Approximately 20% of women who resembled a discharge of clear liquid milk or spontaneously.
When doing breast self-examination (Breast Self-Examination), will be out fluid from the breast in 50-60% of white women and black women, and 40% Asian-American women.

CAUSE
* It could be: Breast abscess (most common in lactating women)
* Injury to the breast
* The drugs (eg cimetidine, metildopa, metoclopramide, oral contraceptives, fenotiazin, reserpin, tricyclic antidepressants, or verapamil)
* Prolaktioma (tumors in the brain that produces prolactin). Prolactin is a hormone produced by the pituitary gland, which triggers the growth of mammary glands and milk formation.
* Intraduktal papilloma (benign tumor that grows on the lining of the breast)
* Mammary duct (widening and hardening of the breasts due to aging lines and damage).

Nipple discharge is not due to malignancy, almost half are caused by the papilloma and the remainder are caused by changes fibrokista or duct ectasia.
Nipple discharge is a malignancy is only about 10% and almost always unilateral.

SYMPTOMS
Liquids such as milk (cloudy, whitish, thin and not sticky) is the kind of liquid most commonly found and most are caused by lactation (milk formation) or excitation mechanism due to touch your nipples, sucking or irritation of clothing during exercise or other activities.

If the fluid contains blood or watery (serous) the cause is papilloma or infection.

Usually clear liquids, like milk, yellow or green, and out of both nipples, not a sign of breast cancer.
Fluids that contain blood or diluted, especially if only one out of the nipples, is an abnormal fluid, but only about 10% of abnormal fluid malignancy.

Liquid from the nipple need special attention if: Color red or red with a thin, pink or brown
Sticky and translucent color or brown to black (glossy)
Exit spontaneously without the need to massage the nipple
Its settled
Only one out of the nipple (unilateral)
Fluid other than breast milk.

Diagnosis
* Diagnostic tests for nipple discharge include: breast biopsy (if lump is found)
* Cytology fluid
* CT scan of the head (to look for pituitary tumor)
* Mammography
* Levels of serum prolactin
* Transillumination
* Ultrasound breast
* Galaktogram or duktogram (to help find papilloma intraduktal).

TREATMENT
Standard treatment for nipple discharge is not influenced by hormones is cutting the channel.
Cutting a channel is usually done with local anesthesia and the procedure is performed through a small incision in the areola (brown area surrounding the nipple).

Menstruation is the periodic bleeding of the uterus that begins approximately 14 days after ovulation (Bobak, 2004)

Menstruation is the periodic vaginal bleeding due to the release of the endometrial lining of the uterus. Normal menstrual function is the result of interaction between the hypothalamus, pituitary, and ovary with associated changes in the target tissue in the normal reproductive tract, the ovary plays an important role in this process, because it seems responsible for the regulation of cyclic changes and the menstrual cycle (Greenspan , 1998).

Menstruation Cycle

1) Clinical menstrual

Most mid-aged women of reproductive, menstrual bleeding occurs every 25-35 days with a median cycle length was 28 days. Women with ovulatorik cycle, time interval between the beginning of menstruation up to ovulation – the follicular phase – varying length. Cycle observed in women who ovulate. Time interval between the beginning of menstrual bleeding – luteal phase – relatively constant with an average of 14 ± 2 days in most women (Grenspan, 1998).

Long menstrual bleeding also varies; in general the length of 4 to 6 days, but between 2 to 8 days can still be considered normal. Menstrual blood expenditure consists of fragments endrometrium mixed with the blood of many is not necessarily. Usually liquid blood, but if the blood flow velocity is too large, clots of various sizes are likely to be found. normal menstrual blood is caused by a system of local fibrinolitik active in the endometrium.

The average amount of blood loss in normal women during the menstrual period has been determined by several research groups, ie 25-60 ml. Normal Hb concentration of 14 g per dl and hemoglobin iron content of 3.4 mg per g, this blood volume containing 12-29 mg of iron and describe the same blood loss with 0.4 to 1.0 mg of iron for every day of the cycle, or 150 up to 400 mg per year (Cunningham, 1995).

