Breast pain: possible causes

Breast pain: mastalgia, if you want the clinical term, is one of the most common breast symptoms there is, and most of the time it is not a sign of anything serious.

What matters is telling the difference between pain that follows a pattern you recognise and pain that does not, so you know when it is worth having looked at. This guide explains both.

01Cyclical and non-cyclical breast pain

Cyclical breast pain

Cyclical pain is linked to your hormones and reproductive cycle. It usually affects both breasts, often starts up to two weeks before your period and eases once it ends. It is most common in women in their twenties and thirties, and around the approach to menopause.

• An achy or heavy sensation: normally in both breasts
• Breasts that feel lumpy
• Pain that can spread to the armpits

Non-cyclical breast pain

Non-cyclical pain is not linked to your cycle. It tends to be constant or unpredictable, and is often confined to one breast or one area.

• Constant or unpredictable discomfort
• Pain isolated to one breast, or one section of it
• Fever, or a breast that feels hot
• Nipple discharge
• A hard lump

Non-cyclical pain has a wider range of possible causes, including cysts, infection, a muscle sprain, certain medications and, less commonly: breast cancer. You are more likely to notice breast pain if you have larger or heavier breasts, take certain hormonal medication, have had breast surgery before, or have a family history of breast cancer or cysts.

02When to get breast pain checked

You can often manage ordinary breast pain at home, but book an appointment if:

• The pain interferes with sleep or daily activities
• It is getting worse over time
• It lasts more than a week or two
• Painkillers do not relieve it

And ask for an urgent appointment if you notice any of the following alongside the pain:

• A fever, which can point to an infection such as mastitis.
• A hard lump that does not move when you press it.
• A change in breast shape or skin thickening.
• Redness, heat or swelling around any part of the breast.
• Skin dimpling, patches that resemble an orange-peel texture.
• A nipple that has pulled inward or changed shape.
• A family history of breast cancer.

03How breast pain is diagnosed

Diagnosis starts with a physical examination. Your breasts and the lymph nodes in your neck and armpits are checked for any signs of change. Depending on what that finds, one or more of the following may follow:

• Ultrasound, sound waves build a picture of the breast tissue; under 40, it is usually just as effective as a mammogram at finding the cause of pain.
• Mammogram, an X-ray of the breast, generally preferred for women over 40.
• Biopsy, a small sample of tissue, taken if imaging shows something that needs a closer look.

04Managing and treating breast pain

Treatment depends on the underlying cause and can include an anti-inflammatory gel applied to the area, prescription medication, or switching to a different hormonal contraceptive if that is contributing. If a cyst or another finding is causing the pain, your doctor will talk through the options with you.

In the meantime, most breast pain settles on its own. A few things can help while it does:

• A painkiller such as paracetamol or ibuprofen.
• A well-fitting, supportive bra, and a soft bra at night, if that helps.
• An ice or heat pack applied to the sore area.
• Good posture, try not to slump or slouch.

Not all breast pain can be prevented, but a well-fitting bra (including a sports bra during exercise), limiting caffeine and keeping to a low-fat diet where you can all tend to help.

05Getting answers, not just reassurance

If you are not sure whether your pain is worth a closer look, that uncertainty is reason enough to book. A consultation gives you a proper examination, and. If it is needed: imaging in the same visit.