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Breast pain (mastalgia) can be described as tenderness, throbbing, sharp, stabbing, burning pain or tightness in the breast tissue. The pain may be constant or it may occur only occasionally, and it can occur in men, women and transgender people.
Breast pain can range from mild to severe. It may occur:
- Just a few days a month, in the two to three days leading up to a menstrual period. This normal, mild-to-moderate pain affects both breasts.
- A week or longer each month, starting before a period and sometimes continuing through the menstrual cycle. The pain may be moderate or severe, and affects both breasts.
- Throughout the month, not related to a menstrual cycle.
In men, breast pain is most commonly caused by a condition called “gynecomastia” (guy-nuh-koh-MAS-tee-uh). This refers to an increase in the amount of breast gland tissue that’s caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly.
In transgender women, hormone therapy may cause breast pain. In transgender men, breast pain may be caused by the minimal amount of breast tissue that may remain after a mastectomy.
Most times, breast pain signals a noncancerous (benign) breast condition and rarely indicates breast cancer. Unexplained breast pain that doesn’t go away after one or two menstrual cycles, or that persists after menopause, or breast pain that doesn’t seem to be related to hormone changes needs to be evaluated.
Causes
Mastalgia can be broken down into two separate categories: cyclic and noncyclic. The causes vary, depending on the kind of mastalgia it is.
Cyclic Mastalgia
Cyclic mastalgia is breast pain that’s related to the hormonal variations associated with the menstrual cycle, which affect how your breasts feel over the course of a month.
The pain is often described as a dull, heavy ache, not focused on any specific spot. It affects both breasts and the armpit areas.
Cyclic mastalgia is typically at its worst shortly before the cycle begins, decreasing on the first day of your period and then going away over the next few days. If hormones are the cause, the symptoms should decrease at certain times during your monthly cycle.
Noncyclic Mastalgia
Noncyclic mastalgia is breast pain that doesn’t vary with the menstrual cycle or with hormonal changes. In postmenopausal females, most breast pain is noncyclic, but you can have it before menopause as well.
The pain may be described as sharp or burning and is often felt only in one breast and one particular area of that breast. It’s also known as “trigger zone” breast pain because you can point to where it hurts. It’s most common between the ages of 30 and 50.1
Noncyclical breast pain is often related to:
- An injury
- Surgery
- Infections
- Breast fibroadenoma, or a breast cyst
- Inflammatory breast cancer
Large breasts (either from obesity or genetics) may also be a source of noncyclic mastalgia. They can be especially painful if a supportive bra is not worn. This is due to the stretching of Cooper’s ligaments, which are bands of connective tissue that support and shape breast tissue.
Since this type of pain is linked to menstruation, premenopausal females are most likely to experience it. Cyclical breast pain can also be associated with oral contraceptive pills and HRT.
Fibrocystic breast changes, which can cause breast pain, swelling, or thick areas, involve the lobes, ducts, and connective tissue.
Noncyclic Mastalgia
Noncyclic mastalgia is breast pain that doesn’t vary with the menstrual cycle or with hormonal changes.In postmenopausal females, most breast pain is noncyclic, but you can have it before menopause as well.
The pain may be described as sharp or burning and is often felt only in one breast and one particular area of that breast. It’s also known as “trigger zone” breast pain because you can point to where it hurts. It’s most common between the ages of 30 and 50.1
Noncyclical breast pain is often related to:
- An injury
- Surgery
- Infections
- Breast fibroadenoma, or a breast cyst
- Inflammatory breast cancer
Large breasts (either from obesity or genetics) may also be a source of noncyclic mastalgia. They can be especially painful if a supportive bra is not worn. This is due to the stretching of Cooper’s ligaments, which are bands of connective tissue that support and shape breast tissue.
Extramammary breast pain
The term “extramammary” means “outside the breast.” Extramammary breast pain feels like it starts in the breast tissue, but its source is actually outside the breast area. Pulling a muscle in the chest, for example, can cause pain in the chest wall or rib cage that spreads (radiates) to the breast. Arthritis that involves the cartilage in the chest, also known as costochondritis, can also cause pain.
When to see a doctor
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Make an appointment with your doctor if breast pain:
- Continues daily for more than a couple of weeks
- Occurs in one specific area of your breast
- Seems to be getting worse over time
- Interferes with daily activities
- Awakens you from sleep
Breast cancer risk is very low in people whose main symptom is breast pain, but if your doctor recommends an evaluation, it’s important to follow through.
Diagnosis
The diagnosis of mastalgia is most often made based on symptoms and a physical breast exam, though imaging studies may be done to further evaluate abnormalities noted during a physical exam.
The chance of mastalgia being a symptom of breast cancer is quite low, but it’s important to screen women who are at risk.
Breast cancer is often painless, but breast pain can be a symptom of the disease. If you do have breast pain, call your doctor for an appointment right away.
Treatment
The best treatment for your breast pain depends on what is causing it.
For both cyclic and noncyclic pain, reassurance and ruling out breast cancer is often a relief. If treatment is needed, there are effective treatment options.
Home Remedies
Many home remedies have been tried to decrease cyclic and noncyclic pain, sometimes with good results.
They include:
- Wearing a well-fitting bra: This can help contain painful breasts and keep them from being pulled uncomfortably.
- Practicing stress relief: Increased stress can affect hormone levels and lead to more discomfort.
- Exercising: Physical activity decreases estrogen, but it’s difficult to tell from studies if it really decreases mastalgia.
- Reducing caffeine and eating a low-fat diet: Studies are mixed on how well this works, but it may help some women.
Keeping a journal can also be helpful, especially if you’re trying to see a pattern in your symptoms, which is the best way to determine the kind of breast pain you have.
Medications
Easing pain with Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) is another option.
If these first-line interventions don’t help, your healthcare provider may suggest prescription medications like Nolvadex (tamoxifen) and Danocrine (danazol). All of these drugs have side effects of their own.
Studies appeared to show the greatest benefit with tamoxifen, but Danocrine is the only medication approved by the Food and Drug Administration (FDA) for treating mastalgia at this time.
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