Nipple discharge can vary in color, amount and how it appears. Clinicians assess whether it is spontaneous or expressed, unilateral or bilateral, and whether it occurs with other signs to decide on likely causes and next steps.
Color, quantity and how the fluid appears are central to evaluation. Clear or milky discharge is often linked to hormonal changes. Spontaneous, unilateral, or bloody (red/dark) discharge is more concerning and usually prompts further investigation. Thick, sticky or multi-duct involvement can point to chronic duct changes.
Frequent causes include benign ductal lesions (for example intraductal papilloma), duct ectasia, breast infections, and hormonal influences such as pregnancy, lactation or menstrual-cycle variations. Certain medications or systemic hormonal disorders can also cause discharge. Malignant causes are less common but considered when specific concerning features are present.
Initial assessment starts with medical history and breast examination focusing on discharge features, laterality and any palpable lumps or skin changes. Imaging such as breast ultrasound and mammography are commonly used. Depending on age and findings, tests may include ductography, cytological analysis of discharge, pregnancy testing or hormonal blood tests.
Seek urgent care for heavy bleeding from the breast, fever or a sudden worsening of general health. Single-sided spontaneous bloody discharge or an accompanying palpable mass should prompt timely specialist referral (breast surgery, gynecology or endocrinology) for further evaluation.
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