Causes of Breast Secretion, Nipple Discharge

Nipple discharge affects many women who are not pregnant or breastfeeding and the presence of breast secretions do not always indicate any serious problem. While breast milk is expected in pregnancy and after child birth, other secretions from the breast may also occur in women of any age. Young women may experience nipple discharge without any cause for concern but persistent discharge in older women may be a sign of an underlying condition.

Secretions from the breast usually occur from the nipple and nipple discharge should be differentiated from fluids secreted through a breast fistula. A breast or mammary duct fistula is an abnormal passage that forms between a mammary duct in the breast to the surface of the skin, usually near the areola. While a mammary fistula is not very common, it may occur after a prolonged infection and the presence of a fistula should not be considered as nipple discharge. A breast fistula requires further investigation and appropriate treatment.

Types of Nipple Discharge

There are different types of nipple discharge and the type of breast secretion may be an indication of the cause of the discharge.

  • Milky discharge may be breast milk production even in women who are not pregnant or breast feeding and is often due to elevated hormonal levels, specifically prolactin.
  • Clear discharge and sticky discharge may be a sign of inflammation or infection.
  • Bloody discharge may be a sign of severe trauma, infection or cancer.
  • Mucus that is yellow or brown and may be mixed with blood could be due to severe infection, especially if accompanied by breast pain.

Evaluating the type of nipple discharge is not usually sufficient to make a conclusive diagnosis. The presence of other signs and symptoms as well as thorough diagnostic investigation by a medical practitioner should determine the underlying cause of the breast discharge.

Signs and Symptoms of Nipple Discharge

Nipple discharge may occur on its own with no other sign or symptoms or may be accompanied by other symptoms which is indicative of certain conditions.

  • Nipple discharge may occur from both breasts (bilateral) or one breast (unilateral)
  • Breast tenderness or breast pain
  • Swollen breasts or breast lumps
  • Fever
  • Irregular menstrual cycle

Causes of Nipple Discharge

In most cases, breast discharge is not a cause for concern but any persistent discharge associated with other changes requires investigation. Any nipple discharge in males needs to be investigated as it is usually an indication of more serious pathology.

  • Galactorrhea is breast milk production in women who are not pregnant or nursing and is often due to elevated prolactin levels (hyperprolactinemia). Hyperprolactinemia may occur as a result of many conditions including :
  1. Stimulation of the breasts
  2. Pregnancy
  3. Stress
  4. Injury to the breast
  5. Sexual intercourse.
  6. Pituitary disorders
  7. Thyroid disorders particularly hypothyroidism
  8. Kidney or liver failure
  9. Certain drugs like oral contraceptives, antidepressants or antihypertensive drugs.
  • Breast abscess or breast infection due to bacterial, viral or fungal causes is usually accompanied by breast pain, tenderness, redness of the skin with a white to yellow discharge. A painful breast lump may be felt in the case of an abscess. Infections of the breast are usually one sided and may also cause breast swelling.
  • Benign breast disorders :
  1. Intraductal papilloma is a small benign tumor of the milk ducts in the breast. It is the most common cause of nipple discharge and usually affects only one breast. The secretion may be bloody or a clear discharge may be noted.
  2. Fibrocystic breast disease (FBD) is the most common cause of breast lumps in women, particularly older women. It may affect one or both breasts and the presence of multiple small lumps may be noticed along with breast tenderness.
  3. Mammary duct ectasia is the blockage of the milk duct and may affect one breast or both sides. Blockage of the duct often occurs as a result of inflammation due to hormonal changes and may be prone to bacterial infections. Smoking is a predisposing cause for mammary duct ectasia. The nipple discharge in mammary ectasia may vary in color and consistency.
  • Breast cancer, usually intraductal carcinoma, may cause a bloody breast discharge. A breast lump is usually present and swollen lymph nodes (lymphadenopathy) may be noticed.
  • Hormonal disorders affecting the female sex hormones which may occur in perimenopause, premature ovarian failure and polycystic ovarian syndrome. Changes in the menstrual cycle are usually evident, with irregular menses, sudden cessation of periods or changes in menstrual flow. Infertility may also accompany these hormonal disorders.
  • Gynecomastia is the enlargement of the male breast which may be normal during puberty. Persistent enlargement with breast tenderness and/or nipple discharge should be investigated although breast secretions in gynecomastia is not common.

