Aching breasts are a fact of life for many women. Around 70 per cent experience breast pain, also known as mastalgia, at some time, according to the National Institute for Health and Care Excellence (NICE) – with twinges, aches and tender spots most common every month with their period.
Around 120,000 women every year are referred to specialist NHS clinics for further investigations as a result of breast pain.
But it can be severe and affect their quality of life, as Dr Karen Morton, a consultant gynaecologist based in Surrey, explains: ‘For some women, breast pain can be severe and yet many feel they have to grin and bear it. Others may feel embarrassed discussing it.
‘But if it’s stopping you from doing everyday activities, seek help.’
While most breast pain is benign, ‘occasionally it can be a warning of something more serious’, says Dr Morton. ‘For example, one-sided pain may be a sign of breast cancer.’
Reassuringly, this is rare: only 2 per cent of breast-pain cases are due to cancer, adds Professor Kefah Mokbel, a consultant breast surgeon at the London Breast Institute.
While any new, persistent breast pain should always be reported to your GP, it can be caused by everything from cysts to muscle strain and wearing the wrong bra.
Here’s a guide to what could be the culprit – and the treatment options.
Around 70 per cent of women experience breast pain, also known as mastalgia, at some time in their lives, according to NICE
Sign: Painful lump with distinct edges that can feel soft and may move about under the skin
Could be: Cyst
‘Breasts are complicated, dynamic structures made up of fat and glandular issue,’ explains Dr Morton. ‘If one of the milk-producing glands or channels that carries milk to the nipples become blocked – which can happen due to normal changes as milk ducts shorten and widen as women age – an accumulation of fluid can lead to a cyst.’
Breast cysts most often affect women aged 35 to 50 who are still having periods.
‘A breast cyst is not usually dangerous, but women may notice that it is more tender or enlarged in the days before their period,’ says Dr Lucy Lord, a consultant obstetrician and gynaecologist and women’s health lead at Central Health London.
Having a cyst does not increase cancer risk – but a woman who has a cyst can still develop cancer, so any new lump must always be checked.
Treatment: Painkillers may help ease symptoms. Cysts can disappear on their own, or need to be drained in clinic.
Sign: Lumpy, tender breasts before a period
Could be: Fibrocystic changes
‘If your breasts feel lumpy, tender or swollen before your period, you may be experiencing fibrocystic changes. These are a combination of fluid-filled sacs (i.e. cysts) and thickened fibrous tissue (similar to the tissue of scars or ligaments in your body),’ says Dr Lord.
‘This can cause breasts to feel rubbery or rope-like, with multiple soft lumps that may vary in size and often move slightly under the skin.
‘These changes are usually most noticeable in the upper, outer areas of the breast and can come with a feeling of fullness or discomfort.’
The exact cause isn’t fully understood, but a genetic predisposition to reacting more strongly to fluctuating hormones plays a part.
‘Fibrocystic changes don’t increase your risk of breast cancer,’ says Dr Lord, ‘but they can make it harder to detect suspicious lumps, so it’s important to be aware and to report any changes to your doctor’.
TREATMENT: ‘Fibrocystic breasts are generally manageable with painkillers and often improve after menopause unless women take hormone therapy,’ says Dr Lord.
Sign: Pain with redness, swelling or tenderness
Could be: Infection
‘One common infection that mainly affects women who are breastfeeding is mastitis,’ says Professor Mokbel. The most common cause of mastitis is oversupply of milk that stays in the breast, putting pressure on the surrounding tissue.
This, in turn, causes milk ducts to narrow, which leads to breasts being extremely full and swollen. A bacterial infection can then take hold, especially if the ducts are blocked.
The most common bacteria that leads to mastitis is Staphylococcus aureus, which are found on normal skin and can enter through a break or crack, usually on the nipple.
Burning pain, flaky nipples and shooting pains inside the breast could signal a yeast infection – thrush – which can occur during breastfeeding. (Your baby may have white patches in their mouth, too.)