2) Hormonal aspects during the menstrual cycle

Mammals, especially humans, their reproductive cycle involving various organs, ie uterus, ovaries, vagina, and mammary held within a certain time or a synchronization, then it is possible the arrangement, coordination, called hormones. Hormones are chemical substances produced by endocrine glands, which flow directly in the bloodstream and affect specific organs called target organs. The hormones associated with the menstrual cycle is;

a) The hormones produced by the pituitary gonadotropin:

o Luteinizing Hormone (LH)

o follicle Stimulating Hormone (FSH)

o Prolactin Releasing Hormone (PRH)

b) Ovarian Steroids

Ovaries produce progestrin, androgens, and estrogens. Many of the resulting steroid is also secreted by the adrenal gland or can be formed in the peripheral tissue through the alteration of steroid precursors others; consequently, plasma levels of these hormones may not directly reflect the steroidogenic activity of ovaries.

3) Phases of the menstrual cycle

Each one menstrual cycle, there are 4 phases of change that occurs in the uterus. These phases is the result of highly coordinated cooperation between the anterior pituitary, ovaries, and uterus. These phases are:

a) menstrual phase or deskuamasi

During this phase, the endometrium regardless of the uterine wall with bleeding and an intact layer only stratum basale. This phase lasted for 3-4 days.

b) post-menstrual phase or phases of regeneration

This phase, wound healing occurs due to the loss of the endometrium. This condition started since the phase of menstruation occurred and lasted for ± 4 days.

c) phase or phases of proliferation intermenstum

After the wound healed, will occur in endometrial thickening ± 3.5 mm. This phase lasted from day 5 until the 14th day of the menstrual cycle.

Proliferative phase is divided into 3 phases, namely:

o early proliferative phase, occurred on day 4 to day 7. This phase can be identified from the thin surface epithelium and the regeneration of the epithelium.

o Phase associate proliferation, occurred on day 8 to day 10. This is a form of phase transition and can be recognized from the shape of the surface epithelium of high piston.

o the late proliferation phase, lasting between 11 days until day 14. This phase can be recognized from the uneven surfaces and found the number of mitosis.

d) Premenstrual phase or phases of secretion

This phase lasted from the 14th day until the 28th. This phase endometrium remained approximately the thickness, but the gland into a long and winding out the sap increasingly real. Part of the endometrial cells are glycogen and lime needed as food for a fertilized egg.

Secretion phase is divided into 2 stages, namely:

o early phase secretion, in this phase of the endometrium is thinner than the previous phase due to loss of fluid.

o Phase secretion further, at this phase in the endometrial glands to grow and become more winding and secretion began to sap that contains glycogen and fat. The end of this period, endometrial stroma changed towards the cells; decidua, particularly surrounding arterial vessels. This situation allows the nidasi (Hanafi, 1997).

4) Mechanism of the menstrual cycle

During the period, the day is taken as the beginning of the first day of the new cycle. Will happen again an increase of FSH levels to reach 5 ng / ml (or the equivalent of 10 MUI / ml), under the synergistic influence of both gonadotropins, these developing follicles to produce oestradiol in significant amounts. Increased serum constantly in the late phase folikuler will suppress the pituitary FSH. Two days before ovulation, estradiol levels reached 150-400 pg / ml. These levels exceed the threshold value for the expenditure stimulated pre-ovulatory gonadotropin. As a result of FSH and LH in serum will increase and reach a peak one day before ovulation. As the same, estradiol levels will come back down. The maximum LH levels ranged between 8 and 35 ng / ml or equivalent to 30-40 MUI / ml, and FSH between 4-10 ng / ml or equivalent to 15-45 MUI / ml.

Occurrence of peak LH and FSH on day 14, then at this time the follicle will begin to break and one day later ovulation will occur. Along with this began the formation and maturation of the corpus luteum is accompanied by increased levels of progesterone, and gonadotropins began to fall again. Increased progesterone does not always make sense, that ovulation has taken place with both, because in some women ovulation does not occur remains found basal body temperature and endometrium according to the luteal phase.

The early luteal phase, along with the maturation of the corpus luteum. Progesterone secretion continuously increased and reached levels of between 6 and 20 ng / ml. Estradiol is released mainly from large follicles that are not experiencing atresia, also appear in the luteal phase with a higher concentration than during the early or middle phase folikuler. Estradiol and progesterone production of maximal encountered between days 20 and 23 (Jacoeb, 1994).

Both short-and long cycles, both showing irregularities in metabolism and hormonal system. The impact is similar, ie be more difficult to become pregnant. In the short cycle, women experience “unovulasi” because the egg is not too ripe so hard to be fertilized. In the long cycle, it indicates the egg cell is rarely produced or women experience infertility long enough. If the eggs are rarely produced by means of conception will be very rare. In fact, menstruation is a sign that women are fertile.

