Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Nipple discharge

A number of readers have sent in queries about nipple discharge. Here are just two of them.

Dear Dr Margaret
For quite a few months now I have had a greeny-blue liquidy discharge from one of my nipples. If I squeeze the area this discharge occurs. Any idea what this could be?

Dear Dr Margaret
I hit the menopause about 4 years ago. Since then I have had a greenish discharge from my breasts. Is this normal? It seems to have lessened recently.

Nipple discharge seems to be a common problem - I have had a lot of emails about it. Usually it is harmless, and does not signify anything seriously wrong. In fact most women can squeeze some discharge out of their nipples, especially if they have had children. The discharge may be whitish or may be yellow-green or almost black in colour. On the other hand, nipple discharge can be a symptom of breast cancer, particularly if it is bloodstained. Therefore you should definitely discuss any nipple discharge with your own doctor. Even if you have not noticed any blood, your doctor may ask you to try to squeeze a few drops out, and will test it for microscopic amounts of blood.

Each nipple has about 15-20 tiny pores on it. These pores are the openings of ducts that connect with the glandular tissue in the breast. Try to work out whether the discharge is coming from just one pore or from several - this is something your doctor will need to find out. The cause is very, very unlikely to be breast cancer if the discharge is coming from several pores, it does not contain any blood, and you are under 50 years of age. If it is blood-stained or it is emerging from just one pore, your doctor will refer you to a hospital clinic for tests (such as ultrasound, mammography and looking at the discharge under the microscope) to make sure that breast cancer is not responsible.

If the tests are all normal, you can stop worrying, but the discharge may still bother you (perhaps soiling your clothes). A possible cause is some inflammation (mastitis) around the ducts. This is linked with smoking, and may improve if you stop smoking and avoid squeezing. A course of antibiotics may help. It is possible to have an operation to close or remove the ducts that the discharge is coming from. This operation may not be a good idea for anyone who plans to become pregnant afterwards - depending on the number of ducts involved, it might make breast-feeding difficult and the breast might become congested.

If the discharge is milky and coming from both breasts, your doctor can do a blood test to check for an imbalance of a hormone called prolactin.

A man with nipple discharge should see his doctor straight away, because the usual cause is a tumour, which will need treatment.

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