Breast Care A-Z · Symptom · BREASTPAIN

Breast pain

also: mastalgia, cyclical breast pain, non-cyclical breast pain, sore breasts

Breast pain (mastalgia) is common, usually benign, and only occasionally a sign of anything serious. You may have pain that has been bothering you and want to know whether it needs investigation, or you have been reassured it is likely harmless and want to understand why.

Quick answers

Should I worry about breast pain that comes and goes?

Cyclical breast pain that comes and goes with the menstrual cycle is usually benign — the most common cause of breast pain in pre-menopausal women. It is rarely associated with cancer. Pain that comes and goes without a clear menstrual pattern is also usually benign but is worth reviewing if it persists or is associated with any other feature.

What kind of breast pain should I worry about?

The pattern that warrants specialist review: focal, unilateral, persistent pain — particularly if associated with a lump, skin change, or nipple change, or in a postmenopausal patient. Most breast pain is not in this category, but where it is, prompt assessment is the right step.

Can stress cause breast pain?

Indirectly — stress can heighten the perception of any pain, including breast pain, and stress-related muscle tension in the chest wall can cause pain that feels like it is in the breast. Stress is not a primary cause of breast pain, but it can make existing pain feel worse.

ONCOLOGY · SYMPTOMATOLOGY breast pain mastalgia · mastodynia cyclical patterns, non-cyclical causes, and the reassurance of benignity PLATE XXXIII FIG 01 Breast anatomy with pain distribution i Cyclical diffuse tenderness ii Non-cyclical focal (UOQ) iii Chest wall origin iv Axillary extension v Skin sensitivity Cyclical zone Focal pain PANEL B — CYCLICAL TIMELINE Day 1 Day 14–28 (pain) · Peaks in luteal phase · Resolves with menstruation · Bilateral, often upper outer · Heaviness and nodularity Hormonally driven; peak age 20–40 yrs PANEL C — MANAGEMENT 1 · Reassurance + symptom diary 2 · Well-fitted bra + simple analgesia 3 · Topical NSAID (diclofenac gel) · Evening primrose oil: limited evidence · Danazol / tamoxifen: refractory cases FIG 02 Cyclical vs Non-cyclical mastalgia Cyclical mastalgia Non-cyclical mastalgia Timing Premenstrual No pattern Location Bilateral, diffuse Unilateral, focal Character Heaviness, tenderness Burning, aching Age peak 20–40 yrs 40–50 yrs Cycle link Yes, resolves post-period None Duration Days to weeks Weeks to months Triggers Hormonal changes Movement, pressure Associated Bloating, mood changes Nil specific Examination Generalised nodularity Focal tenderness Prognosis ~80% resolve Variable FIG 03 Reassuring vs Concerning features Feature Reassuring Concerning Pain character Cyclical, diffuse Persistent, focal Age Any (reproductive) Post-menopausal Lump None Palpable mass Skin Normal Tethering, dimpling Nipple Nil Discharge, inversion Examination Diffuse tenderness Hard, irregular Imaging Normal Suspicious finding Duration Cyclic >3 months persistent Response Improves cyclically No improvement FIG 04 Assessment pipeline STEP 1 Self-report diary › STEP 2 GP assess history › STEP 3 Examination breast › STEP 4 Imaging if indicated › STEP 5 Exclude Ca malignancy › STEP 6 Symptom Mx management Key: reassurance forms the cornerstone; imaging (USS ± mammogram) guided by age and examination findings. Refer to breast clinic if any clinical concern; most mastalgia managed successfully in primary care. Symptom diary: record severity (0–10), location, relation to cycle, triggers, for minimum 2–3 months Imaging threshold: USS preferred under 35 yrs; mammogram + USS for 35 and over with focal pain Red flags: palpable lump, skin change, nipple discharge — refer under 2WW pathway NB: Breast pain alone is rarely the sole presenting feature of malignancy (<3% of cases) FIG 05 Atlas — causes of breast pain Cyclical mastalgia Hormonal, luteal phase; bilateral upper outer ~ Non-cyclical Focal, unilateral; no relation to cycle fx Costochondritis Chest wall; tender on sternal palpation CW Tietze syndrome Costochondral swelling; visible, palpable Tz Drug-induced OCP, HRT, SSRIs; review medication Rx Post-surgical Scar pain, nerve damage, neuroma Sx FIG 06 Key statistics 70% is cyclical of breast pain [1] 80% resolve conservative Rx [2] <3% malignancy association rate [3] 15% severe cases disabling pain [4] FIG 07 References 1. Srivastava A et al. Mastalgia: an updated approach to assessment and management. Breast 2007;16(3):227–238 2. Mansel RE. ABC of breast diseases. BMJ Books 2009 3. NICE CG101. Early and locally advanced breast cancer: diagnosis and management. 2023 4. Smith RL et al. Evaluation and management of breast pain. Am Fam Physician 2004;71(9):1731–1738 5. Dixon JM. Breast surgery: a companion to specialist surgical practice. Edinburgh: Elsevier 2012 All information for educational purposes. Clinical decisions should be based on individual patient assessment and current guidelines. Content reviewed against NICE CG101, NHSBSP guidance, and current breast surgery literature. Breastory Encyclopedia of Breast Health. For professional and educational reference only. Please review the latest clinical guidelines and literature for up-to-date management protocols. Clinically authored by Dr Fiona Tsang-Wright , FRCS (Gen Surg) GMC 4549831 · ORCID 0000-0003-4801-026X
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Definition
Breast pain — also called mastalgia — is one of the most common breast symptoms, usually benign and most often hormonal in origin, with cyclical breast pain (linked to the menstrual cycle) being the commonest pattern.

