Breast pain (mastalgia) is the most common breast related complaint among women; nearly 70% of women experience breast pain at some point in their lives. Breast pain may occur in one or both breasts or in the underarm (axilla) region of the body. The severity of breast pain varies from woman to woman; approximately 15% of women require treatment. Though breast pain is not normally associated with breast cancer, women who experience any breast abnormalities, including breast pain, should consult their physicians.
There are two main types of breast pain:
- Cyclical
- Non-cyclical
Cyclical breast pain is related to how the breast tissue responds to monthly changes in a woman's estrogen and progesterone hormone levels. If breast pain is accompanied by lumpiness, cysts (accumulated packets of fluid), or areas of thickness, the condition is usually called fibrocystic change. During each menstrual cycle, breast tissue sometimes swells because hormonal stimulation causes the breast's milk glands and ducts to enlarge, and in turn, the breasts retain water. The breasts may feel swollen, painful, tender, or lumpy a few days before menstruation. Breast pain and swelling usually ends when menstruation is over. The average age of women who have cyclical breast pain is 34 years old. Cyclical breast pain may last for several years but usually stops after menopause unless a woman uses hormone replacement therapy (HRT).
Cyclical breast pain accounts for nearly 75% of all breast complaints. Of all women who experience breast pain, two thirds experience cyclical breast pain. Physicians often have patients chart their pain to determine whether the pain is cyclical. Though cyclical breast pain is usually related to the menstrual cycle, stress may also affect hormone levels and influence breast pain. Physical activity, especially heavy lifting or prolonged use of the arms, has also been shown to increase breast pain (pectoral (chest) muscles may become sore from physical activity).
Non-cyclical breast pain is far less common than cyclical breast pain and is not related to a woman's menstrual cycle. Women who experience non-cyclical breast pain often experience pain in one specific area of the breast(s). Woman who experience injury or trauma to the breast or those who undergobreast biopsy sometimes experience non-cyclical pain. The condition may occur in both pre-menopausal and post-menopausal women and usually subsides after one to two years. Non-cyclical pain is most common in women between 40 and 50 years of age. Usually, non-cyclical breast pain does not indicate breast cancer, though women should discuss the condition with their physicians.
Another type of non-cyclical pain called costochondritis does not actually occur in the breast; however, the condition may feel as though it is coming from the breast. This type of arthritic pain occurs in the middle of the chest where the ribs and the breast bone connect. Costochondritis may occur as the result of poor posture or aging. Women who experience costochondritis usually describe it as a burning sensation in the breast.
Other factors that may contribute to breast pain in some women include:
- Oral contraceptive pills
- Hormone replacement therapy
- Weight gain
- Bras that do not fit properly
- Tumors (most painful tumors do not usually indicate breast cancer; however, all abnormalities should be examined by a physician. For example, some patients with inflammatory breast cancer describe "stabbing pains" in the breast.)
Women should report all complaints of persistent breast pain to their physicians. Physicians will evaluate the pain, taking into account the woman's personal history, family history, the area of pain, the intensity and duration of the pain, and the extent to which the pain interferes with her lifestyle.
Physicians will also perform clinical breast examinations, and if necessary, order additional breast imaging exams (such as mammography or ultrasound) to help determine whether the pain is related to another breast condition or possibly cancer. If no breast abnormality is indicated, the physician and woman should decide together whether drug treatment is necessary.
Most women with moderate breast pain are not treated with medications or surgical procedures. The following suggestions have been shown to reduce breast pain in some women (although there is not sufficient scientific evidence to establish the effectiveness of any of these suggestions):
- Wear a good, supportive bra to reduce breast movement. Many women with breast pain find it comfortable to also wear a bra while they sleep.
- Limit sodium intake.
- Reduce caffeine intake (coffee, tea, soft drinks, chocolate).
- Maintain a low fat diet rich in fruits, vegetables, and grains.
- Maintain an ideal weight. Losing excess weight may reduce breast pain by stabilizing hormone levels.
- Occasionally use over-the-counter pain-relief drugs such aspirin, acetaminophen, or Motrin.
- Take vitamins. Some women have found that taking Vitamin B6 (pyridoxine), Vitamin B1 (thiamine), and Vitamin E relieves breast pain.
- Try evening primrose oil. Some women have found that regular consumption of the herb, evening primrose oil, in liquid or tablet form reduces breast pain.
- Cyst aspiration. Physicians sometimes drain benign (non-cancerous), fluid-filled cysts to relieve breast pain. It may not be possible to drain very small cysts.
- Relax. Some breast pain can be caused by stress and may subside by reducing anxiety and tension.
If breast pain is severe and interferes with a woman's daily activities, further treatment may be necessary. Diuretics, substances that remove excess fluid from the body in the form of urine, are the most commonly prescribed treatment for persistent, non-cyclical breast pain. The release of fluid in the body helps decrease breast pain and swelling.
Drug treatments for severe breast pain include:
- danazol
- bromocriptine
Bromocriptine and danazol both relieve cyclical breast pain by blocking certain hormones (such as estrogen and progesterone). However, these drugs may cause serious side effects in some women. Bromocriptine is poorly tolerated by many patients; side effects include nausea, dizziness, and fertility problems. Side effects of danazol may include weight gain, amenorrhea (absence of menstruation), and masculinization (such as extra facial hair) when given high doses. Other drugs, such as tamoxifen or goserelin, have been shown to have some effect on cyclical breast pain; however, these drugs are presently only approved for use in women with breast pain in the United Kingdom.
In cases where non-cyclical pain occurs only in a specific area of the breast (localized pain), physicians may choose to inject anesthetics or corticosteriods in this "target area" to relieve the pain. In very rare cases, the painful area may be surgically removed. However, surgery usually leads to increased breast pain, and some women may develop non-cyclical breast pain at the site of previous surgeries on the breast.
