Breast pain and tenderness are common during significant hormonal shifts like pregnancy or while breastfeeding. However, it’s not always a reason to be concerned.
Often, nipple pain and sensitivity is cyclical – it’s associated with your menstrual cycle and occurs in the days leading up to your period. Take OTC pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil), to help reduce the pain.
1. Raynaud’s Phenomenon
The condition known as Raynaud’s phenomenon affects the blood flow to your extremities, mainly your fingers and toes. The problem causes your blood vessels to narrow, starving the area of circulation. This causes the color change, which may also include a painful or throbbing feeling. Your blood vessels usually open again when the affected part of your body is warmed and the blood re-enters the tissues. Symptoms of the condition may also occur in your ears, nose or lips and sometimes your nipples, especially when breastfeeding.
It’s not clear what causes Raynaud’s, but it is thought to be related to cold weather or emotional stress. People living in colder climates are more likely to experience the symptoms, which can last from a few minutes to hours. It’s more common in women than men and tends to start in the teenage years. Sometimes it’s caused by other health conditions, such as scleroderma or lupus and can be aggravated by certain medicines.
Keeping your hands and feet warm can help prevent an attack. Taking vitamin supplements, such as ginger, evening primrose oil or fish oils, can also help.
2. Vasospasm
When a nipple gets flattened or compressed by a baby pinching it during a breastfeed a condition called nipple vasospasm can cause painful, burning, throbbing and stabbing sensations. The nipple may also look pointed or slanted like the top of a new lipstick straight after a feed and it can turn white. This is because the blood vessels constrict making it hard for blood to flow to the nipple. Once the nipple is warmed again and the blood vessels relax there will be a triphasic color change from white to blue to pink.
Nipple vasospasm can occur on one or both nipples, it can be caused by Raynaud’s or it can happen randomly unrelated to breastfeeding. If it happens in conjunction with latching or tongue tie issues it can be confusing as the pain and nipple color changes are often confused with thrush (but it is not thrush!). Nipple vasospasm is also a side effect of fluconazole/diflucan which is used to treat thrush.
Other factors that can lead to nipple vasospasm include cold temperatures, high levels of stress and medications including steroid medications or oral contraceptives. An existing history of autoimmune disease such as lupus or rheumatoid arthritis, scleroderma or thyroid dysfunction, and fibromyalgia are also risk factors.
3. Mastalgia
The medical term for breast pain is mastalgia, and it affects as many as 70% of women at some point in their lives. The degree of soreness varies between women, as does the location and intensity of the pain, but it is most commonly felt in one or both breasts. Pain can be dull or throbbing, sharp or stabbing, and it may be constant or come and go. Pain typically intensifies in the two weeks preceding a period, but it can also occur at other times, during exercise, while taking oral contraceptives or hormone replacement therapy (HRT), and during stressful periods.
Noncyclical mastalgia can be caused by large pendulous breasts, hormonal changes, or even a nipple infection called thrush. Wearing a properly-fitting bra, acetaminophen, and dietary changes can help reduce the pain. If the pain is accompanied by lumpiness, tenderness, or a change in nipple size, a gynecologist should be consulted for further evaluation and treatment.
Fortunately, mastalgia isn’t usually a sign of cancer. However, any new breast pain — whether it’s sharp or throbbing — is cause for concern and should be evaluated by a doctor.
5. Chest Wall Pain
Sometimes chest pain isn’t related to the heart and lungs but rather to the bones, muscles and cartilage of the chest wall. This is commonly referred to as chest wall pain and can be caused by a wide range of issues including a cold, persistent coughing or even an injury. This type of pain can be very specific in location and may feel worse with deep breathing, putting pressure on the area or twisting or moving in certain ways.
If you have chest wall pain, it’s best to see your doctor so they can examine you and take a detailed medical history. They will check to see if the pain is due to heart, lung or gastrointestinal related issues. If these are ruled out then they will label the chest pain as musculoskeletal in nature.
Most of the time, musculoskeletal chest wall pain will resolve with at-home treatments that your doctor can recommend. However, if the pain is chronic and significantly impacts your quality of life, then you might want to consider more advanced treatment options such as injections to interfere with the transmission of pain signals to the spinal cord and brain.
