Breast pain is very common. A survey of women found that almost half had mild breast pain, and about 1 in 5 had severe breast pain, although most had not reported these symptoms to their doctor. Breast pain is the most common breast-related symptom for which patients seek medical treatment, and accounts for about half of breast-related office visits. Fortunately, breast pain is rarely due to cancer.
Most commonly, breast pain is cyclical, meaning that it is related to the normal hormonal fluctuations of the menstrual cycle. Usually it is felt the week before the start of menses, and resolves after the end of menses. Hormonal breast pain tends to be in both breasts, and most severe in the upper and outer aspects of the breast. Minor cyclical breast discomfort is very normal. However, in a small number of women, this cyclical pain can be moderate to severe, affecting day-to-day activities.
Noncyclical breast pain does not follow the usual menstrual pattern. It tends to be on one side and in different locations of the breast. There are many causes of noncyclical/non-hormonal breast pain:
- Large breasts: Large breasts tend to pull on the ligaments of the breast, and discomfort may involve the neck and shoulder as well.
- Diet: Many patients report that cutting back on caffeine has greatly improved their breast pain. Also, a low-fat, high complex carbohydrate diet has been shown to be helpful in some small studies.
- Smoking: Smoking might increase breast pain by increasing epinephrine levels in the breast. Epinephrine is involved in the perception of pain.
- Medication: Up to one third of women taking postmenopausal hormone therapy may experience some degree of noncyclical breast pain. Luckily, this tends to resolve over time. Other medications can also contribute to pain, including some antidepressants, cardiovascular agents, and antibiotics.
- Chest wall pain: This is most commonly from irritation of the pectoralis major muscle. Examples of activities that can cause this muscle pain include waterskiing, raking, rowing, and shoveling.
- Pregnancy: It is important to consider pregnancy as a common cause of breast pain. Half of pregnancies are accidental or unintended.
Diagnosis and Tests
How is breast pain evaluated?
The doctor will do a breast exam to make sure there are no suspicious lumps. A mammogram or ultrasound may also be needed. Whether imaging is done will depend on the type of pain, the exam findings, the woman’s age, and when the last breast imaging was done.
Management and Treatment
What are the treatments for breast pain?
- Use less salt.
- Wear a supportive bra.
- Apply local heat to the painful area.
- Take over-the-counter pain relievers sparingly, as needed.
- Avoid caffeine. Well-designed studies have not shown that avoiding caffeine can treat breast pain. However, many women report significant improvement in their symptoms when they reduce their intake of tea, coffee, chocolate, and energy drinks.
- Try Vitamin E. Studies have not consistently shown benefits of vitamin E for treating breast pain, though some women find it helpful. Using vitamin E for a few weeks to see if it will help is unlikely to cause any harm. However, long-term use of vitamin E supplementation is not recommended for breast pain, as there are some studies suggesting this may not be safe.
- Try evening primrose oil. Similar to vitamin E, studies have not consistently shown evening primrose oil to be helpful in treating breast pain, though it does help some women. Evening primrose oil is found over-the-counter. Side effects might include nausea, diarrhea, and headaches. In the past, there was concern that certain patients might be at increased risk of seizures when taking this supplement, though this is now disputed.
- Try Omega–3 fatty acid. Though not proven to be effective in rigorous studies, some women find increased intake of fish oils/omega-3 supplements to be helpful. Natural dietary sources include: dark green leafy vegetables, ocean-raised ("wild") cold-water fish, flax, walnuts, and sesame. Omega-3 supplements are also available by prescription and over-the-counter.
- Give it time. Most commonly, pain goes away on its own after a few months, without the need for any treatment.