Treatment: ‘Left untreated, mastitis can turn into an abscess or even sepsis,’ says Dr Lord. A GP will usually prescribe antibiotics. Abscesses need to be drained, often via a needle. Larger abscesses may require a small cut and drainage.
Breast and nipple thrush is treated with antifungal medicine and antifungal nipple gel/creams.
Sign: Tenderness (heaviness, tightness or dull ache) normally before a period
Could be: Hormonal
This is the most common cause of breast pain – it reportedly affects two-thirds of women – and is due to a rise in oestrogen and progesterone right before your period.
‘These hormones cause your breasts to swell and can lead to tenderness – which then eases when the period starts as these hormone levels fall again during menstruation,’ says Professor Mokbel.
‘It is usually felt as heaviness, tightness or a dull ache, especially in the upper outer part of the breast, and can affect one or both sides,’ adds Dr Lord.
It can also affect women in perimenopause, she adds, as ‘the expansion and shrinking of breast tissue in response to oestrogen and progesterone can feel more uncomfortable, due to age-related changes that include more thickened, fibrous tissue that feels harder and stiffer to the touch. For many, this is a ‘perfect storm for breast pain’.
Treatment: Depending on the individual, topical non-steroidal anti- inflammatory drugs (e.g. ibuprofen gel) may help. Doctors may also advise adjusting birth control pills or changing HRT medication.
Research has shown that tamoxifen, which is used to treat breast cancer and works by blocking the hormone oestrogen, is also effective in treating cyclical breast pain, so it’s sometimes prescribed – although side-effects can include hot flushes, night sweats and mood changes.
Some women have success using evening primrose oil capsules over a few months, thought to work by boosting levels of a fatty acid called gamolenic acid; low levels have been linked to cyclical breast pain.
Sign: Tenderness after starting a new prescription
Could be: Side-effect of medication
The oral contraceptive pill, HRT and some antidepressants – e.g. selective serotonin reuptake inhibitors (SSRIs) – can make some breast pain worse. The theory is that these drugs may interfere with the normal processing of prolactin – a hormone that affects breast tissue.
This breast tenderness may occur if a woman starts a contraceptive pill or HRT; the breasts may become uncomfortable ‘but this will usually settle’ says Dr Morton.
‘Breasts become very “quiet” after menopause unless a woman is taking HRT. There is nothing stimulating them.’
Treatment: Tenderness related to the Pill usually settles within months, but if it doesn’t then a different formulation could be tried, advises Dr Lord.
Tenderness related to SSRIs is quite rare, but if it does not resolve in time, then again another medication could be tried.
Sign: Achy breasts – especially worse at the end of the day
Could be: Exercise
Without proper support, the ligaments that connect breasts to the chest wall can become over-stretched and painful by the end of the day. The result is achy, sore breasts. This may be especially noticeable during exercise.
A study by St Mary’s University of female marathon runners recently found that a third experienced breast pain while exercising. More than half said it brought discomfort and a further 21 per cent said it caused distress, was horrible or excruciating.
It is also the first piece of research that identifies that pain increases with breast size.
Dr Nicola Brown, an associate professor in women’s health and performance, who led the study, described the results as ‘shocking’, and said: ‘The link between breast pain and exercise has not been formally established, but given so many women identified exercise as the most likely cause of their pain, this has implications for breast pain management.’
Treatment: The best way to avoid breast pain when running or doing serious exercise is by investing in a supportive, well-fitted sports bra, says Dr Morton.
Sign: Sharp pain, which worsens when moving or breathing
Could be: Referred pain
‘Not all breast pain is caused by breast problems,’ says Dr Lord.
‘Back problems, either due to arthritis or disc inflammation or trapped nerves, can give rise to pain perceived to be in breast tissue. This pain is often worse on movement or changes in posture.’
