Breast pain is one of the most common breast complaints that women experience, and it is also one of the most misunderstood. Many women worry that breast pain means something serious. In the vast majority of cases, it has a benign cause and is not associated with breast cancer.

That said, breast pain that is new, persistent, worsening, or accompanied by other symptoms deserves proper assessment. At Breast & Surgical Oncology at The Poche Centre, our specialist breast physicians assess and manage breast pain (medically known as mastalgia) as part of everyday practice. We can help identify the cause, provide reassurance where appropriate, and offer effective treatment when needed.

How Common Is Breast Pain?

Breast pain is extremely common. Up to 70% of women will experience breast pain at some point during their lives, and for many it is a recurring issue. Despite how frequently it occurs, breast pain is significantly under-reported — many women either dismiss it as normal, or delay seeing a doctor out of fear of what they might be told.

The good news is that in the overwhelming majority of cases, breast pain is not caused by cancer. When breast pain is the only symptom — with no lump, no skin change, and no nipple change — the likelihood of cancer is very low. However, a thorough assessment is always worthwhile to establish the cause and provide appropriate treatment.

Types of Breast Pain

Breast pain broadly falls into two categories, and distinguishing between them is an important first step in assessment and management.

Cyclical Mastalgia

Cyclical mastalgia is the most common type and is directly linked to the hormonal fluctuations of the menstrual cycle. It typically occurs in the days leading up to menstruation — when oestrogen and progesterone levels are elevated — and resolves once the period begins.

Women with cyclical mastalgia often describe a sensation of heaviness, swelling, tenderness, or aching in both breasts, most commonly in the upper outer areas. The pain may radiate into the armpit or arm. It can range from mild and manageable to severe enough to interfere with daily activities, sleep, and quality of life.

Cyclical breast pain is most common in women of reproductive age, it can get worse during perimenopause and tends to improve or resolve after menopause. It is very rarely associated with cancer.

Non-Cyclical Mastalgia

Non-cyclical mastalgia does not follow the pattern of the menstrual cycle. It may be constant or intermittent, can affect one or both breasts, and is often localised to a specific area rather than being diffuse.

Non-cyclical pain tends to affect women in their 40s and 50s and may have a number of different causes. Unlike cyclical pain, non-cyclical mastalgia can sometimes be harder to treat, as identifying the underlying cause requires a more thorough investigation.

Extramammary Pain (Pain From Outside the Breast)

Not all pain that appears to come from the breast actually originates there. Pain from the chest wall muscles, ribs, cartilage, or joints can be felt in the overlying breast tissue and is easy to mistake for breast pain proper. This is known as extramammary or musculoskeletal breast pain — sometimes called costochondritis or Tietze's syndrome when the cartilage connecting the ribs to the breastbone is inflamed.

Extramammary pain is typically reproduced when pressure is applied to the chest wall rather than the breast tissue itself, and is often worse with movement or physical activity. It generally responds well to anti-inflammatory treatment.

What Causes Breast Pain?

Breast pain can arise from a variety of causes, and in many cases the precise cause is not entirely clear. Factors that may contribute to or trigger mastalgia include:

Hormonal fluctuations — the cyclical variation in oestrogen and progesterone throughout the menstrual cycle is the most common driver of breast pain. The breast tissue is highly sensitive to these hormonal shifts, particularly in the upper outer quadrant where glandular tissue is densest.

Hormonal medications — the oral contraceptive pill, menopause hormone therapy (MHT, previously known as HRT), and fertility treatments can all trigger or worsen breast pain. If pain began or worsened after starting a new hormonal medication, this is worth discussing with your doctor.

Breast cysts — fluid-filled cysts can cause localised tenderness or pain, particularly if they enlarge rapidly or become under tension. Draining the cyst often provides immediate relief.

Large breast size (macromastia) — women with larger, heavier breasts are more prone to non-cyclical pain due to the physical strain placed on the supporting ligaments and chest wall muscles. A well-fitted bra that provides proper support can make a significant difference.

Musculoskeletal causes — strained chest wall muscles from exercise, heavy lifting, or physical injury are a common and frequently overlooked cause of apparent breast pain.

