Breast pain

Pain alone is generally not a sign of breast cancer. Most women will experience breast pain or tenderness at some point in their lives. Usually this is related to normal hormonal changes in the menstrual cycle. Breast tenderness may develop in the second half of the monthly cycle, becoming worse in the days before the period starts. This is known as cyclical breast pain and it usually settles down again in the days following the period.

Cyclical breast pain:

• Usually occurs in both breasts
• Is often dull, heavy or aching
• May cause you breasts to appear swollen and feel lumpy.

Some tips for managing cyclical breast pain:

• Wear a supportive, well-fitted bra during the day, and at night if needed.
• Wearing a sports bra while exercising can be helpful.
• For moderate pain, over-the-counter medications such as paracetamol or ibuprofen may help. Anti-inflammatory gels rubbed into the skin might provide some relief.
• If the pain is more severe, it may be useful to keep a diary for one to two months to help doctors see if there are patterns to the pain, or triggers which could be avoided.
• The oral contraceptive pill, menopausal hormone therapy (MHT, also called hormone replacement therapy or HRT) and some antidepressants can make some breast pain worse, so discuss this with your doctor.

Non-cyclical breast pain or tenderness is not linked to your menstrual cycle. It may be constant or come and go, and can affect one or both breasts. It is more likely to affect women over the age of 40.

Pain in the breast tissue sometimes has no obvious cause. Pain that feels like it’s in your breast can sometimes come from elsewhere such as your chest wall, ribs, or neck. This is called referred pain, and it may be caused by an injury, muscle strain or inflammation where the ribs join the breastbone.

Breast pain and tenderness are common during early pregnancy and while breastfeeding, as the breasts often swell and become tender. Mastitis is a common infection that can cause inflammation of the breast tissue during breastfeeding. 

Having larger breasts can put extra strain on the tissue that supports them, which may cause pain.

See a GP if you have pain not related to your period that lasts for more than a week. They can prescribe pain relief medicines if needed, and can investigate the cause of the pain.

Periductal mastitis is when the milk ducts (tubes) under the nipple become swollen and infected.

Symptoms may include:

• A tender, hot or reddened breast
• Liquid (discharge) from the nipple which may or may not contain blood
• A lump behind the nipple
• A collection of pus (abscess)
• A small tunnel that forms between a milk duct and the skin (fistula).

Periductal mastitis is usually treated with antibiotics, but it can come back. If this happens repeatedly, surgery may be needed to remove the affected ducts. If you have pain, pain relief such as paracetamol can help.

A breast abscess is a painful pus-filled lump that develops under the skin of your breast, usually after mastitis.

Symptoms may include:

• A painful lump or swelling
• Skin that feels hot or looks red
• Pus or discharge from the nipple
• A fever, chills or feeling generally unwell.

See a GP if you have any of these symptoms. Treatment usually involves draining the pus with a needle. Sometimes a small cut is needed to drain it.

If you develop mastitis or a breast abscess when you are not breastfeeding, a doctor may arrange tests to check for an underlying cause.

Fibrocystic change is the most common cause of breast lumps in women aged 30–50. They are caused by breast tissue responding to normal hormonal changes and are most common before menopause. Fibrocystic changes can make the breasts feel tender, achy or lumpy. 

Lumps can change in size during the menstrual cycle and in some cases, you may notice green or brown discharge from your nipple without squeezing it. 

Mild discomfort may not need treatment. A supportive bra or pain medication like paracetamol can help. If you have a larger, painful cyst, your doctor may recommend draining the fluid with a needle. 

Fibrocystic changes are not breast cancer, and they do not increase your risk of developing breast cancer.

Breast cysts are fluid-filled sacs. You may have a single cyst or several different sized cysts.

They are most common in people over 35 and before menopause, although people taking menopausal hormone therapy (MHT, also called hormone replacement therapy or HRT), can also develop them. 

Some cysts are too small to feel. Large cysts may feel like a lump and can cause tenderness or discomfort. 

A doctor can’t tell for certain whether a lump is a cyst just by examining your breast alone. An ultrasound is usually needed to confirm whether the lump is solid or cystic (fluid-filled) and this should be performed before any cyst is drained. Sometimes a biopsy may also be recommended. 

Simple breast cysts often do not need treatment. If a cyst is very uncomfortable, it may be drained by a doctor to relieve pain. It’s common for breast cysts to come and go, decrease, refill, or return.