Referred pain from the chest wall is common and can be due to trauma or muscle strain after repeated upper-body activity. ‘The ribcage is made up of cartilage and bone – costochondritis [inflammation where the ribs join the bone in the middle of the chest] can also give rise to pain perceived as breast pain,’ says Dr Lord.
‘It is usually sharp, severe and the pain is made worse by pushing on the bony areas of the ribs rather than breast tissue.
‘Rarely heart attacks, pulmonary embolism [clots in the lung] and other serious conditions can be mistaken for breast pain.’
Treatment: Professor Mokbel adds: ‘Costochondritis, which tends to affect people over the age of 40 and particularly those doing high-impact sports such as weightlifting, usually goes away on its own after about six weeks, and seldom comes back.’ In the short term, ibuprofen can help.
Sign: A hard and painful lump causing persistent, sharp pain
Could be: Related to breast implants and breast surgery
Breast surgery, including mastectomies, can also lead to nerve damage around the chest wall, which can cause pain that radiates through the chest or the breast and down one arm.
Also, breast augmentation – the most frequently performed aesthetic surgical procedure in the UK, with around 7,000 operations in 2022 – can lead to this pain.
As Professor Mokbel explains: ‘Pain can occur in women with larger implants or post-mastectomy reconstruction, often due to capsular contracture, when the scar tissue naturally forming around a breast implant becomes unusually hard – leading to nerve irritation in the chest area.
‘Most cases are not serious, but any new or persistent pain in reconstructed breasts should be assessed for complications.’
Treatment: With nerve damage, the nerves usually repair themselves, but it can take months for pain to settle and it may be permanent. Medications, including amitriptyline, duloxetine, gabapentin or pregabalin, may help.
Regular breast self-massage after implant surgery can maintain the softness of the capsule, potentially reducing the risk of capsular contracture, says Professor Mokbel.
For serious cases, the implant may need to be surgically replaced.
Sign: Pain where straps are tight, chafing and achiness
Could be: Badly fitting bra
As women age, breasts may increase in size, particularly after pregnancy and breastfeeding, and many don’t wear well-fitting bras.
According to research, including a study published in Chiropractic & Osteopathy in March 2008, up to 80 per cent of women wear the wrong bra size. A lack of proper support may result in pain as well as irreversible sagging.
The breast has no muscles and relies on the skin and Cooper’s ligaments – thin, paper-like tissues that weave throughout the breast and attach to the chest wall.
It’s thought sagging, which is irreversible, occurs when these ligaments are overstretched.
Treatment: ‘Chafed skin can be treated with a topical painkiller such as Lanacane anti-chafing gel – and wear loose-fitting underwear until the skin heals,’ advises pharmacist Sultan Dajani.
IT WAS DENSE TISSUE – NOT CANCER
Stacey Buckley, 34, a fitness instructor, lives in Stoke. She says:
Last November I suddenly developed a burning sensation in my left breast. I work as a fitness instructor and am always lifting weights, so assumed I’d pulled something.
I tried some homeopathic remedies, but it got worse. I Googled my symptoms, sillily, and saw that changes in sensation can be a sign of breast cancer – but I tried not to panic and carried on to see if it would pass. After about four months, the pain got worse – it started passing through to my back and it hurt to lie down. I thought with horror that I must have cancer and went to my GP, who referred me for a fast-track ultrasound.
Fitness instructor Stacey Buckley urges women to get any breast symptoms checked out
The sonographer said it was just dense, fatty tissue – not cancer – that was responsible for the pain and it was nothing to worry about. I was told to just take painkillers.
I wasn’t convinced and went private to get a second opinion; but again the scan revealed lots of fatty tissue. They told me my pain could be worse because I don’t hold a lot of body fat on my chest.
The pain gets me down from time to time, as I can’t sleep on my left side and can only wear a soft sports bra – but I can carry on knowing its nothing serious. I’d urge women to have any pain or symptom in the breast checked.
Interview by Julie Cook
