Dr Ahmed Ismail

Consultant Gynaecologist & Fertility Expert

FAQs to Gynaecologist

I have discharge from my nipples...

Nipple discharge is the release of fluid from the nipples of the breasts.

Nipple discharge varies greatly in colour and consistency. It may be milky, clear, yellow, green, brown, black, bloody, thick and sticky or thin and watery. Nipple discharge mostly affects women and can be influenced by diet, lifestyle and environmental factors.

Colour is not usually helpful in deciding if the discharge is normal or abnormal.

Bloody nipple discharge is never normal. Other signs of abnormality include nipple discharge from only one breast and discharge that occurs spontaneously without anything touching, stimulating, or irritating your breast.

Normal nipple discharge more commonly occurs in both nipples and is often released when the nipples are compressed or squeezed.

Nipple discharge that is usually abnormal unless proved otherwise:

  • Bloody
  • Comes from only one nipple
  • Comes out on its own without you squeezing or touching your nipple
  • Milky discharge in non pregnant or non postpartum women.

Nipple discharge may also be caused by a wide range of conditions:

  • Pregnancy - Discharge is milky and comes from both nipples. The breasts may start to produce milk from as early as the second trimester (weeks 14-26).
  • Currently breastfeeding
  • Duct papilloma - this is a harmless growth inside your breast duct . Intraductal papillomas are similar to a wart and can cause a bloody or sticky discharge from one breast.
  • Duct ectasia - this is a harmless, age-related breast change that can result in a cheesy or discoloured or green discharge from both breasts. This condition causes the milk ducts to expand, become inflamed and harden. This can cause the ducts to become blocked under the nipple, resulting in infection.
  • Breast or nipple abscess - this is a painful collection of pus that forms in the breast tissue or around the nipple, usually as a result of bacterial infection.
  • Mastitis is an infection of the breast and the leading cause of abnormal nipple discharge in breastfeeding women. If nipple discharge contains pus, it indicates infection is present. An infected breast may also be red, sore and warm to the touch.
  • Fibrocystic Breasts are breasts that contain numerous cysts and thick fibrous tissue. The cysts and thickened breast tissue are more prone to changes due to hormones. This can cause nipple discharge that is clear, yellow, white or even green
  • The contraceptive pill - the discharge is usually just a temporary side effect of starting the pill (some women also get breast tenderness and breast enlargement)
  • Fluctuating hormones from puberty or the menopause
  • Previous breastfeeding - some women continue to produce milk up to two years after they have stopped breastfeeding
  • Stimulation of the nipples and Breast Irritation
  • When the nipples are stimulated or squeezed they may leak fluid. This harmless nipple discharge can be caused by sexual arousal, irritation of nipples during vigorous exercise (especially running, jogging or aerobics), scratchy clothing or a poorly fitting bra. Removing the source of irritation or stimulation will stop the discharge.
  • Medication that causes raised levels of the milk-producing hormone prolactin - this includes antidepressants, anxiolytics, antihypertensives, antipsychotics, synthetic hormones such as Prempro, heartburn and peptic ulcer medications such as Tagamet, Pepcid and Zantac, amphetamines, anesthetics, oral contraceptives and some stomach and anti-nausea drugs. Marijuana and opiates can also cause nipples to secrete a harmless discharge.
  • Galactorrhea is most commonly caused by a type of pituitary tumour called a pituitary adenoma varies in size either micro adenoma or macro adenoma to be diagnosed by CT scan of the head which may leads to blindness if not diagnosed and treated carefully.
  • A hormone problem such as an underactive thyroid gland or Cushing's disease
  • Galactocele is clogged milk, which is usually associated with childbirth
  • An early form of breast cancer called carcinoma in situ, which is found inside the milk ducts and hasn't yet spread (it is usually picked up during a routine mammogram)
  • Breast Trauma - even minor trauma to the breast may cause nipple discharge. Because the discharge was caused by an injury, it may be bloody in colour.
  • Breast cancer is an unlikely cause, but needs to be ruled out. Only 10% of all abnormal nipple discharge is actually the result of breast cancer. If discharge occurs in conjunction with a breast lump or an abnormal mammogram, occurs after age 40, contains blood or is only present in one breast it is more likely that it is caused by cancer.

Conclusion:

Nipple discharge can be normal or abnormal. The crucial point should be to exclude:

  1. Milky discharge with hyperprolactinemia
  2. Bloody nipple discharge in breast cancer

For more information or an appointment at Queensway Gynaecology Clinic call:

Landline: 0207-935 55 40 / 0207-935 66 00

Mobile:

English: 077 409 444 73 / 077 457 481 88 / 077 450 461 44

Russian: 078 351 255 50 / 078 351 255 51 / 077 962 309 99 / 077 450 461 44

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Arabic: 077 409 444 73 / 077 457 481 88

Email: info (at) queensclinic.co.uk

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