What is nipple vasospasm?

Vasospasm is what happens when the blood vessels supplying the nipple spasm (tighten), and reduce the blood flow to the nipple. This affects the flow of milk from the nipple.

It is common to feel intense pain if this happens, especially if the weather is cold. While any of the body's blood vessels can be affected by vasospasm, it can be a very painful condition during breastfeeding.

What causes nipple vasospasm?

Nipple vasospasm can occur in response to nipple trauma (injury), for example, if your baby does not attach well to your breast during breastfeeding.

It can also happen randomly and unrelated to breastfeeds, for example due to Raynaud’s phenomenon (commonly known as Raynaud’s).

Who is at risk of experiencing nipple vasospasm?

Some people are more likely to have nipple vasospasm, including those:

• who tend to have cold fingers and feet
• with poor circulation
• with a family history of Raynaud’s phenomenon
• below average weight for their height
• who smoke, as nicotine constricts the blood vessels

People may first experience nipple vasospasm during their pregnancy.

What does nipple vasospasm with breastfeeding feel like?

People with vasospasm commonly describe it as an intense, throbbing, burning type of pain in their nipples.

When the blood vessels in the nipples are affected by vasospasm, you may feel pain before, during or after breastfeeds. The pain can last for a few seconds or longer. You may also experience vasospasm when you have ‘let down’ (when your milk ejection reflex has been activated).

What does nipple vasospasm look like?

Your nipple or the tip of your nipple can appear pale or white during vasospasm. The colour of your nipple can also change when your blood returns after the episode of spasm is over. This can mean a change from white to purple, blue or red, as your nipples return to their normal colour.

What is Raynaud's phenomenon?

Raynaud’s phenomenon, or ‘Raynaud’s’, occurs when vasospasm happens randomly and is unrelated to breastfeeds. Vasospasm symptoms can also occur in the fingers and toes in response to cold.

Raynaud’s is caused by a temporary interruption to normal blood flow in the small blood vessels in the arms or legs. The fingers, toes, nose, lips and ears are the most common body parts affected.

If you have Raynaud’s when you are pregnant, you may also experience nipple vasospasm when you are breastfeeding.

How do I know if I have vasospasm?

Breastfeeding should not be painful. However, it is common in the early days of breastfeeding to experience some nipple sensitivity as your body adjusts to feeding. If you have nipple vasospasm, you may continue to experience pain when breastfeeding, even if your baby is attached properly and sucking well.

How can vasospasm be treated or managed?

You can manage the effects of nipple vasospasm by avoiding or reducing exposure to things that trigger or worsen your symptoms. Triggers may include:

• nipple damage
• cold temperatures
• smoking
• some medicines

If cold temperatures trigger your symptoms, consider dressing in light layers, which you can take off easily if you feel you’re overheating.

There are other strategies you can try, for example:

• Apply a warm compress or heat pack straight after breastfeeding.
• Breast warmers made from wool or reflective materials can also be soothing. Ask your pharmacist about the options available.
• Try massaging olive oil onto your nipples after feeds.
• Try avoiding caffeine — some people report that avoiding this is helpful.
• Avoid exposing your nipples to cold air and wear additional layers of clothing to avoid getting cold.

You should also check to make sure your baby is well attached when they are breastfeeding, and that you don’t have any nipple trauma or nipple thrush.

Do supplements help for nipple vasospasm?

Some people find that supplements help alleviate the symptoms of vasospasm. Before taking any new medicines or supplements, speak with a healthcare professional or your pharmacist. This is especially important while breastfeeding, as some medicines can be passed on to your baby through your breast milk.

• Fish oil capsules or evening primrose oil (gamma linoleic acid, of GLA) may help to improve blood vessel relaxation.
• Magnesium tablets can help to relax the blood vessels.
• Sometimes, prescription medicines may help. If your symptoms are severe or persistent, ask your doctor, midwife, or a lactation consultant for advice.

Resources and support

For more help with nipple vasospasm and breastfeeding, contact:

• your midwife or child health nurse
• a lactation consultant
• the Australian Breastfeeding Association on their helpline — 1800 mum 2 mum, (1800 686 268)