What are the causes of breast pain?
If the pain is linked to the menstrual cycle, it is known as cyclical mastalgia (cyclical breast pain).
According to the Breast Cancer Foundation, breast pain includes any pain, tenderness or discomfort in the breast or underarm region, and can occur for a number of different reasons. In most cases, the Foundation adds, breast pain is not a sign of breast cancer.
In most cases, breast pain affects the upper, outer area of both breasts - the pain can sometimes spread to the arms.
The California Pacific Medical Center estimates that between 50 percent and 70 percent of women have breast pain in the United States.
Here are some key points about breast pain. More detail and supporting information is in the main article.
- In the majority of cases, breast pain is not a sign of breast cancer.
- Breast pain is most common in perimenopausal and premenopausal females.
- Breast pain is normally defined as "cyclic" (cyclical) or "non-cyclic" (non-cyclical).
- Sometimes it may not be possible to determine precisely why breast pain occurs.
- Doctors may recommend a prescription drug if suggested therapies are unable to alleviate the symptoms.
Symptoms of breast pain
Breast pain is usually classified as "cyclic" (cyclical) or "non-cyclic" (non-cyclical).
Symptoms of cyclical breast pain
Breast pain is relatively common.
- The pain comes cyclically, just like the menstrual cycle.
- The breasts may become tender.
- Patients describe the pain like a heavy, dull ache. Some women describe it as a soreness with heaviness, while others say it is like a stabbing or burning pain.
- The breasts may swell.
- The breasts may become lumpy (not with a single, hard lump).
- Both breasts are typically affected, especially the upper, outer portions.
- The pain can spread to the underarm.
- Pain becomes more intense a few days before a period begins. In some cases, pain may start a couple of weeks before menstruation.
- It is more likely to affect younger women. Postmenopausal women may experience similar pains if they are on HRT (hormone replacement therapy).
Symptoms of non-cyclical breast pain
- It affects just one breast, usually just within a small section of the breast, but may spread across the chest.
- It is common among post-menopausal women.
- The pain does not come and go in a menstrual cycle time-loop.
- The pain may be continuous or sporadic.
- Mastitis - if the pain is caused by infection within the breast, the woman may have a fever, feel ill (malaise), some breast swelling and tenderness and the painful area may feel warm. There may be redness. The pain is usually described as a burning sensation. For lactating mothers, the pain is more intense while breastfeeding.
- Extramammary pain - pain that feels as if the source is within the breast, but it is elsewhere. Sometimes called "referred pain." This may occur in some chest wall syndromes, such as costochondritis (inflammation where the rib and the cartilage meet).
What causes breast pain?
It is not always possible to determine exactly why breast pain occurs. The following factors can be associated with breast pain:
- Acid reflux.
- Alcoholism with liver damage.
- Anxiety, stress, and depression.
- Benign breast tumors.
- Bornholm disease.
- Breast cancer.
- Breast cysts.
- Breast trauma - e.g. previous breast surgery.
- Breastfeeding related - possible infection.
- Cervical and thoracic spondylosis/radiculopathy.
- Chest wall pain.
- Coronary artery disease.
- Cyclical breast pain.
- Diet - especially caffeine.
- Herpes zoster.
- Medications - including digitalis, chlorpromazine, oxymetholone, some diuretics, spironolactone, and methyldopa.
- Peptic ulcer.
- Pulmonary embolism.
- Rib fracture.
- Shoulder pain.
- Sickle cell anaemia.
- Trauma to the chest wall.
In the majority of cases, it is possible to solve cyclical breast pain by taking OTC (over-the-counter) painkillers and wearing well-fitted bras. Cyclical breast pain is often unpredictable — it may well just go away in time, and then come back periodically.
Being diagnosed with cyclical breast pain, as opposed to something more serious, can reassure many patients who then decide their condition is easier to live with.
Women with non-cyclical breast pain may need therapy to treat the underlying cause, for instance, with infectious mastitis, the patient will be prescribed a course of antibiotics.
Some self-help tips for breast pain
In the majority of cases, it is possible to solve cyclical breast pain by taking OTC (over-the-counter) painkillers and wearing well-fitted bras.
