Common Causes of Breast Pain and How to Manage It

You may find yourself wondering how to reduce breast pain, as the majority of women experience at least one episode of breast pain in their lifetime. Breast pain, also known as mastalgia, is exceedingly common and varies in how it presents itself. Pain in the breast can range from pinpointed to diffused, intermittent to constant, and may even radiate. 

The good news is that in most cases, the cause of breast pain is not related to breast cancer. Continue reading below to learn some common breast pain causes and options on how to manage the pain.

Hormones and Breast Changes

Around Your Period

The most common type of breast pain is cyclic, where a woman might experience some tenderness, often right before or during her menstrual period. Women may also have cysts (benign sacs of fluid within the breast tissue) which can increase in size and become irritated, resulting in a more centralized pain. This is due to fluctuations in estrogen and progesterone levels. Symptoms can persist for several cycles.

Puberty, Pregnancy, or Menopause

Other types of hormonal change can trigger similar symptoms, such as puberty, pregnancy, or menopause. Women taking hormonal birth control, and post-menopausal women/transgender women on hormonal replacement therapy, may also experience similar breast pain.

Management of hormonal breast pain is based on symptoms, including over-the-counter pain medications, warm compresses, and ice packs. If symptoms appear to be related to medication and persist, talk to your doctor about adjusting or switching your current regimen.

Infection

Several different infections cause breast pain and can occur in and around the breast, with different presentation and management:

• Skin infection: Just like a pimple on your face, skin follicles can become clogged and infected, resulting in familiar, painful red bumps. This typically happens in the armpits or under the breasts during sweaty summer months. These can be treated the same as you would treat facial acne. Using exfoliating skin products can be a helpful preventative measure. Numerous bumps developing and persisting over more than several weeks could represent a chronic inflammatory skin condition known as hydradenitis suppurativa, and requires medical management, so contact your doctor if symptoms do not clear up over a few weeks.
• Breast mastitis: Focal swelling and skin redness may be accompanied by systemic symptoms such as a fever and chills. This often presents while a woman is breastfeeding due to bacteria infecting a milk duct. Breastfeeding can continue with mastitis. Contact your doctor for a course of antibiotics.
• Breast abscess: An abscess is a collection of infected fluid. You may also notice swelling and skin redness, and the fluid collection may be visible. Sometimes, women report foul-smelling white, yellow, or green discharge. Abscesses can occur in both breastfeeding women (due to mastitis) or in non-breastfeeding women. Seeking medical management is encouraged as antibiotics are a must, and drainage may be indicated. 

Inadequate Breast Support

This type of pain is usually seen as bilateral lateral breast pain, sometimes radiating to the armpits and more commonly occurring in larger-chested women. Having inadequate or incorrect support for your breasts can cause pain which is not immediately apparent, but builds up over time. 

Breast shape and size also change throughout a lifetime, particularly during puberty, but also with pregnancy/breastfeeding, significant weight gain or loss, and menopause.

It is important to wear an accurate bra size, and a great starting point is the calculator at abrathatfits.org. Many women are surprised to find that they need to go up in cup size and down in band size; the latter provides the majority of support in a bra. A professional fitting experience, such as at Nordstrom or another specialty bra store, are often free and can help provide more accurate measurements. Nordstrom’s bra fitting program has even been listed as one of Oprah’s favorite things! 

There are more diverse bra options than ever on the market, including bralettes, non-padded bras, and extended sizes. There are also tutorial patterns and kits to help you sew your own bra. Truly, there is a solution for everyone. It is recommended that one get re-sized every couple of years, or when there has been a notable change in breast shape or size.

It’s also recommended to replace old, worn-out bras and to avoid wearing underwire bras to sleep, as it does not prevent sagging, to help reduce breast pain. 

Dietary and Lifestyle Effects

Although difficult to characterize, dietary and lifestyle breast pain can present itself in different ways and may be due to multiple causes. Excess sodium intake can lead to water retention, indirectly leading to tenderness and pain, while caffeine is a known trigger of breast pain. A fatty acid imbalance can also lead to pain symptoms, and studies show that treatment with evening primrose oil (EPO) with or without vitamin E can be effective. If you are experiencing breast pain, reducing dietary sodium/caffeine and ingesting EPO may be helpful.

The effects of smoking and other life stressors should be considered. Nicotine is a known contributing factor to breast pain and increases the lifetime risk of breast cancer. Trying to quit smoking is highly recommended, and if you don’t smoke, don’t start. Significant causes of stress can manifest physically as pain in the breasts or other body parts. Careful correlation with life changes at the time of onset of pain can help identify the cause.

Extramammary Concerns

Occasionally, breast pain is due to causes outside the breasts themselves. This pain may be described as deep within the chest or radiating from the back or shoulders. Sudden onset pain can usually be attributed to trauma, such as a car accident (with either bruising or fractures of the ribs), whereas more long-standing pain can be related to old injuries or age-related degenerative changes of the back or shoulders. Diagnostic breast imaging can always be helpful to rule out a breast-related cause. Correlation with a detailed clinical history and treatment of the underlying cause is the most beneficial solution.

When To Worry About Breast Pain

Breast pain is common and has a number of causes, many of which are benign. However, when symptoms persist without improvement, particularly in the setting of an associated palpable mass, skin changes, or discharge, you should consult your doctor for appropriate screening.

Remember, you’re never too young to start thinking about your breast health, and no symptom or form of pain is too small. If you’re unsure of the pain you’re experiencing, it is always recommended to visit a doctor’s office, and sometimes, seek a second opinion. Some women are more at risk for breast cancer than others, and it’s always a good idea to be informed.