While looking in the mirror or taking a shower, you may have noticed that your nipples and the pigmented circular patch of skin around them (called the areola) looked darker than usual. Is it normal for this area to darken? What causes it? And do you need to see a doctor? We talked to breast health experts to bring you the facts—largely reassuring—about nipple color changes.

 

Let’s start by recognizing that nipple color varies from person to person and is usually correlated to overall skin tone. So, when we say “dark,” what we really mean is “darker than what’s usual for you.”

With that in mind, the answer is yes: It’s normal for nipples and areolas to darken in response to changes in hormone levels, just as it’s common for breasts to swell and become tender due to monthly hormonal changes, says Sherry Ross, M.D., an obstetrician-gynecologist in Santa Monica, CA, and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period. Nipples may also become more prominent and more sensitive as a result of hormonal changes, she notes. If your nipples darken before or during your monthly period, typically the color will return to baseline after your period ends.

 

So what exactly causes the nipple skin to get darker? “The answer in general is estrogen, which increases pigmentation,” explains Mary Jane Minkin, M.D., a gynecologist and clinical professor in the department of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine in New Haven, CT.

Estrogen is a sex hormone that, along with progesterone, plays a key role in women’s sexual and reproductive health. The level of estrogen in the body fluctuates naturally throughout your menstrual cycle and over your lifetime. When levels of this hormone are high (which is typically around ovulation or mid-cycle), pigment-producing skin cells called melanocytes are “switched on” and begin to produce more melanin, the substance that gives skin its color.

“When melanin is stimulated, pigmentation in different body parts becomes darker in color, including the nipples [and areolas],” Dr. Ross says. Other areas of your body may also darken. For instance, you may develop patches of darker skin, known as melasma, on your cheekbones, upper lip, chin, or forehead. These darker patches of skin may disappear or fade once estrogen production decreases.

Let’s look at some of the specific situations in which hormone-related nipple darkening can occur:

 

Pregnancy

As estrogen production ramps up, darkened nipples and areolas are very common during pregnancy, says Dr. Minkin. This change typically happens in the first trimester and lasts throughout the pregnancy, according to the Cleveland Clinic.

Some moms-to-be also develop a dark stripe, known as a linea nigra, down the center of their pregnancy bump, Dr. Minkin adds. Melasma is also common during this time, affecting 15% to 50% of pregnant women, per the National Library of Medicine.

Increased levels of estrogen are essential for maintaining a healthy pregnancy. Estrogen ensures that the placenta develops properly and that the uterus adapts to meet the increasing demands for blood flow as the pregnancy progresses. By the third trimester of pregnancy, levels of estradiol, one of the main types of estrogen, rise to 100 times its prenatal levels. All that extra estrogen triggers excess melanin production.

Estrogen levels typically fall right before you give birth and throughout breastfeeding and return to normal levels around six months postpartum. At that point, dark nipples and areolas will often fade back to their original color. “Allow yourself nine to 12 months [after giving birth] to see the full fading effects of this normal hormonal change of pregnancy,” Dr. Ross advises.

 

Puberty

Just as rising estrogen levels during puberty enable the development of secondary sexual characteristics like breasts and hips, they may also result in increased production of melanin. Consequently, girls may develop darker nipples during puberty than they had prior to that time.

 

Menstruation

Estrogen levels rise and fall twice during the menstrual cycle, with peaks before and after ovulation. These hormonal changes regulate the menstrual cycle.

As a result of these peaks in estrogen, some women notice that their skin in general darkens before their periods, according to a review in the Journal of Clinical and Aesthetic Dermatology. The medical term for darkening of the skin during the menstrual cycle is “catamenial hyperpigmentation.” You might notice this mainly in pigmented areas like your nipples, areola, and patches of melasma (if you have melasma).

 

Oral Contraceptives

“Oral contraception and other forms of hormonal contraception that contain [synthetic] estrogen can stimulate melanin production, which can create darker nipples,” says Dr. Ross. Other hormonal contraception types include the contraceptive patch and vaginal ring.

 

Type 2 Diabetes

It’s not just estrogen that causes skin color changes. Alterations in your level of insulin, a hormone related to diabetes, can also affect the tint of your nipples and areolas. Insulin is a hormone made by the pancreas that regulates blood sugar. In type 2 diabetes, the cells of your body become less responsive to insulin, which normally signals cells to pull sugar (glucose) out of the bloodstream to burn for energy. This is known as insulin resistance.

In an attempt to counter insulin resistance and keep your blood sugar from getting too high, your pancreas starts churning out more insulin, which it turns out has a similar effect on your melanocytes to estrogen. The increased melanin production by those cells leads to areas of darkened and velvety skin called acanthosis nigricans, which typically appear on the skin folds of the neck, groin, and armpits. The nipples and areolas may also be affected, Dr. Ross says.

Generally speaking, there is nothing wrong or harmful about having darker nipples or changes in your nipple color. If dark nipples are due to estrogen fluctuations, the color will fade on its own when estrogen levels return to normal.

If the change is bothering you, there are over-the-counter skin-lightening creams and ointments on the market, often containing the ingredient hydroquinone, which is a depigmentation agent. However, “you should always discuss using these types of creams on the nipples with your health care provider and dermatologist first to ensure they’re safe,” advises Dr. Ross.

She also advises against using such products during pregnancy, since a substantial amount of hydroquinone is absorbed through your skin into your bloodstream and its safety for the developing baby hasn’t been established. Dr. Ross suggests that women wait nine to 12 months after delivering—the time it usually takes for nipples to return to their original color after pregnancy—before trying a cream.

Sometimes it’s hard to know if a change in your body is a cause for concern or not, and changes in your breasts can be especially unnerving because they might make you think about breast cancer.

Keep in mind that darkening nipples are often a result of natural hormone shifts and nothing to worry about. But if darker nipples are accompanied by other symptoms like frequent urination, increased thirst, and increased hunger, it’s a good idea to talk to a doctor, since these symptoms could indicate diabetes. You should also follow up with your health care provider “if you notice persistent changes in nipple color accompanied by pain, ulcerations, texture changes, discharge, or bumps,” which may be signs of breast cancer. “It is important to know the normal details of your breasts, since you may be the first person to detect something abnormal,” she adds.