Since starting medical school, I regularly receive texts from loved ones asking medical questions. They don’t deem these quite serious enough to necessitate an appointment with their doctors — but they do find them concerning enough to prompt a text to their friendly neighborhood medical student.
I love receiving these questions and the opportunity they present to learn more while helping people I care about at the same time.
The number one question plaguing my female friends? “Why, why, whydo my breasts hurt?” Quickly followed by, “Should I be worried?”
So let’s get to the bottom of this once and for all. What’s going on with breast pain, and when should you do something about it?
Why do my breasts hurt?
Breast pain can be anxiety-inducing, because your first thought might be cancer.
While it’s good to be vigilant and cautious when it comes to breast symptoms, the good news is that breast pain is very common. Most women (about 70%) have had breast pain, and it is rarely indicative of cancer. Breast pain is most commonly caused by the body’s natural physiology, though there are a few harmful causes to be aware of.
To start, there are some red flagfeatures of breast pain that cannot wait. If you have breast pain that affects only one breast or has associated symptoms such as a lump, skin changes or nipple discharge, contact your health care team.
Is there anything I can do for breast pain?
Learning your breast pain is not due to breast cancer may provide sufficient relief to not pursue further treatment. However, benign breast pain may still interfere with your social, sexual or physical activity enough to investigate further.
If so, talk with your health care team to make a plan. Wearing a well-fitting, supportive bra, applying warm and cold compresses, and using topical or oral pain medications may be enough. If you still have pain, additional medications could be considered.
Below are some questions to ask yourself to determine the cause of your breast pain and whether you should schedule a medical evaluation.
Is my breast pain cyclical?
Once you’ve ensured that you don’t have any of the red flag features mentioned above, the next step is to determine whether the timing of your symptoms line up with your period. If so, you could have the most common type of breast pain: cyclical breast pain.
This pain occurs in the days leading up to your period and usually involves both breasts rather than just one breast or one spot. Mild, symmetrical enlargement of the breasts also can occur.
When ovulation occurs on about day 14 of the menstrual cycle, the ovaries begin producing more progesterone and estrogen. As the body prepares for a possible pregnancy, these hormones stimulate the glands in the breast to grow and get ready for milk production. When the egg is not fertilized, meaning no pregnancy occurs, these hormone levels decrease, and you get your period. This signals to the breasts that there is no need for milk. The glands stop proliferating, and breast pain usually resolves.
Different breasts respond differently to these monthly hormone changes. Some people experience breast pain and enlargement while others experience no symptoms. If you have breast pain that occurs right before your period and resolves when your period starts, this is natural — and no cause for concern.
My breast pain isn’t cyclical — now what?
There are several possible causes of noncyclical breast pain. If your breast pain doesn’t match one of the below causes, this is considered a red flag and you should discuss your breast pain with your health care team.
Breast pain may be explained by:
Breast size. Large or heavy breasts can place stress on the supporting ligaments. Neck, back and shoulder pain can be associated with large breasts, as can headaches.
When was the last time you considered how your bras fit? Most women are walking around wearing bras that don’t fit them well. Wearing a well-fitting bra, especially a sports bra with good support during exercise, can alleviate pain caused by strain on the supporting ligaments.
Clothing. Ill-fitting clothing that rubs on the nipple can simulate the sensation of breastfeeding. This can trigger the body to secrete the milk-producing hormone prolactin, leading to breast enlargement and pain.
Hormonal medication. Birth control medication can contribute to noncyclical breast pain, though sometimes it alleviates it. People taking menopausal hormone therapy can experience noncyclical breast pain. This sometimes resolves on its own with time but may require adjusting the dose of the medication.
Breast cysts. Benign cysts are sometimes painful due to the pressure placed on the surrounding tissue. Even though breast cancer is rarely painful, you should always get evaluated if you experience breast pain in a localized spot.
Muscle or rib pain. Strain or soreness of the chest wall muscles, especially those between the ribs, can seem like breast pain. Repetitive activities such as raking, rowing, shoveling or weightlifting are often the culprit.
Breast pain also can stem from rib arthritis or inflammation of the cartilage that joins the ribs to the breastbone — a condition called costochondritis. Musculoskeletal causes of breast pain are usually addressed by stopping the aggravating activity and using over-the-counter anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others).
Nerve pain. Arthritis of the vertebrae of the neck or upper back and spasms of the muscles surrounding the vertebrae may pinch the nerves that exit the spinal cord and run along the ribs to the chest. This causes nerve pain that radiates to the chest and can be felt in the breasts. This is often a burning type of pain. Imaging, such as an X-ray or MRI, of the neck and midspine can help identify whether spine issues are causing your pain.
Ischemic heart disease. If you are experiencing any new chest pain, whether it feels like squeezing pressure or sharp stabbing pain, and especially pain that is worse when you are active, you should have a health care professional rule out heart disease. Women often have heart disease symptoms that are different from those of men. Sometimes upper abdominal pain, jaw pain, arm pain, nausea, sweating, or shortness of breath are symptoms of a heart attack in women. Seek medical care right away if you are experiencing these symptoms.
Mastitis. When breast tissue becomes infected, this is called mastitis. The milk ducts get inflamed and irritated, which presents as breast pain but with other symptoms, including warmth, tension in the breast and red overlying skin. Mastitis usually occurs in the setting of breastfeeding. This can sometimes resolve on its own or with conservative measures, such as applying a warm compress and wearing a supportive bra, but it may require a visit to your health care team for prescription medication.
Remember: It’s much more likely that your breast pain is unrelated to cancer, but that doesn’t mean you have to live with it — solutions are available.
Relevant reading
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