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Nipple discharge

AGE  Risk factors depend on the causeGENDER  
LIFESTYLE  Risk factors depend on the causeGENETICS  Risk factors depend on the cause

Outside of pregnancy, discharge of fluid from one or both nipples may be due to hormonal changes amongst other causes.

Nipple discharge
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It is normal for women to release milk from their nipples during late pregnancy and while breast-feeding. At any other time, a nipple discharge may be due to hormonal changes in the menstrual cycle or a symptom of a minor disorder. However, because the condition may be a sign of a more serious disorder, such as breast cancer, you should see your doctor if you notice an unusual discharge.

What are the causes of nipple discharge?

The main causes of nipple discharge are hormonal changes, infection within the breast, or, more rarely, a breast tumour. Fluid discharged from the nipples can vary considerably in colour and consistency, and its appearance is not always a good indication of the cause.

Hormonal changes

Changes in the levels of female sex hormones may produce a discharge, usually from both nipples, just before a period. This type of discharge is usually clear and watery.

A watery, milky discharge in women who are not pregnant or breast-feeding is known as galactorrhoea. This is usually due to overproduction of prolactin from the pituitary gland. The condition may be due to a noncancerous tumour of the pituitary gland, called a prolactinoma, or may be an effect of a hormonal disorder such as hyperthyroidism. Some drugs, including some antipsychotics, can cause galactorrhoea as a side effect.

Breast infection

In breast-feeding women, blocked milk ducts may become infected and produce a discharge of pus from the nipples (see Mastitis). In nonbreast-feeding women, smoking may be associated with inflammation of the milk ducts, producing a pus-containing nipple discharge. This is most common in women under 40.

Breast tumours

A watery discharge from the nipple may be associated with a cancerous breast tumour. A bloodstained discharge from the nipple may also be a symptom of cancer, although, more commonly, this type of discharge is the result of a noncancerous tumour forming within a duct.

What might be done?

Your doctor will carry out a physical examination of your breasts. He or she may take a sample of the discharge to be examined for evidence of infection or cancerous cells. X-rays of the breast (see Mammography) and ultrasound scanning may be performed. A blood sample may be taken to measure hormone levels.

In most cases, a discharge that is caused by normal hormonal changes is harmless and does not require treatment. Galactorrhoea can often be treated successfully using drugs, such as cabergoline (see Pituitary drugs), which reduce the production of prolactin by the pituitary gland. If galactorrhoea is due to a tumour in the pituitary gland, surgery and radiotherapy, in which any cancerous cells are destroyed by using radiation, may be required. A discharge of pus usually clears up after treatment with antibiotics. A bloodstained discharge caused by a noncancerous tumour of a milk duct is normally treated by surgical removal of the duct.

If initial tests reveal that your nipple discharge has been caused by a cancerous growth in the breast, you will be referred for further tests and treatment.

Posted 09.09.2010

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