Breast pain can range from mild tenderness to a dull ache to a stabbing sensation in the breasts (milk-producing glands composed of fat and other tissue). According to the U.S. Department of Health and Human Services’ Office on Women’s Health, approximately 50 percent of all women experience breast pain at some point in their lives.
In most cases, breast pain is caused by hormonal changes, such as those associated with the onset of puberty, menstruation, menopause, pregnancy and breastfeeding. In addition, certain medications, such as antidepressants, cardiovascular agents or oral contraceptives (birth control pills), can cause breast pain. However, women should notify their physician immediately if they experience breast pain that is persistent, more intense than usual or recurrent, especially if it is exhibited in only one breast.
Diagnosis of breast pain typically begins with a complete medical history and physical examination. Treatment for breast pain is directly related to the cause of the pain. For less serious causes of breast pain, treatment may be as simple as wearing a support bra or taking a pain reliever. For more severe cases of breast pain, there are medications that can relieve the discomfort. For women who are pregnant or breastfeeding, all drugs should be approved by a physician prior to use to avoid possible harm to the baby.
About breast pain
Breasts are milk-producing glands that are made up of fat and other tissue, including nerves, blood vessels and milk ducts (small tube-like paths). Breast pain can occur in a variety of forms - from a slight tenderness to a dull ache to a stabbing pain. Approximately half of all women experience breast pain at some point in their lives, according to the U.S. Department of Health and Human Services’ Office on Women’s Health.
The medical terms for breast pain include mastalgia, mastodynia and mammalgia. It is usually caused by normal hormonal changes in a woman’s body, such as those associated with menstruation. Because of its strong association with hormones, breast pain or tenderness is more common in premenopausal women than in postmenopausal women. Some experts believe that stress can be another factor that affects the development and severity of breast pain. Other conditions that commonly cause breast pain include:
Pregnancy
Breastfeeding
Fibrocystic breast changes
Breast cysts (fluid-filled sacs inside the breast)
Breast infection (mastitis)
Injury or trauma to the breast
Hormone replacement therapy (HRT)
Water retention (common during menstruation)
Surgery to the breast (e.g., breast implants)
Other, less common conditions that can cause breast pain include:
Poorly fitting bra or uncomfortable clothing
Medications, such as antidepressants, cardiovascular agents or oral contraceptives
Excessive caffeine consumption
Breast cancer
Nipple piercing that becomes infected
Mondor’s disease (a blood clot in the breast)
Liver damage from alcoholism
Shingles (a viral infection caused by the same virus that causes chickenpox)
Arthritis or a pinched nerve in the neck area
Inflammation of a rib joint
Muscle pulls or strains
Types and differences of breast pain
Most women experience breast pain at some point in their lives. It is typically associated with hormonal changes, such as those caused by menstruation, pregnancy and breastfeeding. Breast pain is generally divided into three main categories: cyclical, noncyclical and non-breast-origin pain.
Cyclical. Cyclical breast pain is by far the most common form of breast pain. It is frequently characterized by tenderness and pain right before, and sometimes during, menstruation. At times, a woman’s menstrual cycle can lead to the development of lumps. However, these may be merely an accumulation of excess fluid in the breast tissue and normally disappear by the end of menstruation. Cyclical pain often involves pain in both breasts, especially in the upper outer areas of the breast, including the underarm area.
Noncyclical. Noncyclical breast pain is unrelated to a woman’s menstrual period. This type of breast pain is more often found in women between the ages of 40 and 50 years old. Women who experience sudden sharp or stabbing pains that persist or are confined to one location in the breast should speak with their physician to determine the cause of the pain. Noncyclical pain can also be caused by pain from bones, joints or muscles that radiates to the breast. Noncyclical pain often involves pain in just one breast and usually emanates from the center of the breast. This type of breast pain can result from prior breast surgeries, benign (noncancerous) tumors (fibroadenomas) or cysts or even trauma to the breast. Also, women who consume moderate to large amounts of foods containing caffeine (e.g., coffee, chocolate) are more likely to experience noncyclical breast pain. Patients who consume large quantities of caffeine should inform their physician. Oftentimes, the underlying cause of noncyclical breast pain cannot be determined.
Non-breast-origin. Non-breast-origin pain is extremely rare. As its name implies, this type of pain occurs in the breast but does not originate from within the breast. Non-breast-origin pain often stems from a form of arthritis, known as costochondritis. When men develop costochondritis, the pain is similar to that of a heart attack. When women develop costochondritis, many mistakenly believe that they have developed breast cancer. It is important to note that breast pain rarely results in a diagnosis of breast cancer. Treatment for arthritic pain may provide relief from the pain of costochondritis. In addition to costochondritis, a pinched nerve in the neck also may cause a woman to feel pain in her breast. Often, this condition will resolve itself.
Patients experiencing any type of breast pain should notify their physician to determine the cause and rule out possible serious conditions, such as breast cancer.