Common questions The questions patients ask first

Should I worry about breast pain that comes and goes?
Cyclical breast pain that comes and goes with the menstrual cycle is usually benign — the most common cause of breast pain in pre-menopausal women6. It is rarely associated with cancer2. Pain that comes and goes without a clear menstrual pattern is also usually benign but is worth reviewing if it persists or is associated with any other feature1.
What kind of breast pain should I worry about?
The pattern that warrants specialist review: focal, unilateral, persistent pain — particularly if associated with a lump, skin change, or nipple change, or in a postmenopausal patient. Most breast pain is not in this category, but where it is, prompt assessment is the right step.
Can stress cause breast pain?
Indirectly — stress can heighten the perception of any pain, including breast pain, and stress-related muscle tension in the chest wall can cause pain that feels like it is in the breast. Stress is not a primary cause of breast pain, but it can make existing pain feel worse.
Why does only one breast hurt?
Unilateral pain is more often non-cyclical and is sometimes worth investigating. The most common causes are still benign — fibrocystic changes more concentrated on one side, an inflammatory area, or referred pain from the chest wall. Persistent unilateral pain warrants clinical review.

Breast pain — also called mastalgia — is one of the most common breast symptoms, usually benign and most often hormonal in origin, with cyclical breast pain (linked to the menstrual cycle) being the commonest pattern.

Breast pain is rarely a sign of breast cancer — most cancers do not cause pain, and most painful breasts do not have cancer2. Most breast pain is cyclical (related to hormonal changes in the menstrual cycle) and settles with simple measures. Pain that is focal, persistent, or associated with a lump or other change is the kind that warrants specialist assessment16.

Orientation Why you might be reading about this

You may have breast pain that has been bothering you and want to know whether it warrants investigation, or you have been reassured that the pain is likely benign and want to understand why. Breast pain can be one of the more anxiety-inducing breast symptoms simply because it is felt continuously; understanding what kind of pain matters and what kind does not is the most useful thing this page can do.

Related terms: Breast lump · Breast cyst · Mammogram · Core biopsy · Triple assessment

Two patterns The two main patterns of breast pain

Breast pain is conventionally divided into two patterns based on its relationship to the menstrual cycle:

Cyclical breast pain

The most common pattern — pain that changes with the menstrual cycle, typically:

  • Worse in the days before the period.
  • Settles or disappears during or after the period.
  • Often bilateral (both breasts) and diffuse (all over rather than in one spot).
  • Often described as heaviness, tenderness, or aching rather than sharp pain.
  • Usually associated with breast lumpiness or fullness.

Cyclical breast pain is driven by the hormonal changes of the menstrual cycle and is almost never associated with breast cancer26. It can range from mild to severe, with severe cases significantly affecting daily life. It usually settles after the menopause, though hormone replacement therapy can prolong it.

Non-cyclical breast pain

Pain that does not vary with the menstrual cycle:

  • May be unilateral (one side) or focal (in one specific area).
  • May be constant or come and go without a clear pattern.
  • Sometimes feels like it is in the breast but is actually coming from elsewhere — chest wall, ribs, shoulder, or spine (referred pain).

Non-cyclical pain is also usually benign, but the threshold for investigation is lower — particularly if it is focal, persistent, or associated with a lump or other change.

A third category — extra-mammary pain

Some pain that is felt in the breast actually originates in the chest wall (costochondritis, intercostal neuralgia), the shoulder/cervical spine, or gallbladder (right-sided). These are sometimes called extra-mammary causes. A clinical examination usually distinguishes them — pain that is reproduced by pressing the chest wall but not the breast tissue itself is a strong clue.

Reassurance What breast pain rarely is

Some myths worth dispelling:

  • Cancer rarely causes pain in its early stages. Most early breast cancers are painless2. A painful lump is usually less worrying than a painless one — though painful lumps still warrant assessment.
  • Caffeine, chocolate, and dietary triggers have not been shown in good evidence to cause cyclical breast pain3. Cutting them out is harmless if it helps an individual, but it is not a treatment.
  • Bra fitting is one of the few simple measures with consistent evidence — a well-fitted bra reduces cyclical breast pain in many patients5.

