Breast pain

Breast pain is very common in women of all ages. Breast pain can cause a lot of anxiety, and many women worry that they have breast cancer. Breast pain alone is not usually a sign of breast cancer and is much more likely to be either a benign (not cancer) breast condition or chest wall pain due to other factors.

There are three main categories of breast pain.

Severe, long-lasting breast pain can sometimes affect a woman’s daily activities which may cause anxiety and, for some, depression but this isn’t the case for most women and their pain can be helped or managed.

Cyclical breast pain

Cyclical breast pain is linked to changing hormone levels during the menstrual cycle, but the exact causes are unknown. Approximately two out of three women will experience cyclical breast pain at some time in their lives.

These hormonal changes make the breast tissue more sensitive, which can cause pain.

Many women may feel discomfort and lumpiness in both their breasts a week or so before their period. The pain can vary from mild to severe and the breasts can also be tender and sore to touch. It often goes away once a period starts.

You may experience heaviness, tenderness, a burning, prickling or stabbing pain, or a feeling of tightness. The pain can affect either one or both breasts and can spread to the armpit, down the arm and to the shoulder blade. Cyclical breast pain can come back but in about 20–30% of women it will settle down.

This type of pain usually stops after the menopause. However, women taking hormone replacement therapy (HRT) after their menopause can also have breast pain.

Pain can also be due to starting to take or changing contraception that contains hormones.

Non-cyclical breast pain

Non-cyclical breast pain is where the breast pain isn’t linked to the menstrual cycle. It can result in continuous pain or pain that comes and goes and can affect women before and after the menopause

It is often unclear what causes breast pain that is not linked to the menstrual cycle. It can be related to certain benign (not cancer) breast conditions, previous breast surgery or injury to the breast, having larger breasts or side effects from other drug treatments. For example certain anti-depressant drugs and some herbal remedies (for example, ginseng). Stress and anxiety can also be linked to breast pain.  

The pain can be in one or both breasts and can affect the whole breast or a specific area. It may be a burning, prickling or stabbing pain, or a feeling of tightness. Non-cyclical breast pain tends to settle down by itself in about half of women.

Chest wall pain

Chest wall pain (also known as extra-mammary pain - meaning outside the breast) refers to pain that feels like it is coming from the breast, but actually comes from elsewhere. For example, this could be from pulling a muscle in your chest which can cause pain in your breast as well as in your chest wall or ribcage (known as musculoskeletal pain) or it may be a referred pain due to another medical condition, such as gallstones.

The pain can be one sided in a specific area or around a wide area of the breast. It may be burning or sharp, which may also spread down the arm and can be worse when you move. The pain can be felt if pressure is applied to the area on the chest wall.

Diagnosis

Your GP (local doctor) will examine your breasts and take a history of the type of pain you have and how often it happens. To check how long the pain lasts and how severe it is or if the pain is linked to your menstrual cycle, they may ask you to fill in a simple pain chart [PDF]

If your GP thinks you may have non-cyclical breast pain or chest wall pain, they may ask you to lean forward during the examination. This can help them assess if the pain is within your breast or in the chest wall.

Your GP may refer you to a breast clinic where you’ll be seen by specialist doctors or nurses.

Treatment for cyclical and non-cyclical breast pain

If any treatment is needed, the treatment options for cyclical and non-cyclical pain are often the same. However, non-cyclical pain isn’t always as easy to treat.

If you have cyclical breast pain, your GP may reassure you that what you’re experiencing is a perfectly normal part of your monthly cycle. 

Diet and lifestyle changes

Your GP may suggest simple things you can try which might help the pain, but there’s limited evidence to show these work. These include:

  • eating a low-fat diet and increasing the amount of fibre you eat
  • reducing caffeine and alcohol
  • increasing the amount of fresh fruit and vegetables you eat
  • taking regular exercise to help maintain a healthy weight 
  • wearing a supportive and correctly fitting bra during the day, during physical activity and at night can be helpful. For more information see Your guide to a well-fitting bra.

