results in discharge. One-sided nipple discharge even in the absence of a lump can, however, be a sign of breast cancer, particularly in women over 40.
What Will The Doctor Do?
Doctors often send a sample of the fluid that is expressed from the nipple for an analysis of the cells and to check it for blood or infection. They are likely to refer you for a mammogram or an ultrasound scan of the breast if you are over 40 or have a blood-stained discharge. If you can elicit the discharge by stimulating the nipples and it's milky, it is far less likely to be sinister. In this instance, the doctor will often refer you for blood tests to check for hormone imbalance, in particular the level of the hormone prolactin as mentioned above.
If you have a papilloma or an inflammation in the milk duct system, it may be necessary to have a minor surgical procedure to cut the duct out. This is a simple procedure and does not affect nursing a baby or nipple sensation afterwards.
What If They Discover I’m Making Too Much Prolactin?
About 1 in 10,000 women have a prolactinoma - the benign tumor that produces too much of the hormone prolactin. This leads to discharging nipples in non-pregnant women, decreased interest in sex, breast tenderness, infertility, vision changes and headaches. If it is a small growth, it's often left alone, but if the symptoms are bothersome or you're trying to fall pregnant, medication can be used (bromocriptine and cabergoline). If the prolactinoma is very large, you may need to have radiation therapy to the tumor. The first two solutions are, however, the norm.
Nipple discharge should not be ignored. Although it is statistically unlikely, there is an outside possibility that it could be a sign of breast cancer. So get it checked.