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Menopause

Are Your Menopausal Nipple Changes Normal? Here’s What an Ob/Gyn Wants You To Know

Expert answers to common questions about nipple health.

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By now we’re pretty familiar with our breasts: Over the years, we’ve watched them grow, stretch, shrink and change in every possible way… or so we thought! But our we experience breast changes as we get older—including many that affect our nipples—thanks, in part, to the hormone fluctuations that occur during menopause, says Certified Menopause Practitioner Barbara DePree, MD, a gynecologist in private practice and director of Women’s Midlife Services at Michigan’s Holland Hospital and founder of MiddlesexMD.com, an educational resource for women’s sexual health in perimenopause and beyond.

Here, Dr. DePree answers the 5 most common questions women ask about their nipples.

Why are my nipples hard?

Q: I’m 51 and for the past few weeks, my nipples have been constantly erect. It’s embarrassing! Why is this happening?

A: Erect nipples are extremely common and can be caused by many things, including stimulation, irritation to fabric or an allergy. But given your age, it’s likely due to normal hormone fluctuations, which cause breast changes, including increased nerve sensitivity that can cause nipples to harden. Plus, changes in temperature—like going in and out of air-conditioned buildings or into a pool—can also cause erect nipples.

Luckily, you can avoid embarrassment by concealing them with padded bras, looser shirts or silicone nipple covers, like Hollywood Fashion Secrets Silicone CoverUps. Although this is rarely a symptom of anything serious, if you notice discharge, pain or swelling, see your doctor to rule out issues such as a clogged duct or breast abscess.

Is this nipple hair normal?

Q: Lately I’ve noticed wiry hairs growing around my nipples. I’m 53 and worried that something is off since it’s never happened before.

A. Rest assured, I see this breast change often. Many women experience new hair growth around the time of menopause, when estrogen levels are falling faster than androgen levels, resulting in an increased ratio of androgen to estrogen. For some women, this interplay of hormones can promote hair growth on the upper lip, chin, cheeks or chest. The hair can grow like peach fuzz or it can be dark and coarse.

If you’re interested in removing the hair, the process isn’t different from removing it on any other part of your body: You can tweeze, trim with nail scissors, shave, buzz with an electric razor, wax or even laser. Since the hair will likely grow back, experiment to see which method works best. But if this hair is truly bothersome, you can talk to your doctor about other treatments that may help reduce growth, but it should stop as your hormones level off further into menopause.

What are these brown spots around my nipple?

Q: Last week, I noticed raised brown spots around my nipple. I have a mammogram soon, but I can’t stop thinking about them. Could this be cancer? I’m 53.

A: These sound like seborrheic keratoses, benign skin growths that most commonly appear after age 50 and can look raised and waxy, often resembling warts or melted brown candle wax on the skin. And it’s common for several to appear rather than just one.

Rest assured, seborrheic keratoses are harmless and are not related to a higher risk of breast or skin cancer and are just one of many breast changes at this stage. But to ensure the accuracy of your mammograms, it’s important to point them out to the tech so she can mark the spots before taking images of your breasts. At most mammogram facilities the tech will apply a circular marker, similar to a donut-shaped sticker, around the lesion. This will prevent any confusion if the lesion shows up on the mammogram images and mimics or masks an abnormality.

Should I be worried about this green nipple discharge?

Q: An ultrasound confirmed my breasts are fibrocystic. My doctor says it’s nothing to worry about, but now I have a green discharge from my nipples and increased tenderness before my periods. Help!

A. Don’t be alarmed. Fibrocystic breasts occur when fibrous tissue and fluid-filled cysts form in the breasts, causing tender, moveable lumps or thickening tissue that can be constant or cyclical (and can cause the discharge you describe). The condition is triggered by hormonal changes, so it usually disappears after menopause and doesn’t pose additional risk for breast cancer.

Supplementing with 1 to 3 grams of evening primrose oil daily can ease tenderness, as can applying ice to your breasts and taking 400 mg. of ibuprofen as needed. Nursing pads will absorb the discharge, which can be green, yellow or brown. But see your doctor if the discharge is bloody or symptoms persist after a few weeks. She may need to remove fluid from the cysts with a simple in-office procedure.

Why are my nipples so sore after exercise?

Q: I started power walking and my muffin top is going away! But my nipples are so sore, they’re actually bleeding. What can I do?

 Congratulations on your workout routine! It sounds like you’ve developed jogger’s nipple, a common condition triggered by friction from a bra or other clothing against the nipple that causes chafing, cracking and even bleeding. Healing can take up to a week, so consider low-impact exercise like biking or yoga for now.

In the meantime, use gentle cleansers and apply an antibiotic ointment three times daily to soothe skin and ward off infection. When you resume walking, apply a thin layer of Vaseline to your nipples beforehand (cleaning off afterward so your skin can breathe) or try an anti-chafing balm like Body Glide.

To avoid this issue going forward, make sure your sports bra and top fit comfortably: Too much friction (from tight tops) and not enough support (from baggy ones) can lead to chafing. You can also wear nipple guards (like NipGuards) while exercising. But if increasing pain and redness occur and the abrasion isn’t healing, see a doctor to rule out a skin infection.

Related: Ob/Gyns Share the Surprising Causes — and Cures — for Itchy Breasts

Want more breast news? Learn about sad nipple syndrome here:

Reviewed by Barbara DePree, MD

A version of this article originally appeared in our print magazine, First for Women.

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