Benign breast disorders

Intraductal papilloma (a benign tumor in a milk duct)—the most common cause

A bloody or pink discharge from one breast

Usually ultrasonography

Additional tests, such as mammography, MRI, or a ductogram (mammogram of the milk ducts) depending on the results of ultrasonography

Biopsy if other tests cannot rule out cancer

Mammary duct ectasia (dilated milk ducts)

A bloody, pink, or multicolored (puslike, gray, or milky), sometimes thick or sticky discharge from one or both breasts

Same as for intraductal papilloma

Fibrocystic changes (including pain, cysts, and general lumpiness)

A lump, often rubbery and tender, usually developing before menopause

Possibly a pale yellow, green, or white discharge

Possibly a history of having breast lumps

Same as for intraductal papilloma

An abscess or infection

Pain, tenderness, redness, warmth, or a combination that begins suddenly in a breast

Often fever

With an abscess, a tender lump and possibly a puslike discharge that smells foul

Breast examination

If the discharge does not resolve with treatment, evaluation as for intraductal papilloma

Breast cancer

Nipple discharge†

Possibly a palpable lump, changes in the skin, or enlarged lymph nodes, most often in the armpit

Sometimes a bloody or pink discharge

Same as for intraductal papilloma

Increased levels of prolactin‡

Various disorders, including the following:

A milky (not bloody) discharge, usually from both breasts

No lumps

Possibly menstrual irregularities or no menstrual periods (amenorrhea)

Blood tests to measure prolactin and thyroid-stimulating hormone levels

A review of medications being taken

If the prolactin or thyroid-stimulating level is elevated, MRI of the head

• Hypothyroidism (an underactive thyroid gland)

Intolerance of cold, sluggishness, constipation, or weight gain

• Disorders of the pituitary gland or hypothalamus (part of the brain)

Possibly hormonal abnormalities (such as absence of menstrual periods or infertility), changes in vision, or headaches

• Chronic kidney or liver disorders

With liver disorders, ascites or jaundice

In people known to have a kidney or liver disorder

Certain medications including

• Opioids

• Oral contraceptives

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Blood tests to measure prolactin and thyroid-stimulating hormone levels

A review of medications being taken

If the prolactin or thyroid-stimulating level is elevated, MRI of the head