Hormonal changes and breast pain
Hormones are proteins in the body that act as chemical messengers and control many bodily functions. The female reproductive hormones include estrogen and progesterone. Fluctuations in the levels of these two hormones often cause breast pain in many women.
One of the most common hormonal changes to cause breast pain occurs during menstruation. Menstruation is the period in which nonpregnant women discharge blood from their uterus. Often referred to as a woman’s monthly period, menstruation occurs approximately every 28 days from puberty to menopause (the period that marks the end of menstruation). During menstruation, it is fairly common for women to retain water in their bodies. The additional water can cause pressure within the breast tissue, which leads to pain or tenderness in the breasts.
Menstruation is also linked to fibrocystic breast changes, a common cause of breast pain in women. Fibrocystic changes, which typically affect women approaching middle age and often disappear during menopause, are characterized as lumpy, tender breasts. These benign (noncancerous) changes are often found around or near the nipple or upper, outer portion of the breast.
Another possible cause of breast pain in women of reproductive age is the use of oral contraceptives (birth control pills). Many women choose to take birth control pills in order to avoid unplanned pregnancy. This method of contraception alters a woman’s cyclical hormone levels. Common side effects of oral contraceptives can include breast tenderness, pain and discharge.
Although most breast pain is reported in premenopausal women, it can affect women nearing menopause and postmenopausal women. For instance, a condition called mammary duct ectasia, which occurs when the ducts beneath the nipple become clogged, can cause breast pain in women who are approaching menopause. Once diagnosed, the condition can be treated with warm compresses, antibiotics or possibly surgery. In addition, a significant portion of postmenopausal women who take hormone replacement therapy (HRT) also experience breast tenderness or pain. Postmenopausal women who experience breast pain while taking HRT also may be forming denser breast tissue and increasing their risk of breast cancer, according to a recent study.
Other hormonal changes commonly associated with breast pain include puberty (in both girls and boys), pregnancy and breastfeeding.
Pregnancy, breastfeeding and breast pain
A common cause of breast pain is pregnancy. As a fetus grows in its mother’s uterus (womb), her body prepares itself for delivery.
During this time, the milk glands swell in preparation for milk production. The rising hormone levels result in increased blood flow to the breast and lead to breast tissue changes that cause the breasts to feel swollen, sore and tender. This swelling may cause breasts to feel lumpier than normal, which can result in pain or discomfort in some women. Women should inform their physician of any lumps that develop within the breast during pregnancy. Although a lump may result from a clogged milk duct, it can indicate the presence of breast cancer in rare instances.
Breastfeeding is also a common cause of breast pain in many women. When milk ducts become blocked, milk accumulates in the breast, causing intense pain and discomfort in one or both breasts. The blockage, in turn, often leads to a bacterial infection known as mastitis. This condition, which makes the breast appear red and become warm, tender and possibly lumpy, occurs most often in women who are breastfeeding.
Many women who develop mastitis also report flu-like symptoms, including chills, a fever and fatigue. This is often a sign that the clogged duct has become infected. Mastitis can also occur in nonlactating, older women. This condition, known as periductal mastitis, develops when the milk ducts in the nipple become painfully inflamed. Any suspicion of a clogged milk duct and resulting breast infection should be evaluated by a physician since a certain type of breast cancer known as inflammatory breast cancer can be confused with mastitis.
When mastitis is detected early, it can be cured with antibiotics. When it is found later, after pus-containing abscesses have formed, the abscesses must be drained or surgically removed.
It is also common for new, breastfeeding mothers to report sore nipples. However, severe or prolonged pain is not normal and should be reported to the physician. Other conditions that may cause pain while breastfeeding include:
Engorgement (the breast becomes overfilled with milk). When combined with the additional blood supply to the breast, engorgement can cause pain and swelling of the tissue that surrounds the nipple. Although not every new mother will develop engorgement, it is not uncommon for breasts to feel swollen, tender, throbbing, lumpy and uncomfortably full about two to three days after giving birth. However, most lactation experts believe that engorgement is preventable by breastfeeding early and frequently.
Rashes. When breastfeeding, it is not uncommon for a woman to have dry, cracked or itchy rashes, even eczema, on the breast or nipples. These symptoms can cause varying levels of pain for a woman.
Breast herpes. Women who have been exposed to the herpes simplex virus (HSV) can develop painful sores on their nipples that may be more prominent while breastfeeding. In such cases, the breast milk will need to be expressed, possibly using a breast pump, and given to the baby through a bottle until the virus has vanished.
Infections. There are several types of infections that can occur in the breast. It is possible for yeast or bacteria to infiltrate the nipple during breastfeeding. This can lead to impetigo (a bacterial infection) or thrush (a yeast infection) of the nipple characterized by deep, shooting breast pains, burning or irritation after feedings.
