Merck Manual

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Mastalgia (Breast Pain)


Lydia Choi

, MD, Karmanos Cancer Center

Reviewed/Revised Jan 2024

Mastalgia (breast pain) is common and can be localized or diffuse and unilateral or bilateral.

Etiology of Mastalgia

Diffuse bilateral pain may be caused by fibrocystic changes Etiology Etiology or, uncommonly, diffuse bilateral mastitis. However, diffuse bilateral pain is very common in women without breast abnormalities. The most common causes in these women are

  • Hormonal changes that cause breast tissue proliferation (eg, during the luteal phase or early pregnancy, in women taking estrogens or progestins)

  • Large, pendulous breasts that stretch Cooper ligaments

Some studies have found that a high-fat diet and caffeine intake are associated with mastalgia, but it is uncertain whether reducing these dietary factors decreases symptoms (1 Etiology reference Mastalgia (breast pain) is common and can be localized or diffuse and unilateral or bilateral. Localized breast pain is usually caused by a focal disorder that causes a mass, such as a breast... read more ).

Etiology reference

  • 1. Goyal A: Breast pain. BMJ Clin Evid 2011:0812, 2011. Published 2011 Jan 17.

Evaluation of Mastalgia


History of present illness should address the temporal pattern of pain and its nature (focal or diffuse, unilateral or bilateral). The relation between chronic or recurrent pain and menstrual cycle phase should be ascertained.

Review of systems should seek other symptoms suggesting pregnancy (eg, abdominal enlargement, amenorrhea, morning nausea) or fibrocystic changes (eg, presence of many masses).

Past medical history should cover disorders that could cause diffuse pain (eg, fibrocystic changes) and use of estrogens and progestins.

Physical examination

Examination focuses on the breast Evaluation Breast symptoms (eg, masses, nipple discharge, pain) are common, accounting for millions of medical visits every year. Although the great majority of symptoms have benign causes, breast cancer... read more Evaluation , looking for abnormalities such as mass, nipple inversion or discharge, skin changes including erythema, rash, eczematous appearance, edema, or dimpling (sometimes termed peau d’orange [orange peel]), and signs of infection, such as redness, warmth, and tenderness.

Red flags

The following is of particular concern:

  • Signs of infection

  • Mass, nipple inversion, or skin changes

Interpretation of findings

Absence of abnormal findings suggests that pain is due to hormonal changes or large, pendulous breasts.


Pregnancy testing should be done if pain is unexplained and has lasted less than several months, particularly if other symptoms or signs are consistent with pregnancy.

Other testing is indicated infrequently—only if breast examination detects abnormal findings.

Treatment of Mastalgia

For menstrual-related mastalgia, acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) is usually effective. If pain is severe, a brief course of danazol or tamoxifen may be given. These drugs inhibit estrogen and progesterone. If estrogen or a progestin is being taken, stopping may be necessary.

For pregnancy-related breast pain, wearing a firm, supportive brassiere, taking acetaminophen, or both, can help.

Evening primrose oil may reduce the severity of mastalgia.

Key Points

  • Diffuse, bilateral breast pain is usually caused by hormonal changes or large, pendulous breasts.

  • First-line treatment is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID).

  • Severe pain caused by hormonal factors is treated by stopping estrogen or a progestin (if either is being taken) or by giving tamoxifen or danazol.

Drugs Mentioned In This Article

Drug Name Select Trade
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Aphen, Apra, Children's Acetaminophen, Children's Pain & Fever , Children's Pain Relief, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Nolvadex, Soltamox
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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