Breast pain

Overview

Breast pain, also called mastalgia, may be a feeling of aching, tenderness or throbbing in the breast. Or it may feel like stabbing or burning pain. The pain may be there all the time, it may last for just a short time, or it may come and go. Anyone can have breast pain.

Breast pain can be cyclic and noncyclic. Cyclic breast pain happens in a regular pattern. It's linked to menstrual cycles and changing hormone levels in people who menstruate. Noncyclic pain doesn't have a regular pattern and isn't linked to menstrual cycles.

In men, breast pain often can be caused by a condition called gynecomastia (guy-nuh-koh-MAS-tee-uh). In transgender men, pain may happen due to chest binding. Pain also might affect breast tissue that's left behind after gender-affirming chest surgery. In transgender women, gender-affirming hormone therapy might cause breast pain.

Typically, breast pain is due to a condition that is not cancer. It's not common for breast pain to be a symptom of breast cancer.

Causes

Breast pain is common and can happen for many reasons, from normal hormone changes to conditions affecting the breast or nearby areas of the body.

Menstrual cycle

Changing hormones that happen during a menstrual cycle often cause cyclic breast pain. The pain typically starts during the week before the beginning of a period and goes away when the period starts.

Pregnancy

Breast tenderness and pain are common in the early stages of pregnancy.

Breast cysts

Changing hormone levels can cause changes in the milk ducts or milk glands within the breast. Those changes can cause breast cysts. Cysts are a common cause of cyclic breast pain. But sometimes, a cyst also may cause noncyclic breast pain.

Infection

An infection within the breast can lead to breast pain. A common type of breast infection is called mastitis. It often happens in people who are breastfeeding.

Breast injury

Some types of breast pain may be caused by trauma or other injury to the breast.

Medicines

Breast pain may be a side effect of some medicines, including:

• Birth control pills.
• Hormone therapies used for menopause and perimenopause.
• Gender-affirming hormone therapy.
• Selective serotonin reuptake inhibitor (SSRI) antidepressants.
• Some medicines used to treat high blood pressure.
• Some types of antibiotics.

Duct ectasia

This condition affects the milk ducts in the breast. It happens when one or more milk ducts beneath the nipple widen, thicken and fill with fluid. This can cause the ducts to become blocked or clogged and may lead to breast tenderness and pain.

Fatty acids

When the level of fatty acids in the body's cells is out of balance, that may affect the sensitivity of breast tissue to hormones and lead to breast pain.

Activity

Doing a lot of activity and movement without proper breast support can stretch the ligaments, called Cooper ligaments, that hold breast tissue in place. That can lead to deep, sharp, stabbing pain that may last for a short time and then go away.

Cancer

Although it's rare for cancer to cause breast pain, a type of cancer called inflammatory breast cancer may cause pain and tenderness throughout the breast.

Gynecomastia

In men, breast pain can be caused by gynecomastia. This condition causes a rise in the amount of breast gland tissue due to the hormones estrogen and testosterone being out of balance in the body. Gynecomastia can affect one or both breasts.

Chest binding

In transgender men, pain may happen due to chest binding.

A health concern in another part of the body

In some situations, pain in the breast is due to a health issue that happens in another part of the body. This is called extramammary breast pain. For example, pulling a muscle in the chest can cause pain in the chest wall or rib cage that spreads to the breast. Arthritis that affects the cartilage in the chest, a condition called costochondritis, also can lead to breast pain. Other examples of conditions that could lead to breast pain include shingles and a pinched nerve in the neck.

Prevention

Because breast pain has many possible causes, it isn't always possible to prevent it. But the following steps might help.

• Wear a properly fitted bra, and wear a sports bra during exercise.
• Don't lift large amounts of weight on a regular basis for a long time without using proper techniques and taking safety steps.
• Don't smoke. If you need help stopping smoking, talk with your healthcare professional.
• Eat a low-fat diet that includes complex carbohydrates. Some research has shown that a diet that's high in fat may be linked to breast pain.
• Limit caffeine. Some people find that having less caffeine is helpful in avoiding breast pain. But studies of caffeine's effect on breast pain have not shown clear results.

Treatment

For many people, breast pain goes away on its own over time. You may not need any treatment.

If breast pain doesn't go away on its own and you need treatment, your healthcare professional might suggest that you:

• Take steps to get rid of what could be causing the pain or making it worse. This may mean making a simple change, such as wearing a bra with extra support.
• Use a pain reliever you can buy without a prescription, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others). Talk with your healthcare professional about how much to take. Long-term use may raise the risk of liver damage and other side effects.
• Put a cream on the skin to help ease the pain. Creams that have medicines called nonsteroidal anti-inflammatory drugs (NSAIDs) may help ease breast pain. They are available without a prescription. Before you try an NSAID cream, talk with your healthcare professional about which product to use.
• Make changes to medicines. If breast pain could be a side effect of a medicine that you take, your healthcare professional may suggest lowering the dose or taking a different form of that medicine. Don't make any changes to your medicines before talking with your healthcare professional.
• Take prescription medication. Prescription medicines may be used to treat intense breast pain or breast pain that lasts.
  
  For example, tamoxifen is a medicine that has been shown to ease serious breast pain. But it might lead to side effects that are more bothersome than the breast pain. This includes a risk of blood clots and a higher risk of uterine cancer in people who are past menopause.
  
  Another prescription medicine that can relieve breast pain is called danazol. But it carries the risk of potentially serious side effects, such as heart and liver conditions, as well as weight gain and voice changes.
• Treatment for other health concerns. If a health issue happening in another part of the body is causing breast pain, treatment for that condition can often ease or stop the pain.

Preparing for an appointment

You're likely to start by seeing your primary healthcare professional. But when you call to make an appointment, you may be referred to a breast health specialist.

What you can do

When you make the appointment, ask if there's anything you need to do beforehand, such as not eat or drink before a test.

To help your healthcare professional see whether your breast pain is cyclic or noncyclic, write down when you have breast pain and other symptoms and bring that information to your appointment.

Also, make a list of:

• All your symptoms, including any that don't seem related to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins and other supplements you take, including the doses.
• Questions to ask your healthcare professional.

Take a family member or friend along, if possible, to help you remember the information you're given.

For breast pain, some basic questions to ask your healthcare professional include:

• What is the most likely cause of my symptoms?
• What kinds of tests might I need?
• What treatment do you recommend?
• Are there any home remedies I might try?

What to expect from your doctor

Your healthcare professional may ask you questions such as:

• Where in your breast do you feel pain?
• How long have you had breast pain?
• On a scale of 1 to 10, how bad is your pain?
• Do you have pain in one or both breasts?
• Does the pain seem to happen in any pattern?
• Have you ever had a mammogram? When was your last one?
• Do you have any other symptoms, such as a breast lump, area of thickening in the breast or nipple discharge?
• Have you noticed any skin changes, such as a change in skin color or a rash?
• Have you recently had a baby?
• Have you recently had a pregnancy loss?
• How does the pain affect your quality of life? For example, does it make it hard to work, sleep or have sex? Does the pain make it hard for you to do other daily activities?
• Have you been involved in any activities or had a recent injury to your chest that might have caused the breast pain?

Your healthcare professional also may check your risk of breast cancer based on factors such as your age and your personal and family medical history.