Breast Pain (Mastalgia): Causes, Treatment, and When to Worry

Understanding Sore Breasts

Mastalgia affects up to 70% of women. Usually benign, cyclical.

Common Causes

• Cyclical hormonal – Estrogen/progesterone fluctuations (premenstrual, pregnancy, perimenopause).
• Cysts – Fluid-filled sacs; tender if large/superficial.
• Medications – Hormonal contraceptives, HRT, SSRIs, some cardiovascular drugs.
• Mastitis – Infection (lactating).
• Costochondritis – Chest wall pain mimicking breast pain.
• Rare: cancer – Usually painless, but inflammatory carcinoma can hurt.

Management

• Supportive bra (day + sleep).
• OTC NSAIDs/acetaminophen.
• Evening primrose oil / vitamin E (mixed evidence).
• Reduce caffeine, dietary fat (some benefit).
• Hormonal adjustment (OCP change, danazol for severe refractory).
• Cyst aspiration if symptomatic.

Red Flags – Urgent Evaluation

• Unilateral, persistent, non-cyclical pain.
• Palpable mass, skin changes, nipple discharge (bloody).
• Age >40 without recent mammogram.