A bleb is another infection that can occur in the breast. Although highly uncommon, a whitish, tender area can appear under the areola during breastfeeding. This area appears to have milk trapped just beneath the skin, causing the nipple and areola to become inflamed.
Chronic subareolar abscess is a rare bacterial infection that occurs within the sebaceous glands around the nipples. The result is blocked glands that lead to redness or even painful boils.
Producing too much milk (hyperlactation).
Strained chest muscles.
Injury to the breast during childbirth.
In addition, breast pain may result from improper breast pump usage, an ill-fitting nursing bra or uncomfortable positioning during nursing.
Diagnosis of breast pain
Diagnosis of breast pain typically begins with a complete medical history, including a description of the pain and its location, followed by a physical examination and a clinical breast examination. This information will help the physician determine the cause of the pain. Some of the questions the physician may ask include:
Is there any swelling or tenderness? If so, is it recent?
What does the pain feel like?
Does the pain or swelling affect both breasts?
Where in the breast(s) does the pain occur?
How severe is the pain?
Does the pain or swelling develop at the same time each month?
Have menstrual periods been missed or become irregular?
Is there a sore on the breast that has not healed in a reasonable amount of time?
Are there any warm, red areas of the breast that are painfully swollen?
Has breastfeeding caused pain or cracking of the nipples?
Is there a problem with the neck or shoulder area?
Has there been an injury or trauma to the chest?
During the physical exam, the physician will perform a clinical breast exam to see if there are lumps in either breast. The physician will also look for any swelling, dimpling, nipple discharge, tenderness, persistent pain or redness. The physician will examine the lymph nodes in the lower neck and underarm area, as well as evaluate the heart, lungs, chest wall and abdomen
During the physical exam, the physician will ask about the nature of the breast pain and look for any of the following:
Overall lumpiness
Tender breasts
Small, hard lump that can be moved
A firm, unmovable lump
Thickened or dimpled skin
Scaly or tender nipple
Nipple discharge
For women who are younger than 35 years of age and who do not have a lump in their breast, no further testing may be required. However, women who are 35 or older may require additional diagnostic tests, such as:
Mammogram. A specialized x-ray procedure used to create detailed images of the breast. It is the most common screening tool for breast cancer.
Breast ultrasound (sometimes called a sonogram). A test that sends and receives high-frequency sound waves to create images of internal organs or tissues. This test helps differentiate whether a lump is solid or cystic (fluid-filled).
Breast biopsy. A procedure to obtain a sample of tissue that is then sent to a laboratory for analysis by a pathologist.
Breast aspiration. A procedure in which a small needle draws out fluid from a fluid-filled sac in the breast. The sample is then sent to a pathologist for examination.
Women should immediately notify their physician if their breast pain has intensified, persisted for long periods of time or is recurrent.
Treatment options for breast pain
There are several options for treating breast pain. Choosing the best treatment will depend on the underlying cause of the pain. Some of the more common treatments for breast pain include:
Taking an over-the-counter pain reliever (young women under 20 years old should not take aspirin due to the risk of developing Reye Syndrome)
Applying a warm compress to the breast
Applying an ice pack to the breast
Discontinuing oral contraceptives (birth control pills)
Diuretics (water pills)
Wearing a bra with extra support, such as a sports bra
Wearing a sports bra to bed (when pain is especially intense)
There are several other methods for reducing breast pain that are not supported by clinical studies. For example, although unproven, many women report relief of breast pain through the use of supplements, including red clover, evening primrose oil, vitamin E and magnesium. Other unproven alternatives that may be helpful include:
Avoiding caffeine and nicotine
Eating a low-fat, high carbohydrate, reduced-salt diet
Reducing the amount of animal fat in the diet
Adding fish oil supplements to the diet
Switching to oral contraceptives that contain less estrogen
Lowering dosages for women who are taking hormone replacement therapy (HRT)
Using a therapist trained in lymphatic massage
Using relaxation, meditation and visualization techniques
If breast pain is caused by a more serious condition, the underlying condition is typically treated. For instance, breast cancer, an uncommon cause of breast pain, may be treated with radiation therapy, chemotherapy or surgery.
Questions for your doctor regarding breast pain
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions about breast pain:
How will you determine the cause of my breast pain?
How do I know the breast pain is not due to breast cancer?
What can I do to lessen the pain?
Are any of my current medications likely to cause breast pain?
What might be responsible for the lumpiness in my breasts?
Is there anything in my diet than could be responsible for the breast pain?
How will I know if I have developed an infection in my breast?
What do you recommend for pain related to breastfeeding?
How will I know if my breasts are engorged during breastfeeding?
Will my breast pain lessen or disappear after I finish nursing?
If I have had breast pain before menopause, is it likely to get better or worse after menopause?
Which are the best pain relievers for breast pain?
Are there any herbal supplements that you think can help breast pain?
Should I try a different type of oral contraceptive if I’m experiencing breast pain?
