benign physiologic nipple discharge (galactorrhea)
pathologic nipple discharge
Physiologic Nipple Discharge
Galactorrhea is a considered a physiologic nipple discharge because it is frequently the result of
an excess of prolactin from the pituitary gland which stimulates milk production.
Galactorrhea is usually bilateral (but may be unilateral), multi-ductal and milky in appearance in
the non-lactating adult. It can occur in males as well as females.
In females, absent or irregular menstrual periods are likely.
Pathologic Nipple Discharge
Pathologic nipple discharge on the other hand is non-milky, spontaneous, and most often
unilateral and uniductal.
Nipple discharge with a bloody appearance is more suggestive of intraductal malignancy or a
benign intraductal papilloma and should raise a red flag to the provider.
Mammary duct ectasia, on the other hand, is another source of non-milky discharge.
Ectasia is the result of mammary duct dilation with surrounding inflammation and fibrosis.
It can present with variable colors (green, brown or black) and may be seen in both breast
and/or multiple ducts.
Once a benign diagnosis or normal findings have been established by biopsy or imaging, simple
reassurance is often all that is needed. Symptomatic treatment for mastalgia may also include
the following recommendations:
Wear a sports or supportive, wire-free bra
Minimizing caffeine may provide anecdotal relief
Evening primrose oil and vitamin E supplementation-their utility is controversial since benefits
have not been shown consistently in research
Danazol, bromocriptine and tamoxifen have been found effective and used for severe cases but
the significant side effects have limited the acceptability of their use
Changing to contraceptive pill or hormone replacement therapy with less estrogen or
progesterone may offer some relief associated with cyclic mastalgia
Clinical signs and symptoms of ectopic pregnancy
Ectopic pregnancy is the implantation of a fertilized ovum in locations other than the uterine