Diagnosis of Breast Discharge

While nipple discharge may occur frequently in women who are not pregnant or breastfeeding, persistent breast secretions should be investigated. Persistent breast discharge is of particular concern in women over 40 years of age, where the discharge is from only one breast, bloody discharge with the presence of breast lumps.

After physical examination and a case history, your medical doctor may consider a mammogram, fine needle aspiration and cytology. If the prolactin levels are elevated, further blood tests may be conducted to evaluate the functioning of the thyroid gland, particularly by testing the thyroid stimulating hormone (TSH).

If you are using any hormone replacement therapy or related drugs for menopause, as contraception or for infertility, your medical doctor may discontinue or change the drugs if the breast discharge is severe and accompanied by other symptoms like breast swelling, tenderness or pain.

Women experiencing nipple discharge with a personal or family history of recurrent breast lumps, even benign lumps. should undergo extensive investigation to exclude breast cancer.


References

  1. Intraductal Papilloma. Medline Plus
  2. Intraductal Carcinoma. National Cancer Institute
  • Asifa

    Oh sorry i forg0t to mention that I am 21 years old and is virgin.

  • Dr. Chris

    Hi Asifa

    Some discharge from the breasts upon applying pressure does occur. It does not always happen though. However, it is difficult to say whether it is normal in your case. You should see a doctor anyway just to put your mind at ease and exclude any serious underlying disorders.

  • Lcutt

    Hi there,
    I’m 20 years old and just moved away to go to university. I am underweight and am living in a dorm room full of girls. I had sex once with a condom since being at school. Missed that months period so took a coupl of pregnacy test which were negative. I started the birth control pill right after to regulate my periods and got a very very light period at the end of the month. However being on birthcobtrol made me had a bad reaction to it. My breasts started to leak (with pressure) and made my upper stomach feel hard. I have stoped the pill … Could these just all be symptoms of stress, hormone imbalance and all that?

  • Dr. Chris

    Hi LCutt

    Hopefully you were prescribed birth control after consulting with a gynecologist and did not just start it on your own (or with the advice of the campus nurse). It is never advisable to start birth control without first seeing a gynecologist. While it is common practice to do so to prevent pregnancy, if you are looking at regulating the period then you should definitely have first undergone an assessment by your gynecologist. Your irregular periods could have been due to a number of causes which need to be treated in order for your cycle to return to normal. “Forcing” a cycle with birth control is never advisable unless your gynecologist says so. The breast discharge may very well be due to the birth control or it could be a symptom of the underlying disorder which remains undiagnosed. Don’t assume that it is just a hormone imbalance and thats all there is to it – an imbalance suddenly occurs for a reason which needs to be identified.

  • Liz

    Hi. I am 46 years old and healthy. I had my last child more than 19 years ago. I been discharging little milk from my breast, but for the last 6 months they are drying up. Since I started having my annual check up I asked my dr. and he told me that sometimes happen, the mammograms are ok, I have no problems, thank God. I been with my fiance for a while and he likes to suck my breasts and take the little milk out. I want to know what can I do for my breasts to do not dry up? Is there any natural medicine that I can take to produce a little milk? Or how can I stimulate my breasts to have milk?

  • becs

    Hiya im 25 years old and for the past 2weeks i have been getting a clear-milky discharge from left nipple but only if i squeeze it. it doesnt happen on my right nipple. it is only a small amount of discharge. i have no lumps or any changes to my breast that i noticed. i am quite worried bout this. i have been on the oral birth control since having my daughter who is now 6 1/2 years old, i breastfed for 3months. my partner and i have sex regular. the pill im on is cilest which i changed to about 6months ago. what do u think this could be?

