Most of us don’t spend much time considering our areola (plural: areolae, because who doesn’t love a good diphthong), which is the technical name for that darker colored skin around your nipples. If you've noticed changes in your areolae lately, you may be concerned that they're going to fall off, explode, or signal something deeply wrong — but, in many cases, there are simple explanations for areola changes.
"Changes in the areola can be caused by various things," Dr. Jamie Lipeles, D.O., an OB-GYN, tells Bustle. "The most common cause in a change in the areola is pregnancy (which is the result of changes in the hormones seen in pregnancy)." Areolae changes are among the signs of early pregnancy; they can get darker, larger, thicker, and you can start to notice surprising new bumps as your milk glands prepare themselves to feed a tiny human. Age can cause changes too, he says, but those alterations take a long time and are generally pretty subtle.
If you're definitely not pregnant, and have noticed that your areolae are bigger than usual or otherwise changing, they may be telling you something about your health. Here are the main areola changes to look out for, and what they might mean.
1. Your Areolae Change Color
The color of your areola changes naturally over time, which you might have noticed because your areolae darkened when you hit puberty. However, your areolae can change color in adulthood, and not just when you get pregnant. The primary reason for color changes is high levels of progesterone and estrogen, because these hormones cause your body to increase its pigment development.
Darker areolae might be a sign of a hormone imbalance — or just the normal fluctuation of your body as it travels through the menstrual cycle. Dr. Lipeles says that areolae can also change color as a result of medications. "Any medication that affects melanocytes in the body or alters hormones or contains hormones (like birth control pills) can have an effect on the areola," he says.
If your darker areolae is accompanied by other symptoms, such as flaking or peeling, or you notice that only one of your areola has changed in color, there might be something more medically serious going on. Paget’s Disease is a rare cancer that starts specifically in the nipple and areola area, and one of the first signs is discoloration of the nipple. If you notice sustained color changes as well as other symptoms including scaly, flaky, or thicker skin, itchiness or redness, or lumps, definitely schedule a visit to your doctor to get checked out.
2. Your Areola Gets Bigger
Your breasts change size throughout your menstrual cycle, dictated by your hormone levels. This is totally natural, and as your breasts change size, so may your areolae.
Your areolae may also get bigger when you’re turned on. When you’re getting in the mood, your breasts actually swell with blood as your heart rate and blood pressure are both raised. This can cause your areolae to get a bit expanded.
This is going to become something of a refrain but really, the only time to worry is if only one of your areola becomes larger. This breast asymmetry could be a sign of breast cancer, so if this is happening to you, go see your doctor to get checked out. Dr. Felice Gersh M.D., an OB-GYN, tells Bustle that you should also go see a doctor if the expansion is red and painful.
3. You Have New Hair On Your Areolae
Did you know that your areolae and nipples have hair follicles on them, just like the rest of your body? It’s true! It’s therefore totally natural to have some hair growing out of your areola skin. Body hair in this area is triggered by hormonal changes, and is therefore most common in puberty or menopause, but can also be due to taking the birth control pill.
If you notice that suddenly you have lots of chest hair (not just a few hairs around your nipples but a lot on your chest region) this could be a sign of a medical condition. The main culprits are polycystic ovary syndrome, which is a hormonal imbalance that can cause irregular periods and ovarian cysts, and Cushing's syndrome, which is a rare hormonal issue that occurs when your body has high levels of cortisol (the stress hormone) for a long time.
Other symptoms of Cushing's syndrome include getting a hump between your shoulders and stretch marks. If you have any of these additional symptoms, visit your doctor to get your hormone levels checked out. Otherwise, if you just don’t like your areola hair, you can safely remove them by plucking or lasering them off.
4. Your Areolae Are Puffy
Some people notice that their areolae gets puffy or raised. This is most common during puberty and pregnancy, but can also happen at other times during your life. This is completely normal and is not indicative of anything worrisome.
5. Your Areolae Are Itchy Or Flaky
Itchiness on your areola is rarely a sign of anything medically stressful on its own — more likely it’s because your skin is dry, your bra is rubbing you, or you’re allergic to your detergent or soap.
If you notice that your itching persists even after you change your detergents and moisturize, ask your doctor about it. Certain skin cancers include itchy skin in their symptoms, although in these cases you would also have more visible signs (such as flaky or scaly skin).
