Navigating Nipple Discharge: What’s Normal And When To Talk To A Doctor

While unexpected nipple discharge can be a cause for alarm, it's important to know that it may not always be a sign of breast cancer or another severe condition. Nipple discharge refers to the fluid that can be expelled from the nipples, and it can come in a range of colors, consistencies, and quantities.

In this article, we'll explore the nuances of nipple discharge, what's considered normal, and when it's advisable to seek medical attention.

Normal Nipple Discharge

“Not all nipple discharge is screened equal,” said Cosmina Cristea, DO, an independent general surgeon who chooses to practice at Franciscan Health Michigan City. “During reproductive years about 80% of women will experience some sort of nipple discharge. Most nipple discharge is benign.”

Nipple Discharge During Pregnancy and Breastfeeding

Nipple discharge is common during pregnancy and while breastfeeding. This discharge, known as colostrum, is usually yellowish in color and is your body's way of preparing for breastfeeding.

Hormonal Fluctuations And Nipple Discharge

Hormonal changes throughout the menstrual cycle can lead to nipple discharge. Many women notice clear or cloudy discharge that may vary in consistency.

Physical Stimulation And Nipple Discharge

Sometimes, friction or stimulation of the breasts and nipples can trigger discharge.

Medical Conditions Causing Nipple Discharge

Several medical conditions that are not breast cancer can cause nipple discharge. These include:

Galactorrhea

Galactorrhea is a milky discharge from both nipples, when a person is not breastfeeding. Galactorrhea can happen from elevated prolactin level. A hormone called prolactin can be elevated for several reasons, including medication, pituitary tumors or other endocrine abnormalities.

“Most of the time when a patient presents with galactorrhea, they would have bilateral nipple discharge. So it would come from both breasts,” Dr. Cristea said. “Its color most of the time is either white or cream. It can be anywhere from yellow to green, but it's never bloody.”

Ectasia

Ectasia is the process of dilation of the milk gland in perimenopausal women. Ectasia is a noncancerous breast condition but can lead to a blockage of the ducts and possible infections. This infection may also cause breast pain and thick, sticky nipple discharge.

Intraductal Papilloma

An intraductal papilloma is a small, wart-like growth that bumps out into the breast ducts near the nipple, often in women nearing menopause. This causes a bloody or sticky discharge.

Prolactinomas

Prolactinomas – where your body is producing breast milk even if you are not pregnant – are benign tumors of the pituitary gland but are often not cancer. They happen most often in women younger than 50.

When To Talk To Your Doctor About Nipple Discharge

While normal nipple discharge is nothing to worry about, there are instances when seeking medical advice is crucial:

• Bloody discharge: “When we talk about bloody nipple discharge, this falls into the category of pathologic or suspicious nipple discharge,” Dr. Cristea said. “This is worrisome and most of the time it comes from one breast. It is bloody and it can be persistent. You may notice that it's there and it's also spontaneous, so it does not happen after any nipple stimulation. If that's the case, then this definitely needs to be evaluated.”
• Lump or other symptoms in breast: If nipple discharge is accompanied by breast pain, lumps, changes in breast size or shape, or skin changes such as redness or dimpling, you should seek medical attention promptly.
• Spontaneous discharge: If you experience nipple discharge that is bloody, clear, or occurs spontaneously without any manipulation, it's wise to consult a doctor. These can sometimes be indicators of underlying issues.
• Discharge from only one breast: If the discharge is coming from only one breast, especially if it's persistent, you should have it evaluated by a healthcare professional.
• Postmenopausal Discharge: Nipple discharge that occurs after menopause is not considered normal and should be evaluated by a doctor.
• Nipple discharge in men: Nipple discharge in men is not considered normal and should be evaluated by a doctor.

Nipple discharge, while often not caused by breast cancer, should not be ignored, especially when it deviates from what’s normal for your body or is accompanied by other concerning symptoms. Remember that being proactive about your health includes regular self-examinations, routine mammograms in women 40 years old or older, and seeking medical guidance when needed. A healthcare provider can provide the necessary guidance to address any concerns and ensure your peace of mind.