Some women have found relaxation therapy, such as relaxation CDs or apps, or other complementary therapies like acupuncture and aromatherapy useful in reducing the symptoms of cyclical breast pain. 

If your pain started when you began taking a contraceptive pill, changing to a low-dose pill or a different brand may help. If the pain continues, you may want to try a non-hormone method of contraception such as condoms or a cap (diaphragm).

If your pain started or increased whilst taking HRT and doesn’t settle after a short time, you should discuss this with your GP or specialist.

There is evidence that having low levels of an essential fatty acid called gamolenic acid (GLA) can contribute to cyclical breast pain. However, research has shown that taking additional GLA does not help the pain. Despite this, your GP may suggest that you try evening primrose or starflower oil (which contain GLA), as some women have found it helps them to feel better generally. Your GP will advise you how much to take and for how long.

Evening primrose oil doesn’t usually cause any side effects, but you may feel sick, have an upset stomach or get headaches. It’s best not to take it if you’re pregnant or trying to get pregnant. People with epilepsy are usually advised not to take evening primrose or starflower oil.

Anti-inflammatory medicines

Research has shown that anti-inflammatory pain relief (like ibuprofen) can help breast pain, particularly non-cyclical pain. Before using this type of pain relief you should be assessed and get advice from your doctor on the correct dose, how long you should use it for and any possible side effects especially if you have asthma, stomach ulcers or any problems related to your kidneys.

Hormone drugs

If your pain is severe, prolonged and hasn’t improved with any of the options already mentioned, your GP or specialist may want to consider giving you a hormone-suppressing drug. The drugs that are mainly used to treat breast pain are danazol and tamoxifen (tamoxifen is usually used to treat breast cancer). These drugs have side effects, so will only be recommended after a discussion about the benefits and potential risks. 

Treatment for chest wall pain

Treatment for chest wall pain will depend on what’s causing it.

If it’s found that your breast pain is caused by something like a pulled a muscle in your chest, this is likely to improve over time and can be treated with pain relief (see below).

Chest wall pain can also affect the area under the arm and towards the front of the chest and this may be due to:

  • costochondritis - inflammation of parts of the ribs (called costal cartilages)
  • Tietze’s syndrome - inflammation of the costal cartilages and swelling.

NHS choices has more information on costochondritis and Tietze’s syndrome.

Your specialist may be able to tell that the costal cartilages are painful if pressure is put on them. Sometimes this inflammation can feel similar to heart (cardiac) pain. You may feel tightness in the chest and a severe, sharp pain. The pain may also spread down the arm and can be worse when you move.

You may find it helpful to rest and avoid sudden movements that increase the pain. Pain relief such as paracetamol or an anti-inflammatory, such as ibuprofen (either as a gel or tablet) may help. Your GP or specialist may also suggest injecting the painful area with a local anaesthetic and steroid.

Smoking can make the inflammation worse, so you may find that your pain improves if you cut down or stop altogether.

Referred pain from other medical conditions, such as, angina (tightness across the chest) or gallstones, may be felt in the breast. Your GP or specialist will advise you on the best treatment for you.

What this means for you

Breast pain can be very distressing, and many women are anxious that they may have breast cancer. In most cases breast pain will be the result of normal changes that occur in the breasts. Even though you may feel reassured that your breast pain is normal and you don’t have breast cancer, the pain often remains. This can be upsetting, especially if your specialist can’t tell you the exact cause of your breast pain.

Women affected by breast pain may feel many different emotions for example, fear, frustration or helplessness. Although understanding more about your breast pain will not cure it, it may help you to get back some control over your life.

Having breast pain doesn’t increase your risk of breast cancer. However, it is still important to be breast aware and go back to your GP if the pain increases or changes, or you notice any other changes in your breasts.

Content last reviewed April 2015; next planned review 2018