When to act When breast pain warrants assessment

Most breast pain does not need specialist referral1. Patterns that do warrant assessment16:

  • Focal, persistent unilateral pain that has not settled over several weeks.
  • Pain associated with a lump, skin change, nipple change, or any other concerning feature.
  • Pain that is severe enough to disrupt daily life despite first-line measures.
  • Pain in a postmenopausal patient (cyclical pain is rare after the menopause; new pain warrants imaging).
  • Pain in a patient with a strong family history or known high-risk genetic mutation, where the threshold for imaging is lower.

The standard assessment is the same as for any new breast symptom: examination, imaging (ultrasound and/or mammogram depending on age), and biopsy where indicated — see triple assessment.

Management Managing cyclical breast pain

For typical cyclical pain that has been clinically reviewed and has no concerning features:

  • Well-fitted, supportive bra — including a sports bra at night during the worst phase of the cycle5.
  • Simple analgesia — paracetamol or ibuprofen during the symptomatic phase.
  • Topical NSAIDs — gel preparations (diclofenac, ibuprofen) applied to the breast can be effective with fewer systemic side effects4.
  • Evening primrose oil — modest evidence of benefit; safe to try3.
  • Reviewing hormonal contraception or HRT — if pain coincided with starting one of these, an alternative may help.
  • In severe cases, prescription options (danazol (the only UK-licensed option for severe mastalgia, specialist-initiated), tamoxifen used off-label under specialist supervision (typically 10 mg daily for 3–6 months), and bromocriptine (now rarely used). These require counselling about side effects and contraception3.

For most patients, simple measures and the reassurance that the pain is benign are enough. Specialist referral for breast pain alone, without other features, is rarely needed.

Next steps What to do next

For breast pain that fits the typical cyclical pattern in a younger patient:

  • Try the simple measures above.
  • See your GP if the pain is severe, persistent, or affecting daily life.
  • See your GP promptly if you notice any associated change — a lump, skin change, nipple discharge, or any new feature alongside the pain.

For breast pain in a postmenopausal patient, focal pain that does not settle, or pain with any associated finding — see your GP for clinical review and onward referral if indicated. The route into a one-stop breast clinic is usually through your GP.

Resources Further reading

Sources & guidance

Every figure on this page is anchored to a published source. Tap a number in the text or below to jump to the reference.

  1. guideline National Institute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral (NG12). London: NICE. 2015 ;Last updated 2023; section 1.6 Breast cancer https://www.nice.org.uk/guidance/ng12 Cited for: UK referral thresholds for breast symptoms; breast pain alone (without other features) is not, on its own, a 2-week-wait indication.
  2. cohort Barton MB, Elmore JG, Fletcher SW. Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Annals of Internal Medicine. 1999 ;130(8):651–657 doi:10.7326/0003-4819-130-8-199904200-00005 Cited for: Population frequency of breast pain as a presenting symptom; low malignancy yield from breast pain in isolation.
  3. meta analysis Groen JW, Grosfeld S, Wilschut JA, Bramer WM, Ernst MF, Mullender MM. Cyclic and non-cyclic breast-pain: a systematic review on pain reduction, side effects, and quality of life for various treatments. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017 ;219:74–93 doi:10.1016/j.ejogrb.2017.10.018 Cited for: Evidence base for treatments of mastalgia (NSAIDs, evening primrose oil, danazol, tamoxifen, bromocriptine); side-effect profiles.
  4. rct Colak T, Ipek T, Kanik A, Ogetman Z, Aydin S. Efficacy of topical nonsteroidal antiinflammatory drugs in mastalgia treatment. Journal of the American College of Surgeons. 2003 ;196(4):525–530 doi:10.1016/S1072-7515(02)01893-8 Cited for: Topical diclofenac/ibuprofen reduces cyclic and non-cyclic mastalgia severity vs placebo.
  5. cohort Hadi MS. Sports brassiere: is it a solution for mastalgia? The Breast Journal. 2000 ;6(6):407–409 doi:10.1046/j.1524-4741.2000.20018.x Cited for: Well-fitted supportive bra reduces mastalgia symptoms in a substantial proportion of women.
  6. guidance Royal College of Surgeons / Association of Breast Surgery. Best Practice Diagnostic Guidelines for Patients Presenting with Breast Symptoms. London: ABS. 2010 ;Section: mastalgia https://associationofbreastsurgery.org.uk/professionals/information-hub/guidelines/2010/best-practice-diagnostic-guidelines-for-patients-presenting-with-breast-cancer-symptoms Cited for: UK clinical pathway for breast pain; reassurance, examination, imaging only where features warrant.