Breast pain

Breast pain is discomfort, tenderness or soreness in your breast or underarm area. It's very common, can affect anyone, and on its own it's rarely a sign of breast cancer.

What are the common causes of breast pain?

The most common cause is hormonal change during your menstrual cycle, which can make breast tissue tender in the days before a period. Pain can also happen during puberty, pregnancy, perimenopause and menopause, as hormone levels shift.

Other causes, not linked to your cycle, include:

• Wear and tear in the chest wall muscle, the muscle beneath your breast that runs to your shoulder. Pain from this can be felt near the armpit or breast, even though it isn't coming from breast tissue itself.
• A benign (not cancer) breast condition, such as fibrocystic changes, where breast tissue becomes lumpy and tender.
• An injury, previous breast surgery, or having larger breasts.
• Certain medicines, including the contraceptive pill, hormone replacement therapy (HRT), some antidepressants, and some herbal remedies such as ginseng.
• An infection, such as mastitis or a breast abscess.
• Stress and anxiety.
• Other medical conditions, such as costochondritis (inflammation where the ribs meet the breastbone), gallstones or angina, where pain is felt in the breast but comes from somewhere else.

In men, breast pain is usually caused by gynaecomastia, an increase in breast gland tissue linked to a change in the balance of the hormones oestrogen and testosterone.

Are there different types of breast pain?

Yes, breast pain is generally grouped into three types:

• Cyclical breast pain: linked to your menstrual cycle. It usually affects both breasts, often starting about a week before your period and easing once it begins. It can feel like heaviness, tenderness, burning, prickling or tightness, and it usually stops after menopause.
• Non-cyclical breast pain: not linked to your cycle. It's often unclear what causes it, and it tends to affect one breast or one area, either constantly or on and off. It's more common over the age of 40 and goes away by itself in around half of women who get it.
• Chest wall pain: felt as though it's coming from the breast, but actually caused by something else nearby, such as a pulled muscle in the chest.

How is breast pain diagnosed?

Your GP will examine your breasts and ask about the type of pain you have, how often it happens, and whether it's linked to your periods. They may ask you to fill in a simple pain chart to track how long it lasts and how severe it is.

If needed, your GP may refer you to a breast clinic for a more detailed assessment by a specialist.

How is breast pain treated?

If your pain is cyclical, your GP may simply reassure you that it's a normal part of your monthly cycle. Beyond this, treatment options for cyclical and non-cyclical pain are often similar.

• A well-fitting, supportive bra, worn during the day, during exercise and, if helpful, at night.
• Pain relief, such as paracetamol or an anti-inflammatory like ibuprofen, taken as tablets or rubbed into the area as a gel.
• Diet changes, such as a low-fat diet, more fibre, and less caffeine and alcohol, though there's limited evidence these help.
• Relaxation therapies, such as relaxation apps, acupuncture or aromatherapy, which some women find helpful for cyclical pain.
• A change in contraception, if your pain started after beginning a hormonal contraceptive pill. Switching pill, or trying a non-hormonal method such as condoms, a copper coil or a diaphragm, may help.
• Reviewing your HRT, if pain started or increased after beginning hormone replacement therapy.
• Evening primrose or starflower oil, which some women find helps them feel better generally, though evidence for pain relief itself is mixed. These are not suitable during pregnancy or if you have epilepsy.
• Tamoxifen, a hormone-blocking medicine, for pain that is severe or long-lasting and hasn't responded to other treatments. It has side effects, including hot flushes, night sweats and mood changes. A specialist breast consultant may discuss the benefits and risks of this with you.

When should I see a doctor?

See a GP about breast pain if:

• it's new, unusual for you, or getting worse
• painkillers or other self-help measures aren't helping
• there is a history of breast cancer in your family
• you have signs of pregnancy
• you notice any other changes in your breast, such as a lump, swelling, or changes to the nipple or skin

Get an urgent GP appointment or call NHS 111 if you have breast pain along with:

• a very high temperature, or feeling hot, cold or shivery
• a hard lump that does not move around
• nipple discharge, especially if it looks like it has blood in it
• a change in the shape of one or both breasts
• dimpled skin, like orange peel
• a rash on or around the nipple, or a nipple that has sunk inwards.