If your breasts hurt, don’t panic. Though your mind may jump to breast cancer, the chances your breast pain is caused by cancer are extremely slim.
In fact, breast pain is usually not a sign of a serious condition, and is rarely a sign of cancer. Instead, breast pain is most commonly brought on by hormonal changes. It can also be caused by injury, chest wall pain, breast feeding, an infection, a medication side effect, noncancerous cysts, or even your bra not fitting correctly.
If you are experiencing breast pain and are concerned, talk to your doctor. Your primary care physician and/or obstetrician-gynecologist will review your symptoms and do a breast exam by touch. Don’t be surprised if your doctor doesn’t schedule a mammogram: Unless you have a lump or another sign of breast cancer, a mammogram is unlikely to uncover the cause of breast pain. Instead, your doctor will discuss ways to alleviate the pain and offer guidance on next steps based on your symptoms and the likely cause of your discomfort.
Breast Pain and Hormones
Many women have breast tenderness and pain, also called mastalgia, at some point in their lives; in fact, approximately 70 percent of women in the United States experience breast pain. The pain is commonly connected to the monthly menstrual cycle. If this is the case, the pain is considered cyclic and is caused by normal monthly changes in hormones. Breasts may become sore a few days before your period starts, and the pain usually subsides once menstruation beings. Most women with cyclic pain say they feel the pain in both breasts. They describe it as a heaviness or soreness that radiates to the armpit and arm.
Hormonal breast pain is often worse during perimenopause–the years leading up to menopause–because of greater fluctuations in estrogen and progesterone levels. After menopause, women generally don’t experience hormonal breast pain; breast pain after menopause is often caused by inadequate support as breasts sag, putting a strain on ligaments in the breast tissue.
Breast pain caused by hormone changes will usually go away on its own, but if you are uncomfortable, you can try to eliminate caffeine, eat a low-fat diet, reduce salt intake, and quit smoking. Taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, can also help, as can applying moist heat to your chest a few times a day.
If you take birth control pills or hormone replacement therapy, talk with your doctor to see if making a change may help alleviate cyclic breast pain.
Also note: Breast pain is often one of the earliest signs of pregnancy for many women.
Other Causes of Breast Pain
Breast pain not connected to the menstrual cycle is called noncyclic pain. Noncyclic breast pain can be caused by:
Breast injury. You may feel a sharp, shooting pain at the time of injury, and tenderness can last for days or even weeks. See your doctor if the pain doesn’t improve.
Infection. Breast pain, redness, swelling, and warmth around a breast are symptoms of infection. Other signs include fever, red streaks extending from the breast, and general body aches. Connect with your physician right away because you may need prescription antibiotics. In some cases, particularly in women over age 40, an imaging test may be recommended.
Chest wall pain. What feels like breast pain may actually be coming from your chest wall. This is the area of muscle, tissue, and bone that surrounds and protects your heart and lungs. Common causes of chest wall pain include a pulled muscle, inflammation around the ribs, trauma to the chest wall or a bone fracture.
Unsupportive bras. Without proper support, the ligaments that connect breasts to the chest wall can become overstretched and painful by the end of the day. The result is achy, sore breasts. Make sure your bra is the correct size and provides good support, especially during strenuous exercise.
Breastfeeding. For many women, breastfeeding is painful. Your nipples may hurt if your baby improperly latches. You may feel a tingling sensation when the milk starts to flow to the baby. You may have nipple soreness from being bitten. Or you may have dry skin or an infection. Your doctor or lactation consultant can help you find ways to reduce breast pain during breastfeeding. Don’t be shy about asking for help.
Medication side effects. Some antidepressants, water pills, hormone therapies, medications to treat heart failure, and medications to treat high blood pressure may cause breast pain as a side effect. If you suspect this is the cause of your breast pain, talk to your doctor to see if an alternate medication might be better for you.
Breast cysts. If a tender lump suddenly appears in your breast, you may have a cyst. These fluid-filled lumps aren’t dangerous and often don’t need to be treated. But get any lump in your breast checked by a doctor. To diagnose a cyst, your doctor may recommend an ultrasound and or mammogram. Your doctor may need to drain fluid from the cyst to alleviate pain.
When to Connect with Your Doctor
Though breast pain is rarely a sign of something serious, reach out to your doctor with any concerns. Also, be sure to connect with your doctor if you have new changes in a breast, such as:
- A lump or thickening in your breast or armpit
- A change in the breast’s size or shape
- Skin changes, such as dimples or puckers
- Nipple discharge
- A change in the color or feel of the skin of your breast or the darker area around the nipple
- A change in the shape of the nipple
Mammograms and Breast Pain
Mammograms are an extremely important tool in detecting breast cancer at its earliest, most treatable stages. We offer mammograms for women at low risk of developing breast cancer starting at age 40, and then every 1 to 2 years thereafter. For women at high risk for breast cancer, we start screening earlier. Women should talk to their physician about a schedule that makes the most sense for them based on their personal risk factors.
A lot of patients think if they have breast pain, they need a mammogram immediately. However, research has shown that breast pain is rarely linked to breast cancer, and mammograms are extremely unlikely to determine the cause of noncancerous causes of breast pain.
If you have breast pain, your doctor will help determine whether you need imaging tests, such as an ultrasound or mammogram.
Your doctor will start by talking with you about your symptoms, reviewing your mammogram history, and doing a breast exam by feeling your breasts. If no lump is felt, imaging tests likely will not be immediately recommended. (Though if you are due or overdue for a mammogram, we’d recommend getting the test scheduled.)
If a lump is detected, your doctor will consider your age, symptoms, risk factors for breast cancer, and mammogram history to determine whether you need an ultrasound, mammogram, or both. Your doctor may also suggest waiting 1 to 2 menstrual cycles to see if the lump goes away on its own, as is often the case with noncancerous cysts.
Because so many factors go into whether a mammogram or ultrasound is recommended, it’s important to share your concerns and symptoms with your physician.
Though pain of any kind can be scary, when it comes to breast pain, remember that hormonal fluctuations are the main cause. Try not to worry but do reach out to your doctor with any concerns.
Amy Banulis, MD, is a board-certified obstetrician and gynecologist (OB/GYN) with the Mid-Atlantic Permanente Medical Group. She leads the medical group’s focus on serving women and especially mothers and children. She sees patients at the Kaiser Permanente Falls Church Medical Center.
Summer Herlihy, MD, is a board-certified radiologist with the Mid-Atlantic Permanente Medical Group. She is the modality chief for mammography and sees patients at the Kaiser Permanente Kensington Medical Center.
For more expert advice, subscribe to our Health newsletter.