  • Dr. Chris

    Hi Liz

    Your doctor is correct. This small amount of milk secretion can happen for years after childbirth but eventually it does stop. While manual stimulation will cause a small amount of milk production/secretion, you also have to consider that your age is a factor as well. I cannot advise any medication or supplement for milk production as it is not for a medical reason and could affect other organs of the body. If you are intent on doing so, speak to your doctor or pharmacist.

  • Dr. Chris

    Hi Becs

    White breast discharge upon manual stimulation is not uncommon and may not be related to any disease process. It can occur when using birth control or after pregnancy/childbirth – even for years afterwards. However, when there is breast discharge from a single breast, it should be investigated even if it is not abnormal (yellow, green, bloody and foul smelling). See your gynecologist as soon as possible. A mammogram may be necessary if you do not have annual check ups.

  • Hemi imm

    Dr chris i am 20 and sexualy active last had sex 4 days ago noticed a whiteis discharg dat is bilateral 4rm my niples am scared on squezing pls help me

  • Dr. Chris

    Hi Hemi Imm

    Bilateral indicates a hormonal cause most likely. You should speak to your doctor. A pregnancy test is necessary. If negative, other investigations would need to be considered. This type of discharge is not always abnormal but rather be cautious and consult with a doctor.

  • debisf

    Hi Dr.

    I’m 40 years old and had my tubes tied over 10 years ago. I haven’t had my period since this past October. I noticed this morning that one of my breast was bigger than usual and I squeezed it and to my surprise a grayish gel like discharge came out. I quickly check the other one and a whitish..milky discharge came out as well. I took a home pregnancy test but the result were negative. Is it possible that I could be pregnant and just got a wrong reading since my tubes are tied. Please respond as soon as possible. Thanks

  • Dr. Chris

    Hi Debisf

    Despite your tubes being tied, a home pregnancy test is only so effective in the early stages. A blood test needs to be done to conclusively rule out pregnancy. So to answer your question, yes, you could be pregnant despite the negative test result. While it is rare, there may have been a tubal ligation failure.

    Remember that there are a number of other causes of breast discharge. Given your age, you should see your doctor immediately who will consider further investigations.

  • Mash

    Hi Dr. Chris
    Thanks for ur information but i still could not find a way to visit a doc or consult it with my mother. i am just too scared. I am still a minor because as i said before my nipple discharge is always in very small amounts and it is not frequent. And now it comes out from both my breasts, whenever my bf sucks the nipples.
    I am not pregnant…but along with the discharge I am having very irregular periods. I am having them every month but they are delayed (for about 5-6 days). This month my date was the 21st, but on the 20th i had unprotected sex with my bf and then had an emergency contraceptive pill(i-pill). Now today is 29th and i am still not having my periods. Is this a major problem? Can it cause severe problems in the future. I read that nipple discharge can cause infertility…and i got really scared. Till last month i had delayed periods but this month i still did not have as i mentioned above. Please Doctor, help me out. You are the only one who can help me now. At least tell me the possible causes for this and ensure me if it can cause problems in the future or not. And if so then what are the possibilities?
    Thank you…..

  • Dr. Chris

    Mash,

    We have strict guidelines about just how far we can assist. Firstly, you are not our patient, we have not seen your medical records or consulted and examined you. Whatever information is being provided is subjective and you may be missing crucial points that only your medical doctor would identify. Secondly, we are here to guide you to the appropriate practitioner and cannot diagnose, prescribe or even suggest any treatment. You would have read this on the comment policy box that popped up when you submitted your comment.

    You need to speak to your mother and consult with a doctor. You do not have to give specific details about your boyfriend’s involvement but you have to report the discharge. Yes, it could be serious. If it is associated with some gynecological problem that is a result of a hormonal imbalance then treating it as soon as possible would be preferable. Waiting till later in life could mean that the treatment would be less effective. There is no reason to be afraid – this is a medical issue and not a relationship issue. All you need is to get to a doctor with whom you can speak to confidentially and reveal all the relevant details.

    By trying to seek help from online platforms, you are wasting time and putting your health at risk. And from our side, by answering any more of your questions, you will delay further and not seek any treatment. Please speak to your mother/doctor immediately.

