Although it can be upsetting when a woman who isn’t breastfeeding has fluid coming out of one or both nipples, it’s true to say that this is actually very common and seldom leads to serious concern.

The human female breast is a complex and beautiful structure. It is unique in the animal kingdom for combining multiple ducts into one shapely form, with a well designed “bulls-eye” in the middle so that even a newborn baby knows where to find food. We can thank our lucky stars for this, because every foetus starts out with two converging rows of nipples similar to the ones you can see on your pet dog! All but two of these disappear long before birth, though occasionally a child is born with a third nipple – Napoleon was rumoured to have this unusual feature. Most women can press fluid from their nipples if they try – though this is no longer recommended as part of routine self-examination as it’s not likely to do any good. The nipple is a sensitive and erotic zone in which the boundary between pleasurable stimulation (which may also cause discharge) and harmful irritation can be somewhat subjective!

The nipple has microscopic openings or pores for milk release which occurs under the influence of hormones.  Discharge from both nipples and from several pores suggests hormonal upset; this is fairly common during peri-menopause whilst some thyroid conditions also affect breasts.  Fluid that looks similar to milk and comes out freely (in the absence of a baby to feed) could indicate a very rare non-cancerous pituitary tumour, for which you may need a blood test followed by MRI scan and specialist advice, as this tiny master-gland lies too deep within the brain for a simple operation. 

Although there isn’t always an obvious reason for nipple discharge, medications including certain antidepressants, anti-anxiety treatments, mood stabilizers, blood pressure medicine, ulcer medicine, and long-term psychiatric drugs can cause it. Birth control pills and hormone replacement therapy, by altering hormone levels, are also common culprits, as are some herbal treatments and street drugs especially cannabis. Men can also experience breast problems such as enlargement, pain and discharge. Though often a source of amusement to others it is no laughing matter for the man concerned, who should make no delay to consult his doctor and find out the cause. 

It’s fascinating to note that in circumstances of high emotional stress, the nipples can leak bloody fluid – for example, after a public disaster that affects us personally, when children leave home, or when new grandchildren are painfully missed. It seems that women really are mothers of the nation: our breasts can express our love for those “children” and our sadness over losing them or being separated from them, just as a nursing mother’s breasts can leak milk as she thinks of her baby.

It is fortunately rare for nipple discharge to be a sign of breast cancer, but women should be aware of the following situations:

  • Discharge that starts suddenly and without anyone squeezing or manipulating the breast
  • Fluid coming from only one nipple and/or only one pore or opening in that nipple
  • Discharge of a clear fluid with a sticky consistency
  • If you are over 60 and not on any kind of hormone treatment
  • Bloodstained discharge (often nothing to worry about but should be investigated)
  • Associated with a lump that you can feel or an abnormal mammogram
  • With or without discharge, a red, itchy rash over the areola which doesn’t get better with lotion

Even though nipple discharge is usually benign and resolves itself, it should always be reported to your doctor. If atypical cells are seen in the fluid, a breast specialist can examine the ducts more minutely. Small benign growths called “papillomata” can cause blockages and recurrent discharge; though not dangerous, most patients understandably want these removed. More rarely, there may be a cancerous or precancerous change in cells of the duct that is causing the discharge.  

Ducts can be removed surgically without leaving the breast deformed – no woman should have to undergo the old procedure whereby major excisions removed all the ducts and altered the natural shape of the breast. Similarly, a cancer which affects only the nipple can also be treated with conservative “lumpectomy” and a short course of radiation, and the nipple can be reconstructed.

On the popular website Women to Women, Dr Dixie Mills has crucial advice for any woman worried about her breast or breasts:

“Women should always feel that they are being listened to and not thought to be complaining or whining when they are genuinely anxious about breast or nipple change….Knowledge is power, and a woman should always feel comfortable asking questions – and more questions – if necessary.”

Pointing out that breasts and nipples provide the beginning of nurturing and mother-care in human life, Dr Mills urges women to

“…make awareness of breast health a part of your own process of self-nurturance”.

If you have noticed a discharge from one or both breasts and are thinking of calling your doctor – go right ahead. It may well turn out to be easily treatable, and is your way of taking the best possible care of yourself and your health.

Reference: Dr D. Mills, “Breast discharge: Why it happens and what you can do”.