My Breasts Hurt All The Time But My Doctor Says I'm Fine, What Should I Do?
My name is Sarah Zimmerman, PA-C and I am a freelance writer and Physician Assistant. I recently started working in a breast center, and The SEAM editors have kindly asked me to write a regular column on all things breast related. I’m starting off with the basics but would also love to hear from readers. What would you like to know from ‘an insider?’
I aim to provide medical knowledge in direct and accessible ways. The fact is, breasts are complicated organs, and it’s easy to feel lost in the myriad diagnoses, tests, and treatment options. I’m here to try to make it all clearer.
The basics of benign breast pain
First, it’s important to know that up to 70% of women experience breast pain in their lives, especially from age 30-50, and that most of the time it is not an indication of cancer. It can however be extremely irritating and interfere with daily life.
The first thing to determine is if there is a pattern with the pain.
· Are there certain times of day or days of the month when the pain is most noticeable?
· Is the patient breastfeeding when the pain occurs or have they recently lactated?
· Are there any other activities that seem to elicit the pain?
· Is it in both breasts or just one?
· Is it consistently in the same spot or does it vary?
· Are any lumps or bumps present with the pain?
· Is there any discharge from the nipples?
· Does the skin look different?
When seeing a medical provider about breast pain, having answers to these questions will help them sort out what’s happening. Depending on the patient’s age and personal and family history, the provider should perform a breast exam and may order a breast ultrasound, mammogram, or other imaging, and sometimes, a breast biopsy. They may also recommend a breast specialist for further evaluation.
Although most breast pain is benign, whenever there’s a change in the breast that seems to be lasting or recurring, it’s important to rule out cancer. If, along with the pain, a lump is seen on imaging, a biopsy may be recommended to determine if the cells are cancerous, pre-cancerous, or benign. If nipple discharge is also happening, the color and consistency, frequency, and whether it’s occurring in one or both breasts will help the provider determine the cause. The skin on the breasts can also be a source of discomfort and concern with conditions like eczema or psoriasis causing irritation, or yeast infections under the breasts in larger-breasted people. A provider should evaluate these and treat them appropriately.
Once we know that the pain is benign, we can determine how to best manage it.
If breast pain occurs when a patient is lactating, it might be a sign of engorgement, overfull milk ducts, pain at the nipple from a difficult latch, or from mastitis, an infection of the breast tissue that occurs when a milk duct is blocked. In this case, the breast can become red, swollen, warm, and painful and the patient might feel achy all over, feverish, and generally miserable. An antibiotic is required in that case, and a plan to prevent the duct from clogging again. If an abscess forms, otherwise known as a galactocele in the milk ducts, it may require drainage or surgical removal. Lactation consultants and OBGYNs are typically the providers who help with all breast pain related to lactation issues, or a breast surgeon in the even that surgical intervention is required.
If the pain is unrelated to lactation, is present in both breasts, and comes and goes with the menstrual cycle, it is most likely related to fluctuating hormone levels. It’s common for breast tissue to feel more sensitive, swollen, and even painful while pregnant, on fertility treatments, while menstruating, or when taking the hormones estrogen and progesterone for contraception, during a transition in transgender women, or as hormone replacement therapy postmenopause. Although this pain is nothing to worry about, it can be annoying and might require switching to different hormones. Also, over-the-counter pain medications can help during the most difficult days and in general, reducing the amount of caffeine and salty and fatty foods consumed and avoiding smoking might make a difference.
Pain unrelated to hormones is more typically one-sided, and often due to an injury, infection, medication, or benign breast condition like a cyst or fibroadenoma. Bruises and other injuries, infections, and abscesses can occur in the breast tissue or chest musculature like anywhere else on the body, and should be treated appropriately. People with large breasts or who have undergone breast surgery like augmentation or reduction might find they have more breast pain and need additional support. Medications such as certain SSRI antidepressants, blood pressure medications, diuretics, and antibiotics may also cause breast tenderness. All side effects should be discussed with a provider.
A breast cyst is a fluid-filled sac in the breast tissue that, while non-problematic, can cause a great deal of discomfort, often enlarging and becoming more tender just before menstruation. They might feel hard or soft to the touch. Once these are evaluated and determined to be benign, the course of treatment might include aspirating, or removing the fluid with a thin needle under imaging guidance, or simply waiting and watching for it to resolve on its own. Some people have frequent cysts in their breasts. It’s important to be familiar with what’s normal and abnormal for each individual. A fibroadenoma is typically less painful and feels rubbery to the touch and moves freely. Depending on the size and nature of the fibroadenoma, the age and family history of the patient, these can be left alone or removed surgically. Some fibroadenomas pose an increased risk of later developing cancer, in which case they would be removed upon discovery and the patient would receive more cancer surveillance going forward.
In general, after ruling out cancerous or precancerous conditions, the best ways to manage benign breast pain are:
· Wear only properly fitting bras- get regularly updated fittings, and make sure the bra maintains its integrity and is appropriate for the task at hand (supportive sports bras with any exercise)
· Limit/eliminate caffeine- large caffeine intake exacerbates pain and cystic changes
· Follow a low-fat diet with more complex carbs
· Do not smoke
· Avoid excessive/prolonged lifting activities that may cause chest muscle strain
· Apply topical analgesics like Aspercreme, carefully try heat to the area (protect the skin)
· Consider vitamins and herbal remedies: Vitamin E and magnesium supplements, evening primrose oil
· Discuss pain management options with your provider- NSAIDS, Tylenol, and other prescription drugs may be necessary
· Avoid hormone therapy and medications that are known to cause breast pain, if possible
· Relaxation and complementary therapies
Breast pain can interfere with life in a big way and it’s critical to discuss it with an experienced provider. Investigating and finding solutions for our discomfort in and on our breast tissue provides us reassurance and relief. This is a common concern for so many people, we are not alone in our pain.
Sarah Zimmerman is a freelance writer in Northern California and is working on her first novel. In past lives,, she has been a Physician Assistant in Women's Health and the owner of a vegan ice cream business. Sarah writes about marriage, sex, parenting, infertility, pregnancy loss, social justice, and women's mental and physical health, always with honesty and humor. She has written for Ravishly, Cafe Mom, Pregnant Chicken, and more and can be found at sarahzwriter.com and on Medium, Twitter, Facebook, Instagram and TikTok at @sarahzwriter.