Breast pain and other breast changes that are usually not cancer

If your breasts feel sore and heavy in the days before a period, you’re in good company: the NHS says breast pain is usually linked to periods, and that breast pain by itself is unlikely to be a symptom of cancer. A few changes still need a closer look, and they’re set out near the end.

Pain that follows your cycle

Doctors call this cyclical (or cyclic) breast pain. The NHS describes it as pain that usually begins up to 2 weeks before a period, gets worse, and then goes away when the period ends. It tends to feel dull, heavy or aching. It usually affects both breasts and sometimes spreads into the armpit.

ACOG, the US college of obstetricians and gynaecologists, links cyclic pain to shifting hormone levels: the menstrual cycle itself, hormonal contraception and hormone therapy for menopause. The pain can also be sharp, burning or itchy, and one breast may hurt more than the other. It’s often worst just before a period starts and eases once bleeding begins.

Logging tender breasts alongside your period in Ruva gives you a record of whether the pain rises and falls with your cycle, which is one of the first things a GP or doctor will want to know.

Pain that doesn’t follow a pattern

Non-cyclical pain has nothing to do with your cycle. It usually sits in one specific area of one breast, and it can be there all the time or come and go. Injury, infection, medicines and large breast size can all cause it. In rare cases it can be caused by breast cancer, which is why ACOG suggests talking to your doctor about this type of pain.

Sometimes the pain starts somewhere else. Injuries or sprains to the neck, shoulder or back can be felt as breast pain, and so can shingles, where a painful blistering rash appears on the skin of the breasts.

Hormones, medicines and life stages

Breast tenderness often comes from hormone changes rather than anything in the breast itself.

• Contraception. The NHS and MedlinePlus both list the contraceptive pill as a cause of breast pain. MedlinePlus also notes that certain pills may help ease breast pain in other people.
• Pregnancy. Pregnancy is on the NHS list of causes, and tenderness tends to be more common in the first trimester. If you have breast pain with any signs of pregnancy, the NHS suggests seeing a GP; you could do a pregnancy test first.
• Perimenopause and menopause. The NHS includes hormone changes during the menopause as a cause.
• HRT. Both the oestrogen and the progestogen in HRT can cause breast pain or tenderness. The NHS says these side effects usually go away after a few weeks. Speak to a GP if they’re severe or last longer than 3 months.
• Other medicines. The NHS mentions some antidepressants. MedlinePlus lists others, including water pills (diuretics) and spironolactone.

If a medicine or your contraception seems to be the cause, talk to your GP, doctor or pharmacist before stopping it. They can suggest other options.

What can ease it

Paracetamol or ibuprofen can help (acetaminophen is the US name for paracetamol), as can a painkilling gel rubbed on the breasts. Follow the leaflet, and ask a pharmacist if you’re unsure which suits you. If you’re pregnant or trying to get pregnant, check with a pharmacist or doctor first: the NHS advises avoiding ibuprofen during pregnancy unless one of them recommends it.

A properly fitted bra during the day and a soft bra to sleep in can help. A supportive sports bra is another option, and heat or ice on the breast may help too.

Diet and supplements come up a lot. MedlinePlus says there is no good evidence that cutting down on fat, caffeine or chocolate reduces breast pain. Vitamin E, thiamine, magnesium and evening primrose oil are not harmful, but most studies have not shown any benefit, and the NHS also finds little evidence that vitamin E tablets or evening primrose oil help. Talk to a doctor or pharmacist before starting any supplement.

For severe pain, your doctor may prescribe medicines for a short time. If you use combined hormonal contraception, ACOG says taking it continuously may improve symptoms, so that’s worth raising with whoever prescribes it.

Lumps, cysts and lumpy breasts

The NHS puts it plainly: “Most breast lumps are harmless, but some can be serious.” It asks you to get any lump checked by a GP.

These are the common causes that aren’t cancer:

Change	What it is
Cyst	A build-up of fluid in a sac. If a cyst is large or uncomfortable, the fluid can be drained.
Fibroadenoma	A non-cancerous growth of breast tissue, which ACOG describes as a solid, well-defined lump.
Fibrocystic changes	Breast tissue with lumps or cysts that tend to be more tender just before a period. MedlinePlus calls this a common cause of breast pain.

The names are there to help you follow what a doctor tells you. They can’t sort out your own lump, by feel or by whether it changes with your cycle, and the NHS asks you not to try working out the cause yourself. Get any new lump checked rather than waiting to see if it goes away.

A few benign breast conditions can raise the risk of cancer in the future, so some people are offered follow-up checks or scans afterwards. Your clinician can tell you whether that applies to you.

Nipple discharge

Nipple discharge is more common if you’re pregnant or breastfeeding, but it can affect anyone. Common causes include a blocked or enlarged milk duct, a small non-cancerous lump called a papilloma, a breast infection, and medicines including the contraceptive pill. Because it can sometimes be a sign of breast cancer, the NHS and ACOG both say any nipple discharge should be checked.

According to ACOG, benign discharge tends to come from both breasts, only when squeezed, and is usually milky white or greenish. Discharge that is bloody or clear is more concerning.

When to get it looked at

Breast pain that comes and goes with your cycle is common. The changes below are the ones not to sit on.

Ask for an urgent GP appointment or contact NHS 111 in the UK, or see your doctor or an urgent care clinic in the US, if:

• part of your breast is red, hot or swollen
• you have breast pain with a very high temperature, or you feel hot, cold or shivery
• there’s a hard lump in your breast that doesn’t move around
• you have nipple discharge that may be streaked with blood
• one or both breasts change shape, the skin looks dimpled like orange peel, or there’s a rash on or around a nipple or it has sunk inwards

Book a GP appointment, or see your doctor, for any new lump in your breast or armpit, any other nipple discharge, pain that isn’t improving or isn’t helped by painkillers, breast pain with any signs of pregnancy (you could do a pregnancy test first), or breast pain when there’s a history of breast cancer in your family.

If you’re breastfeeding or recently gave birth, a painful, red, swollen area can be mastitis, which can come with flu-like symptoms such as fever and aches. Contact your doctor if you gave birth within the last week and your breasts are swollen or hard.

Call 999 now (UK) or 911 (US), or your local emergency number, if you’re unwell with a breast infection and you’re breathing very fast, become confused, or your skin looks blue, pale or blotchy. The NHS lists these as signs of sepsis, a serious reaction to an infection that can be life-threatening.

At the appointment, the GP or doctor will usually examine your breasts and may refer you for a mammogram or ultrasound. The NHS says these tests usually show that a lump is not cancer.