Breast pain
The breast responds to everything the hormones do, which is why it aches in most women at some point: at one age or another, on particular days of the month…
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Medicines commonly prescribed for Breast pain
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: ORAL SOLUTION/SUSPENSION, 600 mgActive substance: ibuprofenManufacturer: Kern Pharma S.L.Prescription requiredDosage form: INJECTABLE PERFUSION, 4 mg/mlActive substance: ibuprofenManufacturer: Altan Pharmaceuticals SaPrescription requiredDosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Towa Pharmaceutical S.A.Prescription required
The breast responds to everything the hormones do, which is why it aches in most women at some point: at one age or another, on particular days of the month, with varying force. This page is about pain in the breast itself — in its tissue, its skin, the nipple. If what presses, burns or squeezes sits deeper, behind the breastbone and closer to the heart, that is an entirely different matter with its own page, «Chest pain». Everyday speech lumps the two together, but the only thing they share is the word.
The fear that brings people here
Let us start with the reason this page usually gets opened. Pain on its own is almost never the first sign of cancer. A breast tumour typically announces itself not through pain but as a firm lump that can be felt and does not hurt at all. It is precisely that painlessness which makes a lump treacherous: it causes no trouble, so it is easy to leave it alone for months.
That does not mean pain can always be ignored. The few situations in which it genuinely matters are set out below, one by one. But pain without a lump and without skin changes points to hormones, to a muscle or to a rib far more often than to anything dangerous.
Pain that comes round with the cycle
The commonest pattern is tied to the cycle and is recognised by three features:
- it starts in the second half of the cycle, one to two weeks before a period, and eases as the period begins or during its first days;
- it affects both breasts at once, more strongly in the upper outer part, and often spreads towards the armpit and shoulder;
- it feels like heaviness, fullness and swelling rather than a stab in one spot.
On those days the breast seems denser and larger, touch is unpleasant and underwear gets in the way. It is at its sharpest from the thirties onwards and in the years before the menopause, when hormone levels swing most. After the menopause cyclical pain usually settles by itself, unless hormonal preparations are being taken.
This kind of pain is not a disease and needs no treatment as such. It is worth acting on when it stops you sleeping, hugging your children or exercising — and the most useful measures are not tablets, as described further down.
When one breast hurts in one place
Pain unrelated to the cycle behaves the other way round: one side, a specific spot you can point to with a finger, and no connection to the calendar. What lies behind it is usually not the gland at all but what sits underneath it:
- the rib cartilages where they join the breastbone — costochondritis. The tenderness runs strictly along the edge of the breastbone, increases when you press with a finger and on taking a deep breath;
- the muscles of the chest wall after exertion, carrying something heavy or unaccustomed work with the arms;
- the neck and upper spine: an irritated nerve root refers pain along the line of a rib, and the woman honestly experiences it as breast pain;
- large breasts and an unsuitable bra, pulling ceaselessly on the ligaments and on the muscles of the neck and back;
- scarring, tightness and numbness after breast surgery;
- a cyst, particularly if it has filled quickly.
Medicines deserve a line of their own. Combined hormonal contraceptives, menopausal hormone therapy, some antidepressants and fertility treatments all cause tenderness and pain. Do not stop them on your own initiative: your doctor will either find an alternative or suggest waiting, because a proportion of these effects fade after two or three months.
Pain while breastfeeding
In a breastfeeding woman the pain is almost always mechanical rather than a disease, and almost always fixable. The three commonest causes are:
- a poor latch — the baby takes only the nipple into the mouth rather than the areola. Hence the cracks, the blood on the nipple and the sharp pain in the first seconds of each feed;
- milk stasis, giving a firm tender area that softens noticeably after a feed or after expressing;
- spasm of the blood vessels in the nipple: the nipple blanches after a feed and a burning pain appears, worse in the cold.
Simple things help: feed more often, start on the sore side, have the latch checked once by a breastfeeding adviser, apply warmth before a feed and something cool after it, and treat cracks with pure lanolin. Feeding is not usually stopped — on the contrary, an emptied breast hurts less.
A red, hot breast with a temperature
This is the one situation on the page that is never sat out. Part of the breast, or all of it, turns red, becomes hot and hard, the skin is stretched tight, the temperature rises and a flu-like ache sets in. In a breastfeeding woman this is usually mastitis: she needs to be seen the same day, because untreated it turns into an abscess, and an abscess has to be drained.
If the same picture appears in a woman who is not breastfeeding, the matter needs sorting out faster and taken further. There is an uncommon but aggressive form, inflammatory breast cancer, and it looks exactly like inflammation: redness over a good part of the breast, swelling of the skin with widened pores giving an orange-peel appearance, firmness and heaviness, sometimes an indrawn nipple. There may be no palpable lump at all. What sets it apart is that antibiotics bring no improvement. The rule is straightforward: a «mastitis» in a woman who is not breastfeeding and which has not settled after a week of treatment calls for examination and imaging, not a second course of antibiotics.
What genuinely eases the pain
- A properly fitted bra with wide straps and real support: by day and, on the worst days, at night as well, soft and without underwiring. This is the most underrated measure of all, and for many women it does more than tablets.
- A sports bra during exercise. Running and jumping without support stretches the ligaments, and the pain then lingers for days.
- A short course of pain relief — paracetamol or a non-steroidal anti-inflammatory. When it is a rib cartilage or a muscle that hurts, an anti-inflammatory gel rubbed into the sore spot works well too.
- Warmth or cold, whichever feels better to you, applied through cloth rather than directly to the skin.
- A diary kept over two or three cycles: date, pain score out of ten, which side. It shows what is not always obvious by eye, namely whether the pain is tied to the cycle or not, and saves time at the appointment.
- A review of everything you take with your doctor, including medicines prescribed for reasons that have nothing to do with gynaecology.
Vitamin E and evening primrose oil come up constantly: there is no convincing evidence that they help, there is usually no harm in them either, and the decision is yours. A link between the pain and coffee or fatty food has not been confirmed in studies, but if you notice one in yourself it costs nothing to test.
What to see a doctor about without delay
- a lump or an area of thickening you can feel that was not there before, in the breast or in the armpit;
- an indrawn patch of skin, a dimple or a crease, especially one that shows when you raise your arm;
- a nipple that has turned inwards or changed direction;
- discharge from the nipple outside pregnancy and breastfeeding, all the more so from a single duct, clear or bloodstained;
- a change in the shape or size of one breast;
- redness, swelling of the skin, an orange-peel texture, a crust or a sore on the nipple or areola that will not heal;
- pain in one fixed spot that persists for weeks and takes no notice of the cycle;
- pain appearing for the first time after the menopause;
- any of these findings in a man.
If what you have found is a lump, then strictly speaking the neighbouring page is the one you want, «Breast lumps»: it explains how a cyst differs from a solid finding and what happens next. Assessment begins in any case with an examination, with ultrasound or mammography added according to age, and a needle sample taken where necessary. There is no point waiting for a convenient moment, but no point either in panicking while you wait: most findings turn out to be benign.
Online consultation
An online appointment can do the essential part: work out which of the patterns described fits your pain and whether a face-to-face examination is needed at all. The doctor will go through how the pain relates to your cycle, look at your list of medicines, explain how to tell a sore rib cartilage from pain in the gland itself, advise on cracks and milk stasis if you are feeding, and check separately for the signs in the final list. If an in-person examination is needed, you will leave knowing who to see and which test to ask for, rather than leaving with the worry alone.
This material is for information only and does not replace medical advice.
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