Breast Pain

Many people deal with breast pain at some point in their life. Cyclic pain is the most common type and is related to a person's menstrual cycle and fluctuating hormones. It is typically in both breasts and goes away after someone starts their period. 

Noncyclic pain stays in one place and does not come and go. Its causes include infection, large pendulous (drooping or sagging) breasts, pregnancy, and more. 

This article discusses the difference in the symptoms for each type of breast pain, causes, diagnostic tests, treatment, and when to see your healthcare provider. 

Symptoms of Breast Pain

Mastalgia (breast pain) is a common complaint and affects up to 70%–80% of women. Healthcare providers categorize breast pain into the following two groups.

• Cyclic pain is the most common type. It affects both breasts and sometimes the axilla (armpits). People often describe this type of pain as tender or heavy. Cyclic breast pain varies with the menstrual cycle.
• Noncyclic breast pain is not related to the menstrual cycle or periods. It is more persistent, does not come and go, causes sharp or burning pain, occurs on one side, and typically stays in the same place.

Causes of Breast Pain

The most common cause of cyclic pain is fluctuating hormones. Noncyclic pain can be caused by large breasts, mastitis, pregnancy, lactation, injury, and more.

Cyclic Pain

Estrogen rises during the luteal phase of the menstrual cycle (the week or two leading up to your period). This causes water retention in the breasts that leads to discomfort. Cyclic pain usually goes away within a couple of days of starting your period (menstrual bleeding).

Noncyclic Pain

Causes of noncyclic breast pain include the following:

• Poorly fitted bra: A poor-fitting bra can cause breast, neck, or back pain, poor posture, and discomfort around bra strap areas.
• Large, pendulous breasts: Overly large breasts can strain Cooper’s ligaments (connective tissue that helps to support and shape the breasts) and cause soreness. They might also cause a rash under the breast or back, neck pain, and shoulder pain.
• Mastitis: This is caused by a clogged milk duct and can occur with or without infection. It is most common when a person is lactating (secreting milk) but can occur in those who are not lactating. Mastitis causes redness, swelling, and inflammation in the breasts and may cause flu-like symptoms. 
• Pregnancy or breastfeeding: During pregnancy, hormone fluctuations and increased breast tissue and blood supply can cause breast discomfort.

• Fibrosis: This is the thickening of breast tissue that can make breasts feel lumpy and may cause cysts that come and go. The cysts are typically benign (noncancerous) but can cause swelling and tenderness.
• Gynecomastia: This is the enlargement of breast tissue. It is caused by increased estrogen and is typically seen in cisgender males. Potential causes include medications and endocrine, liver, and kidney disease. 
• Injury: Sometimes what feels like breast pain is chest wall pain caused by overworking the muscles, injury, or trauma.
• Radiating pain: Radiating pain moves to the breast from another area of the body, including the chest wall, heart, lungs, and gastrointestinal (stomach and digestive tract) system.
• Non-breast-related causes: Breast pain is sometimes related to health disorders such as arthritis, shingles, and fibromyalgia.

What Medications Can Cause Breast Pain?

The following medications can cause breast tenderness:

• Antidepressants, including Zoloft (sertraline)
• Antipsychotics such as Thorazine (chlorpromazine)
• Androgens such as Anadrol-50 (oxymetholone)
• Diuretics (water pills) such as Aldactone (spironolactone)
• Heart medications such as Lanoxin (digoxin)
• Hormonal contraception (birth control) such as Yaz (drospirenone/ethinyl estradiol)
• Hormone replacement therapy such as Vagifem (estradiol)

Medications that may cause gynecomastia include:

• Antiandrogens such as Casodex (bicalutamide), which are used to treat prostate cancer 
• Protease inhibitors such as Norvir (ritonavir), which are antiviral drugs used to treat human immunodeficiency virus (HIV)
• Nucleoside reverse transcriptase inhibitors (NRTIs) such as Epivir (lamivudine or 3TC), which are antiviral drugs that treat HIV and chronic hepatitis B

Are There Tests to Diagnose the Cause of Breast Pain?

It is helpful for you to track your breast pain. Note the timing, location, and type of pain. Include what makes it better or worse and if it goes away and returns. Check for any changes in the appearance of your breast.

