DEFINITION: Drainage of fluid from a nipple duct or ducts.
3 MAJOR CATEGORIES:
- Physiologic – normal
- Pharmacologic – medication induced
- Pathologic – Caused by disease
Changes in hormonal balance may cause discharge.
- from both breast (bilateral)
- from multiple duct openings on the nipple
- milky (cloudy or opaque) or serous (yellowish) or greenish.
- occurs in small amounts
- occasionally throughout the menstrual cycle
- occurs more frequently before the menstrual period
- occurs in postmenopausal women on hormonal replacement therapy
- is not associated with a breast lump/mass
- any manipulation or pressure may cause discharge. DISCHARGE THAT IS NOT SPONTANEOUS (i.e. DISCHARGE THAT OCCURS ONLY WHEN THE BREAST IS MANIPULATED OR SQUEEZED) IS VERY RARELY OF SIGNIFICANCE.
- occurs in pregnancy and after pregnancy. Occasionally this discharge can be bloody, and is may not be significant. (You should, however, notify your doctor if this occurs) .
TREATMENT: Usually knowing the discharge is physiologic and not of significance is all that is needed.
Caused by over-the-counter medications, prescription medications and some herbal products.
MEDICATIONS: (This list is not felt to be all inclusive)
- Birth control pills
- Hormones, such as estrogen
- Blood pressure medications
- Narcotics and pain relievers
- Psychiatric medications
- Gastrointestinal medications
- Heart medications
DO NOT STOP TAKING ANY PRESCRIPTION MEDICATION WITHOUT CONSULTING YOUR PHYSICIAN WHO PRESCRIBED THE MEDICATION.
Most medication induced discharge will be from both sides (bilateral)
Stopping medication/herbs may bring relief, but it will usually take 4-6 weeks
Your pharmacist can help you determine whether anything you are taking is a cause of nipple discharge.
HERBAL PRODUCTS: Complete information on herbs is often not available as they are not regulated by the FDA.
Herbs used to treat premenopausal and menopausal symptoms, diets high in soybean or tofu, Ma Huang (and other ephedra sources), caffeine or caffeine like products can cause discharge.
TREATMENT: After discussion with your physician, stopping the medication or herbal product is appropriate to see if the discharge ceases. If you can be sure that that discharge is pharmacologic, then you, with your physician, can decide whether to continue taking the medication or herbal product.
Caused by both benign (non-cancer) or cancerous breast diseases. Conditions that elevate a hormone called prolactin (e.g. tumors of the pituitary gland, a gland in the base of the brain) can also cause pathological discharge.
- persistent throughout cycle.
- spontaneous—occurs without squeezing the nipple.
- from one side (unilateral)
- usually occurs from one duct, or ducts from one quadrant
- abnormally colored—clear, watery, yellowish, greenish-gray, bloody (pink or red—your doctor can test the discharge to confirm it is bloody and evaluate the cells), milky colored if related to pituitary gland tumors
Benign conditions: Most common are papillomas (small benign nodules in the ducts—most common cause of bloody nipple discharge), duct ectasia (dilated ducts) and sclerosing adenosis/fibrocystic changes (increasing fibrous changes in the breast). Infection can cause purulent (pus) nipple discharge.
Cancer: May be associated with a lump or other breast changes. Usually discharge is watery or bloody. LESS THAN 5% OF ALL WOMEN WITH BLOODY NIPPLE DISCHARGE HAVE BREAST CANCER.
Mammography and ultrasound are the two tests used initially to evaluate women with discharge. Occasionally a ductogram (dye is injected into the ducts and mammographic images are taken); or an MRI (Magnetic Resonance Imaging) will be done.
TREATMENT: Treatment varies depending on the abnormality found on the diagnostic workup. Occasionally, if suspicious discharge continues without an obvious cause, a surgical biopsy will be needed.
CONTACT YOUR PHYSICIAN WITH ANY CONTINUING SYMPTOMS.