Breast Pain Causes: Understanding Mastalgia, Hormones & Menopause

What Is Mastalgia?

Breast pain (mastalgia) is common and rarely a sign of cancer. It can be cyclical (linked to menstrual cycle) or non-cyclical.

Major Causes

• Hormonal Fluctuations: Estrogen/progesterone changes during menstrual cycle, perimenopause, menopause, or HRT cause ductal/glandular swelling.
• Breast Cysts: Fluid-filled sacs; often tender premenstrually.
• Fibrocystic Changes: Lumpiness, rope-like texture, tenderness; common 30s–50s.
• Medications: Hormonal contraceptives, HRT, antidepressants (SSRIs), some cardiovascular drugs.
• Other: Large breast size (strain on Cooper's ligaments), costochondritis (chest wall pain), trauma, infection (mastitis), referred pain (cervical spine, gallbladder).

When to See a Doctor

• Pain is severe, persistent (>2 weeks), or worsening
• New lump or thickening
• Nipple discharge (especially bloody or unilateral)
• Skin changes (dimpling, redness, ulceration)
• Pain localized to one spot

Treatment

• Supportive bra (professionally fitted)
• Warm/cold compresses
• OTC NSAIDs (ibuprofen) or topical diclofenac
• Evening primrose oil (GLA) or vitamin E (evidence mixed)
• Adjust hormones (if on HRT/contraceptives)
• Cyst aspiration if large/painful
• Treat underlying condition