These menstrual irregularities also make it difficult to find any mother fertile and did not. Should, if regular menstruation, fertile period can be found easily. For example, if the 30-day cycle, the fertile period is expected 16 days after the first day of menstruation. In contrast to the long and short cycles, it’s hard to calculate fertile period because there is no formula that can be used.

However, she did not need to be discouraged. Because, with the sophistication of modern medicine, this can be overcome. Later the doctor will help the mother find what the cause, and then given an appropriate solution. Of course cooperation is needed more intense between mothers and couples with a doctor. Hopefully with therapy can be made as soon pregnant mothers.

Causes & Solutions

Many of the causes why the length of the menstrual cycle or vice versa, short. However, the handling of cases with menstrual cycle is not normal, not based on a long or short menstrual cycle, but based on the abnormalities found. Handling done by physicians based on the cause.

* Function Hormones Bothered

Menstruation is closely related to the regulated hormone system in the brain, precisely in the pituitary gland. This hormonal system will send a signal to the ovaries to produce eggs. If this regulatory system is interrupted, the automatic menstrual cycle would be disrupted.

Handling:

If there is a lack of hormones, you can include a lack of these hormones (eg, lack of the hormone estrogen, the hormone estrogen can be added). If there are excess hormones, the administration made certain that the hormone levels returned to normal (eg, levels of the hormone prolactin excess may be reduced by giving certain drugs). If there are hormonal imbalance, then added another hormone to be more balanced.

* Systemic disorders

There are mothers whose bodies are fat or thin. This can affect the menstrual cycle because the system in the body metabolism does not work properly. Or the mother suffering from diabetes, will also affect the mother’s metabolic system so that menstrual cycles were irregular.

Handling:

To overcome the problem of fat or thin so that the system is improved metabolism by regulating the proper diet. Mom can go on a diet with guidance from an expert in order intake in accordance with the needs of the body. As for diabetics blood sugar levels or blood insulin levels in the high that can cause menstrual cycle, administration of drugs or drug antidiabetik insulin sensitizer “can improve the return to normal menstrual cycles and even improve the chance for pregnancy.

* Stress

Stress should not be taken lightly because it will disturb the system in the body’s metabolism. It could be because of stress, the mother became easily tired, losing weight dramatically, even sick, so disturbed metabolism. When disturbed metabolism, menstrual cycle, too distracted.

Handling:

Stress can cause changes in menstrual cycle is a severe psychological stress as a very great sadness (parent or spouse or child dies), or a stressful life as life in prison women. Great mental stress can increase cortisol hormone, or CRH, which may disrupt production of reproductive hormones. To overcome this problem is to cope with stress through therapy itself is conducted by experts. If the stress can be overcome, can be a normal menstrual cycle.

* Gland Goitre

Disruption of thyroid function / thyroid can also cause irregular menstrual cycles had. Interference could be the thyroid gland producing too high (hyperthyroid) or too low (hypothyroidism). Because the hormonal system of the body part affected.

Handling:

If thyroid hormone is too high it is necessary to add drugs to the thyroid production decreases, and vice versa if thyroid hormone is too low it is necessary to add drugs to the thyroid hormone back to normal. The point of production must be in accordance with the gland body needs.

* Hormones Prolactin Overstated

In breastfeeding mothers, prolaktinnya hormone production is high enough. The hormone prolactin is often a mother never menstruated because this hormone levels suppress maternal fertility. In this case no problem, it is very good to provide opportunities for mothers to maintain their reproductive organs. Conversely, if you’re not breastfeeding, the hormone prolactin can also be high, usually caused by abnormalities in the pituitary gland located in the head.

Handling:

Production of excessive hormone prolactin can be caused by a great psychological stress or because there is a tumor on the pituitary gland produces more of the hormone prolactin. To suppress the production of excess hormone prolactin may be prescribed alone, or if necessary may do surgery to remove a tumor in the pituitary gland.

FOCUS On WANT PREGNANT

Many women are upset, menstrual cycle disorders to have a child prevented. Not only mothers who do not have children, mothers who have children can experience it. In this case the handling of the menstrual cycle that do not normally always notice whether the patient is still hoping to get pregnant or not. If you still want to get pregnant, then the treatment should be focused on efforts to help the patient become pregnant. If the patient does not want to become pregnant again, it is enough to regulate the handling menstrual cycle only.