On average, 70–80% of women will experience breast pain during their lifetime. The most common breast symptom in women of all ages, breast pain is not usually a sign of cancer and, in most cases, resolves on its own.
Types of Breast Pain
There are two types of breast pain: cyclical and noncyclical.
- Cyclical breast pain is the most common type of breast pain. It is associated with hormonal changes and is typically related to menstruation, usually beginning the week prior. Most often this pain is described as a dull, heavy, or aching feeling that is commonly bilateral and localized in the outer part of the breast and can radiate to the underarm. Cyclical breast pain is worse at the time of a woman’s period and disappears when the period ends. Pregnancy, lactation, hormone replacement therapy, and oral contraceptives can also be associated with breast pain. Perimenopausal breast tenderness and swelling are reported in one in three women.
- Noncyclical breast pain can occur intermittently or continuously. It is not related to the menstrual cycle and may occur in one or both breasts. Noncyclical breast pain is described as a tight, burning, stabbing, aching sensation that may be felt in one area of the breast or throughout. Possible causes include cysts, infection or inflammation, ill-fitting bras, large breast size, benign tumors, medication, surgery, musculoskeletal pain, caffeine intake, smoking, a high-fat diet, hormone therapy, and gynecomastia in men. This type of breast pain is most common after menopause and usually resolves on its own. Focal pain without a palpable mass is almost always benign. Focal pain with a mass is usually benign but must be evaluated.
Breast Pain Evaluation
To properly identify the cause of breast pain, the American College of Radiology recommends the following imaging tests for women with focal noncyclical breast pain without a mass:
- Women under the age of 40 should have an ultrasound.
- Women 40 years and older should have a diagnostic mammogram (if they have not had a mammogram within six months of the pain first presenting) and an ultrasound.
For cyclical breast pain, imaging is not necessary.
Non-breast-related factors may cause pain that is perceived as breast pain, but is in fact caused by something unrelated to the breasts. For example, a muscle pull or strain in the rib cage or chest wall may cause pain that radiates to the breast. Having a comprehensive medical history and physical examination performed by your clinician can help identify the source of your pain.
Managing Breast Pain
Breast pain may be alleviated by:
- Wearing a well-fitting bra during the day
- Wearing a soft bra at night
- Using a warm compress or ice
- Gently massaging the area
- Using topical NSAIDs (diclofenac gel, Aspercreme®, or Nuprin®)
- Taking oral NSAIDs (Advil or Motrin®)
Alternative methods that may be helpful include:
- Reducing caffeine intake (chocolate, coffee, cola, tea)
- Maintaining a low-fat diet
- Taking vitamin E (400–800 IU daily)
- Using primrose oil (1000–3000 mg daily)
- Trying herbal products (phytoestrogens, agnus-castus, or chamomile extract)