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Definition

Breast pain is any discomfort or pain in the breast.

Considerations

There are many possible causes for breast pain. For example, changes in the level of hormones during menstruation or pregnancy often cause breast pain. Some swelling and tenderness just before your period is normal.

Some women who have pain in one or both breasts may fear breast cancer. However, breast pain is not a common symptom of cancer.

Causes

Some breast tenderness is normal. The discomfort may be caused by hormone changes from:

• Menopause (unless a woman is taking hormone replacement therapy)
• Menstruation and premenstrual syndrome (PMS)
• Pregnancy -- breast tenderness tends to be more common during the first trimester
• Puberty in both girls and boys

Soon after having a baby, a woman's breasts may become swollen with milk. This can be very painful. If you also have an area of redness, call your health care provider, as this may be a sign of an infection or other more serious breast problem.

Breastfeeding itself may also cause breast pain.

Fibrocystic breast changes are a common cause of breast pain. Fibrocystic breast tissue contains lumps or cysts that tend to be more tender just before your menstrual period.

Certain medicines may also cause breast pain, including:

• Oxymetholone
• Chlorpromazine and other antipsychotic medicines
• Water pills (diuretics)
• Digitalis preparations
• Methyldopa
• Spironolactone
• Oral contraceptives
• Estrogen replacement therapy
• Selective serotonin reuptake inhibitors, such as fluoxetine

Shingles can lead to pain in the breast as there is a painful blistering rash that appears on the skin of your breasts.

Home Care

If you have painful breasts, the following may help:

• Take medicine such as acetaminophen or ibuprofen
• Use heat or ice on the breast
• Wear a well-fitting bra that supports your breasts, such as a sports bra

There is no good evidence to show that reducing the amount of fat, caffeine, or chocolate in your diet helps reduce breast pain. Vitamin E, thiamine, magnesium, and evening primrose oil are not harmful, but most studies have not shown any benefit. Talk to your provider before starting any medicine or supplement.

Certain birth control pills may help ease breast pain, although in other cases it may cause breast pain. Ask your provider if this therapy is right for you.

When to Contact a Medical Professional

Contact your provider if you have:

• Bloody or clear discharge from your nipple
• Given birth within the last week and your breasts are swollen or hard
• Noticed a new lump that does not go away after your menstrual period
• Persistent, unexplained breast pain
• Signs of a breast infection, including redness, pus drainage, or fever

What to Expect at Your Office Visit

Your provider will perform a breast examination and ask questions about your breast pain. You may have a mammogram or ultrasound.

Your provider may arrange a follow-up visit if your symptoms have not gone away in a given period of time. You may be referred to a specialist.

References

Family Practice Notebook website. Medication causes of mastalgia: breast pain due to medication. fpnotebook.com/Gyn/Sx/Mstlg.htm. Accessed January 1, 2023.

Klimberg VS, Hunt KK. Diseases of the breast. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 35.

Sandadi S, Rock DT, Orr JW, Valea FA. Breast diseases: detection, management, and surveillance of breast disease. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 15.

Sasaki J, Geletzke A, Kass RB, Klimberg VS, Copeland EM, Bland KI. Etiology and management of benign breast disease. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 5.

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