19 August 2020

Montgomery Tubercles: Are they an Early Sign of Pregnancy?

Doctor
Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London

 

Montgomery tubercles, also known as Montgomery glands, are raised white bumps that look similar to goosebumps on the nipple and surrounding areola. They are named after William Fetherstone Montgomery, an Irish physician and obstetrician who first described them in 1837, although it is fair to assume that many thousands of women, over many generations, had been aware of their existence well before that date! They can be an early sign of pregnancy, although this is not always the case. However, there is definitely a connection between Montgomery tubercles and pregnancy, as these small glands have specific functions and benefits for both mother and a breastfeeding child.

Here we take a closer look at what these tubercles are, what causes them and how they function. We also have some tips for how to recognise when the tubercles are normal or in which circumstances they may signal a problem.

What are Montgomery tubercles?

The tubercles are sebaceous glands, which you have all over your body, but which are particularly active in some areas. These are the same glands that produce the natural lubrication that makes hair supple, or greasy if left unwashed, and can cause problems with oily skin, especially during puberty. Their basic function is to lubricate and protect the skin. These glands are only known as Montgomery tubercles when they are on the nipples and areolas of your breasts. Here they have a generally similar function, producing secretions which are rich in moisturising lipids to lubricate the skin of the nipples and provide a protective oily barrier to guard against infection.

We all know that breasts and nipples come in a very wide variety of shapes and sizes, and the same goes for Montgomery tubercles, which may vary in number from only one or two to as many as 30. They can also increase in number in response to hormonal changes, the most obvious example being pregnancy.

A sign of pregnancy?

While Montgomery tubercles can be an early sign of pregnancy, they are not always among the symptoms. Studies have shown that between 30% and 50% of pregnant women notice these tubercles and where they do occur, they can be one of the very first signs, even before a missed period. But, of course, nobody should take their sudden appearance as an isolated confirmation of pregnancy without. Other signs of pregnancy often include:

  • Breasts that feel tender, heavier than normal or enlarged;
  • Implantation bleeding, a light spotting of blood, that may occur few days before the normal period is due, sometimes accompanied by mild cramps;
  • Morning sickness;
  • A feeling of deep fatigue, more than the normal tiredness at the end of a busy day;
  • Unusual emotional sensitivity and mood swings;
  • A need for frequent urination.

You can see more in our IVI blog article about the early signs of pregnancy. Naturally, if you have some of these symptoms, as well as a missed period, you should get a pregnancy test and if positive, consult your GP. However, if you are not pregnant, it is still common to notice Montgomery tubercles around your nipples. These are usually quite normal and nothing to worry about. Some of the non-pregnancy causes include:

  • The menstrual cycle, contraceptive pill, pre-menopause or menopause;
  • Stress, which can create a hormonal imbalance;
  • A disruption of hormonal balance for other reasons, including a response to some medications;
  • Weight loss or gain, especially when this is a sudden change;
  • Nipple stimulation;
  • Clothes and bras that are too tight-fitting.

Montgomery tubercles and pregnancy

Even if Montgomery tubercles are not one of your own early signs of pregnancy, you are quite likely to notice them later on as the pregnancy progresses. Your nipples will probably darken in colour and you could well notice some of these raised spots as your breasts prepare for breastfeeding. This is absolutely normal and should not cause any concern. The glands become enlarged during pregnancy in response to hormonal changes, to prepare for lactation and breastfeeding. Their functions include:

  • Increased secretion of oil to keep the nipple moist and supple to protect from damage or soreness during breastfeeding. The oils that are secreted have antibacterial properties that protect the nipples and surrounding skin of the breasts from infection.  
  • The secretions of the tubercles, as well as the early production of colostrum and milk, contain volatile compounds producing a scent that helps to guide a newborn infant to the source of sustenance.

 

Clearly, the functioning of these glands is important both for the comfort of the mother and the health of the baby. You can help to maintain these functions by following a few guidelines:

  • Avoid washing your nipples with soap or using astringent cleansers when you are pregnant or breastfeeding – a rinse with clean water is adequate – so that the oils necessary for keeping the skin supple and infection-free are not stripped away.
  • Try to avoid any non-breathable material like plastic lining in your bra, bra pads or nursing bra.

 

What can go wrong?

Sometimes the swollen glands can be filled with a waxy substance, giving them the appearance of spots or a pimple with a yellowish or white head. These are harmless and you should avoid squeezing or popping them as this could lead to infection or skin injury.  Sometimes the glands can become blocked, inflamed or infected. Signs would be a painful swelling or inflammation around the nipple area. Itching or a rash could be symptoms of a yeast infection as well. You should see your doctor if you have any of these symptoms if you are not breastfeeding, or if you have a discharge of blood or pus at any time, as (although very occasionally) these signs could mean a more serious underlying condition.

Take a look

Pregnant or not, you certainly have these glands in your nipples and areolas, sometimes visible and sometimes escaping notice. They are normal and natural, and have a positive role to play in pregnancy and post-pregnancy. Take a look, you may find they have been there all along!

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