Breast pain is very common in women of all ages. Approximately two out of three pre-menopausal women (women who haven’t been through the menopause) will experience it at some time in their lives. There are two main categories of breast pain.
Severe, long-lasting breast pain can affect a woman’s daily activities causing a reduced quality of life, which can result in further anxiety and, for some, depression.
Cyclical breast pain is linked to changing hormone levels during the menstrual cycle and mainly affects women before the menopause. These hormonal changes make the breast tissue more sensitive, which in turn can cause pain.
You may experience heaviness, tenderness, a burning, prickling or stabbing pain, or a feeling of tightness in the area. 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 will settle down by itself in about 20–30% of women, although it can come back.
This type of pain usually stops after the menopause. However, women taking hormone replacement therapy (HRT) after their menopause can also experience breast pain.
Although cyclical breast pain is linked to the menstrual cycle, its exact causes are unknown.
There are two types of non-cyclical breast pain.
- Pain comes from the breast but isn’t linked to the menstrual cycle.
- Extra mammary (meaning outside the breast) pain, which feels as though 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).
Both types can result in continuous pain or pain that comes and goes, and can affect women before and after the menopause. 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 in the area. Non-cyclical breast pain tends to settle down by itself in about 50% of women.
It is often unclear what causes breast pain that is not linked to the menstrual cycle. It may be related to certain benign (not cancer) breast conditions, previous breast surgery or other medical conditions not directly related to the breasts.
Your GP (local doctor) will examine your breasts, and take a history of the type of pain you have and how often it occurs. To check if the pain is linked to your menstrual cycle, they may ask you to fill in a simple pain chart. To see an example of a breast pain chart, download our Breast pain booklet.
If your GP thinks you may have non-cyclical breast 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.
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.
The treatment options for cyclical and non-cyclical pain are often the same, however non-cyclical pain is not always as easy to treat.
Diet and lifestyle changes
Your GP may suggest simple things you can try that might help to reduce pain, although there is limited evidence to show they work. These include:
- reducing the amount of processed fats (low-fat diet) and increasing the amount of fibre you eat
- reducing intake of 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 at night as well as during the day. For more information see Your guide to a well-fitting bra.
Some women have found relaxation therapy, such as relaxation tapes, useful in reducing the symptoms of cyclical breast pain. Other complementary therapies that promote wellbeing may also be helpful.
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-hormonal method of contraception such as condoms or a diaphragm (cap).
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 reduce pain levels. 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 experience nausea, an upset stomach or headaches. It’s not advisable 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.
Research has shown that non-steroidal anti-inflammatory pain relief can help breast pain, particularly non-cyclical pain. Before using this type of pain relief you should be assessed and advised by your doctor on the correct dose, how long you should use it for and any possible side effects, especially if you have asthma or stomach ulcers.
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 used to treat breast pain are danazol, tamoxifen and goserelin.
Danazol is the only drug currently licensed to treat breast pain. Tamoxifen and goserelin are usually used to treat breast cancer. These drugs all have side effects, so they are only suitable for use following a thorough discussion of the benefits and potential risks.
Treatment for pain from elsewhere
Pain from elsewhere usually comes from the chest wall area and can affect the area under the arm and towards the front of the chest. It can also be associated with an underlying problem such as:
- costochondritis - inflammation of parts of the ribs (called costal cartilages)
- Tietze’s syndrome - inflammation and swelling in the costal cartilages.
Your GP or 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 a non-steroidal anti-inflammatory such as ibuprofen or diclofenac (either as a cream, gel or tablet) may help. Your GP or specialist may also suggest injecting the painful area with a local anaesthetic and steroid.
It's thought that smoking makes the inflammation worse, so you may find that your pain improves if you cut down or stop altogether.
Occasionally, pain from other conditions can be felt in the breast – for example, angina (tightness across the chest) or gallstones. This is known as referred pain. If this happens, your GP or specialist will advise you on the most appropriate treatment.
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 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 persists. 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. Fear, frustration or helplessness are all normal reactions. 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 does not increase your risk of breast cancer. However, it is still important to be breast aware and go back to your GP if you notice any other changes in your breasts.
Content last reviewed January 2013; next planned review 2015