  • Riddhima

    Hello
    I am 20 years old and from last 2-3 months, I am observing a water like fluid coming out of my breasts when squeezed, also at 1-2 times a white fluid coming out. Is it a cause of concern and should I get it examined? Also, can this lead to breasts cancer? In my family from my maternal side two cases of cancer have come, including one with breast cancer. Can that also be a cause.

    Looking for an early reply!
    Riddhima

  • Jennifer

    Hello Dr, am 30 yrs old i have this clear colour discharge from both breats When squeezed very hard, though my curiosity was triggered when my younger sister 22 yrs complained of same. I had a termination like 12 yrs ago & have been on contraceptive pills until 5 yrs ago. My menstruation has always been regular & flows well ….
    Dear Dr Chris, my question is “Do I need to worry” ? ….Do I need to see a doctor ???.. cos I really need answers now since am planning to get married & start having children of my own I wouldn’t want anything to hinder my conception cos in this part of region (Africa) any married woman without children is not recognized.

  • Dr. Chris

    Jennifer,

    You should see a doctor. I cannot tell you if you need to worry or not because the relevant tests have not been conducted and anyway, it is against our policy guidelines to do so. We are not treating you and we do not know your entire medical history/case despite the information you have provided. We are only here to advise you on possibilities. Your doctor will be able to better advise you.

  • Jennifer

    Dear Dr Chris,

    Thanks for your advise i ‘ll do so right away , then give you feedback soon.

    Thanks for the prompt response.

    Bye

  • Dr. Chris

    Hi RIddhima

    You should see your doctor about these symptoms. There is no way for us to tell you if this is serious or is due to cancer. You need to see a doctor who will conduct further investigations to confirm a cause and exclude other diseases. While a clear discharge, particularly upon firm pressure is not uncommon, you should nevertheless get it checked by a doctor, preferably a gynecologist, given your concerns.

  • Beauty

    Dr Chris,I am experiencing a clear to milky discharge which is coupled by irregular menses.I normally skip my periods for three to four months and have tested negetive on all these instances that i was not mensurating.Also when i mensurate i experience a very heavey and painful bleeding.I have been married for 8 years nw but have not been able to conceive.Please help Doctor.

  • Dr. Chris

    Hi Beauty

    Your menstrual symptoms, breast discharge and difficulty falling pregnant are indicative of hormone related conditions like PCOS (polycystic ovarian syndrome). PCOS is also one of the most common causes of infertility. There are other possibilities that could account for these symptoms – from endometriosis to uterine fibroids. At this point you should be seeing a gynecologist, preferably a fertility specialist. This is essential if you want to resolve this problem and possibly fall pregnant. Speak to your family doctor / GP about a referral to a gynecologist in your area. This needs specialist medical attention.

    You can read more on PCOS in these articles – What is PCOS? and PCOS Symptoms

  • KK

    Hi Doc,

    My fiancee, is having the same kind of problems since 3 days. I have got an appointment with the Gynaec Doc tomorrow, but I am bit panicked at the moment. She had some thin liquid bit whitish and yellowish in colour coming out bilaterally when squeezed. We had sex some 20 days back and on March 11, she had her periods. There is no swollen or pain in the breast (as she says). Let me know what might be the possibility. Thanks in advance.

  • nish

    I am newly married. I am on birth control pills. My beast is (both)is giving out white salthy discharge. what could be the reason

  • Dr. Chris

    Hi KK

    If it is bilateral, then the cause is more likely hormonal. A slight whitish to yellow discharge is not uncommon even without pregnancy but it should nevertheless be investigated. Pregnancy must first be excluded before other conditions are considered. Your doctor will advise you further.

  • Dr. Chris

    Hi Nish

    As you can see above, there are many possible causes. The high estrogen levels associated with a hormone contraceptive can cause certain changes in the breast tissue which may contribute to this discharge. However, you have to also exclude various other causes which requires a medical examination and caerful evaluation of your medical history, including your family history. Stimulation of the breast can also contribute to a discharge which is not abnormal. Nevertheless, see your doctor as soon as possible.