Mastitis — infection of the breast tissue, most often in breastfeeding women, can cause significant localised pain, warmth, and redness.

Previous breast surgery or biopsy — scar tissue from prior procedures can occasionally cause localised discomfort.

Caffeine and diet — some women report that reducing caffeine intake helps with cyclical breast pain, though the evidence for this is limited.

How Is Breast Pain Assessed?

Keep a Breast Pain Diary

Before your appointment, it can be very helpful to track your pain over several weeks using a simple diary or calendar. Note the days when pain is present, how severe it is (on a scale of 1–10), which breast or area is affected, and where it falls in your menstrual cycle. This information helps your specialist quickly identify whether the pain is cyclical or non-cyclical and guides the assessment and management approach.

Clinical Assessment

Your specialist will take a detailed history, including the nature, location, duration, and pattern of your pain, your menstrual history, any medications you are taking, and your personal and family history of breast conditions. A thorough clinical breast examination will follow.

Imaging

Depending on your age, symptoms, and clinical findings, your specialist may recommend a mammogram, ultrasound, or both. Imaging helps to exclude an underlying lesion that may be contributing to the pain and provides reassurance when the results are normal.

Biopsy

Biopsy is not routinely required for breast pain, but may be recommended if a suspicious lump or area is identified during examination or imaging.

Treating Breast Pain

The right treatment for breast pain depends on its type and underlying cause. Many women find that reassurance alone — knowing that the pain is benign and not a sign of cancer — significantly reduces their distress and perceived pain levels.

Supportive bra — one of the most effective and underrated interventions for breast pain is wearing a well-fitted, supportive bra, especially during exercise. For women with larger breasts, proper bra support can dramatically reduce both cyclical and non-cyclical pain. A professionally fitted sports bra is particularly helpful. Some women find that wearing a soft bra at night also helps.

Topical anti-inflammatory gel — applying a topical non-steroidal anti-inflammatory drug (NSAID) gel directly to the painful area is an effective and well-evidenced treatment for localised breast pain, particularly non-cyclical or musculoskeletal pain. It avoids the systemic side effects of oral pain relief.

Oral pain relief — paracetamol or oral NSAIDs such as ibuprofen can help manage musculoskeletal and non-cyclical breast pain. These are most useful for pain that is intermittent or related to specific activity.

Lifestyle modifications — some women find that reducing caffeine, wearing a supportive bra more consistently, and managing stress helps reduce cyclical pain. While the evidence for dietary changes is limited, they carry no risk and are worth trying.

Oral contraceptive pill — some women with cyclical mastalgia experience improvement on a low-dose oral contraceptive pill by stabilising hormonal fluctuations. However, for other women the pill makes breast pain worse, so this is always an individual decision made in consultation with your doctor.

Evening primrose oil — widely used by women for cyclical breast pain, though high-quality clinical evidence for its effectiveness is limited. It is safe to take and may offer benefit for some women.  We usually recommend 1000mg three times a day, taken for at least 6 weeks.

Aspiration of breast cysts — if a cyst is identified as the source of pain, draining it under ultrasound guidance typically provides rapid and effective relief.

Hormonal medications — for severe mastalgia that significantly impacts quality of life and has not responded to other measures, medications such as danazol or tamoxifen may be considered. These are effective but carry a risk of significant side effects and require careful specialist supervision. They are reserved for cases where pain is genuinely debilitating and other treatments have failed.

When Should I See a Specialist About Breast Pain?

Most breast pain does not require specialist review — a GP assessment and reassurance is often sufficient. However, you should seek specialist assessment if:

• Your pain is new, severe, or worsening
• The pain is localised to one specific area and persistent
• Pain is accompanied by a lump, skin change, or nipple change
• The pain is not following a clear cyclical pattern
• You are concerned and want specialist reassurance
• Your pain has not responded to initial management from your GP

Our team at The Poche Centre in North Sydney provides prompt, expert breast pain assessment. We take mastalgia seriously — because while it is rarely dangerous, when it is significant it deserves proper attention and effective management.

Breast Pain Assessment in North Sydney

If breast pain is affecting your daily life or causing you concern, don't put up with it or put it off. Our specialists provide thorough assessment and practical, evidence-based management for all types of breast pain.