Sore nipples are almost always caused by something treatable, from hormonal shifts and friction to infections and skin irritation. The soreness can range from mild tenderness to sharp, shooting pain, and the cause usually becomes clear once you consider the timing, your activities, and any visible skin changes.
Hormonal Changes and Your Menstrual Cycle
The most common reason for nipple soreness in people who menstruate is the rise and fall of hormones throughout the menstrual cycle. In the days before your period, rising progesterone levels cause breast tissue to swell and retain fluid. This makes both the breasts and nipples feel tender, heavy, or sore. The discomfort typically peaks in the few days before bleeding starts and fades once your period begins.
If you’ve recently started or switched hormonal birth control, that can trigger the same kind of soreness. The body needs a few cycles to adjust to new hormone levels, and nipple tenderness during that window is expected.
Early Pregnancy
Nipple soreness is one of the earliest signs of pregnancy, often showing up before a missed period. Rising progesterone levels cause a tingling sensation in the breasts, and the nipples can feel unusually tender or sore to the touch. This tenderness tends to be more intense than typical premenstrual soreness, and it doesn’t go away after a few days the way cycle-related pain does. Many people notice it within the first few weeks of pregnancy, and it can persist through much of the first trimester as hormone levels continue climbing.
Friction and Chafing
If your nipples are raw, stinging, or visibly irritated after exercise, friction is the likely culprit. This is common enough in runners that it has a name: jogger’s nipple. Repetitive rubbing from clothing, especially over long distances or during sweaty workouts, can chafe the skin until it cracks or even bleeds.
Cotton shirts are particularly notorious for this. They absorb sweat, get heavier, and create more abrasive contact with each stride. Switching to a moisture-wicking synthetic fabric reduces friction significantly. For extra protection, you can apply petroleum jelly or a sports-specific anti-chafe balm to your nipples before a run. Even a simple adhesive bandage placed over each nipple works well as a barrier. If you wear a sports bra, make sure it fits snugly without seams sitting directly over the nipple.
Skin Irritation and Allergic Reactions
The skin on and around the nipple is thinner and more sensitive than most of the body, which makes it prone to contact dermatitis. This shows up as redness, itching, flaking, or a rash on the nipple or areola. Two types of reactions cause this.
Irritant dermatitis comes from direct contact with harsh substances: soap, laundry detergent, body wash, or rough fabrics. Switching to a fragrance-free detergent and avoiding direct application of soap to the nipples often resolves it within a week or two.
Allergic contact dermatitis is a true immune reaction to a specific ingredient. Common triggers include fragrances, preservatives in lotions, lanolin (found in many nipple creams), vitamin E oil, botanical ingredients like tea tree oil or aloe vera, antibiotic ointments, and nickel from nipple piercings. If you recently started using a new product on or near your chest, that’s the first thing to eliminate.
Breastfeeding-Related Soreness
Some degree of nipple tenderness is normal during the first week or two of breastfeeding as the skin adjusts. But pain that persists beyond those early days, gets worse over time, or makes you dread feeding usually points to a fixable problem.
A shallow latch is the most common cause. When the baby doesn’t take enough breast tissue into their mouth, the nipple bears the brunt of the suction and compression. This leads to cracked, blistered, or bleeding nipples. A lactation consultant can assess the latch and often resolve the issue in a single visit.
A less well-known cause is nipple vasospasm, where blood vessels in the nipple constrict suddenly, cutting off blood flow. The nipple turns white (blanches), then may shift to blue or red as circulation returns. Cold temperatures trigger it, and the pain can be intense, often described as burning or throbbing. This is essentially Raynaud’s phenomenon affecting the nipple, and it can occur during pregnancy or even outside of breastfeeding.
Infections
Two types of infections commonly cause nipple pain: yeast infections and mastitis.
Yeast Infections
A yeast infection on the nipple (sometimes called thrush) causes a distinctive pattern: shiny or flaky redness, cracked skin, swelling around the nipple, and a deep shooting or burning pain that continues between feedings. The pain often feels disproportionate to how the skin looks. Yeast thrives in warm, moist environments, so breastfeeding parents and people who sweat heavily under tight clothing are most susceptible.
Mastitis
Mastitis is an inflammation of breast tissue that can progress to a bacterial infection. It typically affects one breast at a time and starts as a tender, warm, red area that may feel hard or swollen. When it becomes infected, systemic symptoms appear: fever, chills, and a general flu-like feeling. If those symptoms last longer than 24 hours or worsen despite rest and frequent milk removal, medical evaluation is important. Early postpartum hot flashes and sweating can sometimes mimic a fever, so using a thermometer rather than guessing is helpful.
Medications That Cause Breast Tenderness
Certain medications increase levels of prolactin, a hormone that stimulates breast tissue. When prolactin rises beyond normal levels, it can cause breast and nipple tenderness, unexpected milk production, and menstrual irregularities. The most common medications responsible are antipsychotics, but some antidepressants, blood pressure medications, and drugs that speed up digestion can also elevate prolactin. If your nipple soreness started around the same time as a new medication, that connection is worth discussing with your prescriber.
When Soreness Looks Like Eczema but Isn’t
Paget’s disease of the breast is a rare form of cancer that mimics the appearance of eczema on the nipple. It causes crusty, oozing, or hardened skin on the nipple or areola that doesn’t heal with standard eczema treatments. A key distinguishing feature is that it almost always affects only one breast. If you have a persistent, eczema-like rash on one nipple that hasn’t improved with moisturizers or steroid creams after several weeks, that warrants a medical evaluation. Paget’s disease accounts for a small percentage of breast cancers, but catching it early makes a significant difference in outcomes.
Figuring Out Your Cause
A few questions can help you narrow things down. Consider when the soreness started: around your period, after starting a new medication, during early pregnancy, or following a change in your workout routine or laundry detergent. Look at the skin itself. Cracked, raw skin suggests friction or a latch problem. Redness with itching points to dermatitis or yeast. A warm, hard area with fever suggests mastitis. A crusty, non-healing patch on one side raises a flag for something that needs professional evaluation.
Bilateral soreness (both sides equally) that comes and goes with your cycle or coincides with a new medication is almost always hormonal. Soreness that’s one-sided, persistent, or accompanied by visible skin changes is more likely structural, infectious, or, rarely, something that needs further investigation.