- During the daytime, wear a well-fitting bra.
- Many women swear by evening primrose oil. A study in the American Journal of Obstetrics and Gynecology, however, found that evening primrose oil offered no benefits for breast pain. Pregnant women, those planning to become pregnant, and people with epilepsy should not take evening primrose oil without checking with their doctor first.
- To relieve the pain, take OTC medications, such as acetaminophen (paracetamol, Tylenol) or ibuprofen.
- Wear a soft-support bra during sleep.
- When exercising, wear a good sports bra.
Some topical NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen gel or diclofenac gel can be rubbed directly on to the painful areas. Do not rub NSAID gels onto broken skin. ("Topical" means you apply it directly onto the skin).
Coffee, caffeine, and breast pain - a study published in The Nurse Practitioner found "caffeine restriction is an effective means of management of breast pain associated with fibrocystic disease."
Smoking and breast pain - several health authorities, hospitals, and health groups advise women with breast pain to stop smoking. The argument being that nicotine constricts the blood vessels and smoking is more likely to cause inflammation.
However, a study published in Climacteric, the Journal of the International Menopause Society, found "smoking reduces the incidence of breast tenderness in women receiving oral EPT (estrogen-progestogen therapy)."
Prescription medications for breast pain
If breast pain symptoms are severe, and none of the therapies mentioned above helped, the doctor may recommend a prescription drug.
The following medications may help alleviate the symptoms of breast pain:
Approved for the treatment of fibrocystic breast disease, a condition that causes non-cancerous growths to develop in the breasts.
Approved for treating certain breast conditions.
Approved for breast cancer treatment. Tamoxifen is also prescribed off-label for mastalgia.
Also approved for breast cancer therapy and used as an off-label treatment for mastalgia.
Another breast cancer drug that is used off-label for breast pain.
If a woman is on the contraceptive pill, the doctor may consider making adjustments or switching to another birth control pill.
The doctor may also consider adjusting the dosage of hormone replacement therapy.
Complications of breast painBecause there are so many potential reasons for breast pain, complications depend on the specific causes. In many cases, there are no complications.
When to see a doctor
You should see your doctor if:
- One or both breasts change in size or shape.
- There is a discharge from either nipple.
- There is a rash around the nipple.
- There is dimpling on the skin of the breasts.
- You feel a lump or swelling in one of your armpits.
- You feel pain in your armpits or breast that is not related to your menstrual cycle.
- You notice a change in how your nipple looks.
- You notice an area of thickened tissue, or a lump in your breast.
Diagnosis of breast pain
A mammogram may be used to provide an X-ray of the breast.
If a woman is pre-menopausal, the doctor will try to determine whether the breast pain might be cyclical.
The doctor will probably ask:
- How much caffeine she consumes.
- Where within the breasts the pain is.
- Whether both breasts are painful.
- Whether she is a smoker.
- Whether she is on any medication or the combined contraceptive pill.
- Whether she might be pregnant.
- Whether there are any other symptoms, such as nipple discharge or a lump.
The doctor will listen to the patient's lungs and heart, and also check her chest and abdomen to rule out other possible conditions and illnesses.
The doctor may also conduct a clinical breast exam to determine whether there are any lumps, changes in nipple appearance, or nipple discharge. The lymph nodes in the lower neck and armpit will also be checked to determine whether they are swollen or tender to the touch.
If a breast lump or unusual thickening of an area of tissue is detected, or a specific area of breast tissue is particularly painful, the doctor may order further tests:
- Mammogram — an X-ray exam of the breast.
- Ultrasound scan — sound waves produce images of the breasts. Even if the mammography does not detect anything, an ultrasound scan is usually done as well.
- Breast biopsy — if anything suspicious is detected, the doctor will surgically remove a small sample of breast tissue and send it to the laboratory for analysis.
The patient may be asked to complete a breast pain chart, which can be used to confirm the diagnosis and help the doctor decide on the best therapy.
Is breast pain a cause for concern?
In the video below, Dr. Katharine Lee from the Cleveland Clinic, talks about the different types of breast pain.