All skin has the potential to get dry and flaky, and areola skin is not exempt from this situation. Peeling or flaking skin could be due to weather changes, if you were suntanning topless and got a sunburn, or if you had a sexy romp that included rough nipple play and your nipples and areolae got chafed.
If you notice that your areola or nipple skin is flaking or peeling, and particularly if this is happening to just one areola or nipple, make an appointment to see your doctor. It’s possible that you could have eczema, a chronic skin condition that causes itchiness and flaky skin. Eczema runs in families, so look for this in particular if you know someone else in your family has it.
These skin changes could also be a sign of skin cancer. A number of skin cancers present with scaly, flaky, red patches on the skin and can show up on the areola and nipple area, and Paget’s Disease starts in this area.
6. Your Areola Is Bumpy
"Little bumps around the areola are completely normal and mean nothing at all," Dr. Gersh tells Bustle. It’s totally natural for your areola skin to get bumpy when you’re cold, so if you notice bumps after you’ve been walking outside during winter, don’t worry — they will go away once you warm up.
Another reason for areola bumps is Montgomery tubercles, which is the technical name for when your areolar or Montgomery glands get clogged. Clogged Montgomery glands can get sore, change color to be red or yellow, and grow in size a bit.
While Montgomery tubercles show up mostly during pregnancy, they can also be triggered by hormone imbalance or stress, as well as physical changes such as significant weight change. So if you notice you have these bumps and you know you’re not pregnant or stressed, you might want to talk to your doctor about getting your hormone levels tested.
7. You Have Pimples On Your Areolae
Because your areolae have both sweat and sebaceous (oil-producing) glands as well as hair follicles, it’s possible for these glands to get clogged, giving you… nipple pimples! This can happen in particular right before menstruation.
Most areola pimples are not a medical issue and will go away if you clean the area with warm water and a gentle (non-perfumed, chemical-heavy) cleanser. If you are struggling with these pimples, you can always go see a dermatologist to get more help and prevention tips based on the specific reasons why your body is producing these pimples. If they start to ooze or get painful, Dr. Gersh says, you should see your doctor in case they're infected.
8. Your Areola Retracts
"The most concerning change in the areola is what are referred to as retractions," Dr. Lipeles says. "Retractions are when the areola or nipple appear to be getting pulled in a different direction." If your nipple or areola looks as if it's been attached to a string and the string has been pulled inward, shifting it in a different direction and creating tension, that's a retraction.
"Retractions should be looked at by a health professional immediately and imaging of the breast should be ordered right away to rule out cancer," Dr. Lipeles says. Retractions are a pretty serious deal, so get them checked out right away.
9. You Feel Lumps Under Your Areola
There are many potential culprits for lumps under your areola, and most of them are not cancer. The most common option is that you have fibrocystic breasts, which is a really normal change many breasts go through, often right before you get your period. If your breasts are fibrocystic, it means your breast tissue changes to feel more ropey and lumpy. This often goes away on its own. Lumps can also be due to clogged milk ducts (which you have even if you’re not lactating); an infection; or an intraductal papilloma, which is a fancy name for a benign (aka, non-cancerous) tumor in your milk ducts.
Sometimes, a lump could be what’s called ductal carcinoma in situ, which is the name for the earliest form of breast cancer. At this stage, the cancer is very treatable, but you do have to have a doctor see it so the cells don’t spread to other parts of your breast.
"If someone notices a lump affecting the areola, they should have imaging and a breast exam done," Dr. Lipeles says. If you have a tumor or the beginnings of breast cancer, you will likely want to get that treated. Infection should be treated as well.
You know your breasts better than anyone else — they’re yours, after all! Because some medically scary things can happen in this area (mainly cancer), it’s a good idea to keep an eye on them and notice any changes. "Whenever it's unclear what the problem is, an examination is needed," Dr. Gersh says. A study published in Cancer epidemiology in 2017 found that while 53% of breast cancer patients turn up to their doctors concerned about a lump, 7% first decided to seek medical attention because they'd seen something radically different about their nipples.
So pay attention to your areolae, but definitely don’t stress about them too much, either. Most of the potential changes are not medically worrisome.
Dr. Felice Gersh M.D., OB-GYN
Dr. Jamie Lipeles, D.O., OB-GYN
Koo, M. M., von Wagner, C., Abel, G. A., McPhail, S., Rubin, G. P., & Lyratzopoulos, G. (2017). Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis. Cancer epidemiology, 48, 140–146. https://doi.org/10.1016/j.canep.2017.04.010
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