If your healthcare provider suspects your breast pain is caused by something other than hormone fluctuations or they find a lump, they may consider the following diagnostic tests:

• Mammogram: Mammograms are specialized X-rays used for breast cancer screening. Even though there is a very small risk of breast cancer with breast pain, depending on your age, healthcare providers may order a mammogram to rule it out.
• Ultrasound: An ultrasound is a noninvasive imaging test that uses sound waves rather than radiation. They are typically ordered in younger women with breast pain or if there are suspicious findings on a mammogram.
• Magnetic resonance imaging (MRI): An MRI uses magnetic and radio waves to create detailed images that provide information about a mass or suspicious findings detected on an ultrasound or mammogram.
• Biopsy: Biopsies test a lump or breast tissue sample to rule out cancer. They are used when any imaging shows a suspicious lump or mass.
• Blood draw: Blood may be collected by a healthcare provider to check for infection, pregnancy, certain hormone levels, and more. 
• Culture and sensitivity: A sample of milk or nipple discharge may be collected and sent to the lab for culture. Cultures help identify which bacteria may be causing an infection. Sensitivities provide information about which antibiotic would be most helpful.

How to Treat Breast Pain

Treating breast pain varies depending on the cause.

Cyclic Treatment

Cyclic pain is often treated with an oral or topical nonsteroidal anti-inflammatory drug (NSAID) such as Voltaren (diclofenac).

In severe cases, a specialist may prescribe these medications.

• Centron (ormeloxifene) 
• Danazol (danazol)
• Nolvadex (tamoxifen)

Noncyclic Treatment

 Noncyclic treatment depends on the underlying cause. 

• Large breasts: A supportive bra may help those with large breasts. In severe cases, your healthcare provider may suggest a breast reduction.
• Muscle soreness: Tylenol (acetaminophen) or Advil or Motrin (ibuprofen), a cool compress, or a warm bath can help relieve muscle soreness.
• Shingles: An oatmeal bath, cool compress, and calamine lotion help with itching. Tylenol (acetaminophen) or Advil or Motrin (ibuprofen) may help with discomfort. Your healthcare provider may prescribe antivirals or pain medications.
• Breastfeeding: Frequent feeding, pumping, or expressing milk is helpful. If needed, a lactation consultant can assist you with feeding techniques. 
• Mastitis: Treatment includes antibiotics, frequent milk removal, and pain medications. A warm or cool compress and massage can help. If an abscess develops, your healthcare provider may need to drain it using a local anesthetic.

When to See a Healthcare Provider 

If you have any of the following symptoms, see your healthcare provider:

• Discharge or blood from your nipple
• Skin redness or flakiness
• Cracking on the nipple
• Given birth within the last week and your breasts are swollen or hard
• A new lump that does not go away after your menstrual period 
• Persistent, unexplained breast pain
• Breast pain that stays in one area and doesn’t go away within two weeks
• Signs of a breast infection, including redness, swelling, pus, or fever
• Swollen lymph nodes
• If you are concerned about the pain

Summary 

Cyclic breast pain is usually from fluctuating hormones due to the menstrual cycle. Noncyclic is not related to a cycle and can be caused by breastfeeding, mastitis, muscle soreness, fibrocystic changes, large breasts, pregnancy, and more. 

Cyclical pain does not usually require diagnostic tests and is most often treated with topical pain medications. For noncyclic pain, diagnostic tests are decided based on a medical history and exam. Treatment depends on the cause of the pain.

Contact your healthcare provider if you have abnormal nipple discharge, breast skin changes, a new lump that does not go away, persistent pain in one area, or signs of infection.

A Word From Verywell 

While breast pain is rarely caused by breast cancer, the possibility can cause anxiety. Keep in mind that this is a very rare symptom (1%-7%) of breast cancer. Hormone fluctuations are a much more common cause of breast pain.  

If you are experiencing breast pain, keep track of how it feels and when it occurs. This will help you and your healthcare provider narrow down possible causes and treatment, if necessary. Breast pain is usually mild but can be debilitating for some people. If it affects your sexual health, mental health, sleep, or daily activities of living, contact your healthcare provider.