It’s a tit bit nipply out there!

As the weather gets colder, nipple pain increases. Why? Because when your nipples get hard, the muscles contract, which decreases the amount of blood flow to the tips of your nips!  Less oxygen means more pain, kind of like a charley horse or a runner’s cramp.

This is called vasospasm, also known as Raynaud’s phenomenon.

Vasospasm most often occurs in one of two situations:

  • You have a previous diagnosis of Raynaud’s phenomenon in another part of your body. This typically happens in your finger and toes since it is most difficult to get adequate blood to far away extremities.
  • You have a history of nipple trauma.  If your nipples have been cracked, abraded, or bruised, they often spasm in response to cold as they are healing.

How vasospasm feels:

Vasospasm often happens in both nipples at once and is typically described as needle-like pain, shards of glass, or burning.  It often does not radiate up into your breasts, but rather stays very concentrated in the nipples.

How vasospasm looks:

When you experience pain, the nipple undergoes biphasic color change.  Your nipples turn white, then purple, then return to pink. The pain either subsides or changes to a throbbing sensation once your nipples return to pink.

If you feel a searing pain in your nipple, quickly pull it out of your shirt and look at the color of your nipple (assuming you are in an appropriate place to do this; it might not be a great idea to do this while checking out at the grocery store).

Note:  It isn’t uncommon to have color change in your nipples during or after breastfeeding or pumping. The color change isn’t the problem; the pain is the problem.  So, if you see your nipples turning purple and you have no pain at all, no worries!

How vasospasm is tricky:

Vasospasm is often misdiagnosed as nipple yeast.  The burning sensation feels a lot like yeast, but a surefire giveaway that this has been misdiagnosed is that the treatment for yeast makes symptoms worse, not better.

How to treat vasospasm:

Stop the trauma:

If your nipples are repeatedly being abused by breastfeeding, you must fix the latch! If your nipple is coming out of the baby’s mouth pinched or white in color, trust me, there is trauma that is likely to lead to vasospasm.

Keep warm: 

Episodes of vasospasm most often hit when cool air hits moist nipples.  This typically happens right after baby unlatches from the breast or when stepping out of the shower.  The cold weather causes nipples to become erect more often, so donning wool breast pads or an extra layer of clothing can be helpful.  Keep self-activating hand warmers or heating pads in your pockets or a good old-fashioned plug-in heating pad on your favorite nursing chair.

I like Lily Padz for moms with vasospasm because it buries the nipple in the breast and keeps the nipple warm. There are also these really cool breast warmers you can order from Australia, but I think shipping takes a while.

Stop air-drying:

You know that advice that you should expose your nipples to air in order to help them dry? Well, if that doesn’t feel good, don’t do it! Protect your nipples from air whenever possible, covering them immediately before stepping out of the shower or immediately after the baby unlatches.

Massage with warm olive oil:

Some moms find that massaging (not just applying) nipples with warm olive oil gives instant and long term relief from vasospasm.


Dr. Jack Newman recommends the following supplements to assist with vasospasm:


  • Vitamin B6 Multi-Complex: There have not yet been studies done to show that vitamin B6 works, but enough anecdotal evidence has come forward to suggest that it does work at least some of the time. It is safe and will do no harm. It is best that B6 not be taken on its own, but instead as part of a B complex of vitamins that includes niacin. Depending on the overall dose of the B complex, the amount of B6 itself should be approximately 100 mg 2x/day for at least a couple of weeks. So, for example, if the overall capsule is 125 mg of B complex and there are only 50 mg of B6 in that capsule, then you would need to take two capsules at a time to equal one dose and that dose would need to be taken 2x/day. You would continue the B complex until you are pain free for a few weeks. It can be restarted if necessary. If you have been pain free for a week or two, try going off the vitamin B6. If vitamin B6 does not work within a week, it probably won’t.
  • Calcium Magnesium supplement 500 mg (Calcium)/250mg (Magnesium).  Take one capsule two times a day

Gotta love the APNO:

  • All Purpose Nipple Ointment, a specially compounded nipple cream, often helps symptoms of vasospasm because of the anti-inflammatory element. If nipple tissue isn of vasospasm because of the antuscle contraction is less likely to cut off the blood supply to the tip of the nipple.

The prescription blood pressure medication Nifedipine has been used successfully for treatment of Raynaud’s phenomenon.  Generally, this is a last resort after trying more holistic approaches and you have to find a provider that knows how to manage it. I have seen it work really well.

If your nipples hurt, when in doubt, just do what Mary Catherine Gallagher would do.

I pray that a majority of my readers will get this joke. I realize that in ten years the breastfeeding mamas who read this blog will think my jokes are dated and uncool. But, I am a child of the ‘90s and I will ride that train as long as I can.