Nipple pain is almost always caused by something harmless, most commonly hormonal shifts during your menstrual cycle, friction from clothing, or skin irritation. Less often, it can signal an infection, a medication side effect, or a condition that needs medical attention. The cause usually becomes clear once you consider the timing, what the pain feels like, and whether there are visible changes to the skin.
Hormonal Changes Are the Most Common Cause
Fluctuating levels of estrogen and progesterone throughout your menstrual cycle make nipple tissue more sensitive. You’re most likely to notice soreness in the week leading up to your period, though some people feel it around ovulation as well. This type of pain is cyclical, meaning it shows up around the same point each month and fades once your period starts. It often affects both sides equally and may come with general breast tenderness.
Pregnancy causes a sharp increase in the same hormones, and sore, tingling nipples can be one of the earliest signs, sometimes appearing before a missed period. Your nipples may darken, the veins in your breasts may become more visible, and the tissue may feel fuller or heavier. If your period is late and your nipples have been unusually tender, a pregnancy test is a reasonable next step.
Friction and Chafing
Repeated rubbing from clothing is a well-known trigger, especially during exercise. Runners call it “jogger’s nipple.” Cotton shirts are particularly notorious because they absorb sweat, get heavy, and cling to skin, increasing friction with every stride. Cold weather makes the problem worse by causing nipples to become more erect and more exposed to rubbing.
A few simple changes prevent this entirely. Switching to moisture-wicking fabrics that pull sweat away from the skin reduces friction significantly. A snug-fitting shirt or a supportive sports bra limits the back-and-forth fabric movement that causes chafing. Applying petroleum jelly or an anti-chafe balm before a workout creates a protective barrier. Even a simple adhesive bandage placed over each nipple works well.
Breastfeeding-Related Pain
Nipple pain during breastfeeding is extremely common in the first few weeks while your body adjusts. A shallow latch, where the baby doesn’t take enough of the areola into their mouth, is the most frequent culprit. Correcting the latch usually resolves the soreness within a few days.
Two infections can complicate breastfeeding and need different treatment. Mastitis is a bacterial infection that causes flu-like symptoms: fever, chills, body aches, and fatigue. The affected breast feels warm or hot to the touch, looks pink or red, and may produce a yellowish discharge. Thrush, a fungal infection, feels different. It causes persistent soreness even with a good latch, along with pink, flaky, shiny, or cracked nipples and deep shooting pains in the breast during or after feedings. A telltale clue is white spots inside your baby’s mouth, on their cheeks, tongue, or gums.
Nipple Vasospasm
Some breastfeeding parents experience vasospasm, a sudden constriction of blood vessels in the nipple triggered by cold, stress, or nipple damage from feeding. The nipple or its tip turns noticeably pale during the spasm, then shifts through purple, blue, or red as blood flow returns. It can cause intense, throbbing pain. People who tend to have cold hands and feet, have poor circulation, or have a family history of Raynaud’s phenomenon are more susceptible. Smoking, caffeine, and alcohol also increase the risk because they constrict blood vessels.
Piercings and Trauma
Nipple piercings take a long time to heal, and mild irritation during that period is normal. The tissue may appear red and feel sensitive, but this typically settles within a few days on its own. An actual infection looks different: the piercing feels hot to the touch, the pain is more intense rather than just tender, and you may see green, yellow, or brown discharge with a bad odor. Fever, body aches, and fatigue can accompany a more serious infection. If you notice pus or worsening symptoms rather than improving ones, the piercing needs medical attention.
Medication Side Effects
Several types of medication can raise prolactin levels, a hormone that stimulates breast tissue. When prolactin rises too high, it can cause nipple tenderness, swelling, and sometimes a milky discharge even when you’re not pregnant or breastfeeding. Medications that can trigger this include birth control pills, certain antipsychotics, some blood pressure medications, SSRI and tricyclic antidepressants, heartburn and acid reflux drugs, anti-nausea medications, estrogen therapy, and opioid pain relievers. If your nipple pain started after beginning a new medication, that connection is worth raising with your prescriber.
Skin Conditions and Allergies
The skin on and around your nipples is thin and sensitive, making it prone to contact dermatitis from laundry detergents, fabric softeners, body lotions, soaps, or synthetic fabrics. This usually shows up as redness, dryness, or itching on both nipples. Eczema can also affect the nipple area and tends to cause flaky, itchy patches that come and go.
Warning Signs Worth Checking
Rarely, persistent nipple changes can signal something more serious. Paget’s disease of the breast is an uncommon form of cancer that closely mimics eczema. It causes flaky, crusty, or scaly skin on the nipple, along with itching, a burning sensation, and sometimes straw-colored or bloody discharge. A key distinguishing feature is that it almost always affects only one breast and starts at the nipple before spreading outward. Eczema, by contrast, more commonly affects both sides.
Certain changes warrant a prompt visit to a healthcare provider regardless of the suspected cause:
- Nipple discharge that is bloody or clear (not milky), occurs without squeezing, or comes from only one breast
- A new lump that feels harder or different from the surrounding tissue or from your other breast
- Skin changes such as dimpling, puckering, or persistent redness on the breast
- A newly inverted nipple that has turned inward when it didn’t before
These warning signs apply to all genders. The most common sign of breast cancer in men is a painless lump or thickening in the breast, chest, or underarm area, though any new nipple changes, including an itchy, scaly rash, should be evaluated.