Patient's question:
Hello! My wife is 46 years old this year. Six months ago, there was nipple discharge in her right breast. She has taken a lot of medicine, but it hasn't improved. Could you please advise on any good methods for treatment? Additional questionDoctor's answer:
Nipple discharge is divided into two types: physiological and pathological. Generally, bilateral discharge may be physiological, such as in the case of women who still secrete a small amount of milk within one year of stopping breastfeeding; during the second and third trimesters of pregnancy, some pregnant women's breasts may secrete a small amount of thin colostrum; in a few women, post-intense sexual climax, due to highly congested breast blood vessels, breast enlargement, and nipple erection, temporary nipple discharge may occur; and during menopause, endocrine disorders may cause some women to secrete a small amount of milk. Additionally, conditions such as breast hyperplasia, duct ectasia, breast trauma, inflammation, various benign and malignant breast tumors, hyperprolactinemia, hypothyroidism, and pituitary tumors, as well as endocrine disorders caused by these conditions, can lead to pathological nipple discharge. The reason for nipple discharge is the excessive secretion of prolactin in the body. The causes of hyperprolactinemia are complex and include both physiological and pathological factors, which can be systemic or local. For example, multiple induced abortions after giving birth can lead to elevated prolactin levels in the body; poor sleep, long-term use of sedatives or sleeping pills; long-term use of anti-tuberculosis drugs for pulmonary or intestinal tuberculosis; post-marital women who need long-term oral contraceptives due to discomfort from an intrauterine device; as well as hyperpituitarism, pituitary microadenomas, hypothalamic disorders, and the use of antihypertensive medications. Physiological discharge is often caused by intense sexual stimulation, leading to a temporary increase in prolactin, which quickly returns to normal. In non-pregnant women, if lactation occurs accompanied by amenorrhea, it is referred to as hyperprolactinemic amenorrhea syndrome, which can lead to infertility. Breast duct ectasia may also result in a small amount of milky-like discharge. Some women with breast hyperplasia may experience nipple discharge accompanied by breast tenderness, which may be caused by endocrine disorders. If the discharge is bloody or entirely bloody, it should be a warning sign of breast cancer. In summary, women with nipple discharge should not take it lightly but should also avoid panic. They should promptly seek medical attention for detailed examinations, such as smear tests of the discharge, fasting blood tests for prolactin, or even mammography, to identify the underlying cause and receive appropriate treatment.