Breast pain, also known as mastalgia, mammalgia and mastodynia, is common and may include a dull ache, heaviness, tightness, a burning sensation in the breast tissue, or breast tenderness. 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. The National Health Service, UK, says that cyclical breast pain is not linked to a higher risk of developing breast cancer.
In most cases, breast pain affects the upper, outer area of both breasts - the pain can sometimes spread to the arms.
In the majority of cases, mastalgia starts between one and three days before a woman's period starts, and gets better by the end of her period. For some women, the pain starts many more days before the beginning of their periods.
Although older (postmenopausal) women can have breast pain, it is much more common in perimenopausal (around the menopause) and premenopausal females.
The California Pacific Medical Center estimates that between 50% and 70% of women have breast pain in the USA. Health Authorities in the UK say that up to 66% of women between 30 and 50 years of age experience breast pain.
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Here are some key points about breast pain. More detail and supporting information is in the main article.
- Breast pain can be referred to as mastalgia, mammalgia or mastodynia.
- In the majority of cases, breast pain is not a sign of breast cancer.
- Breast pain commonly affects the upper, outer area of both breasts, though pain can spread to the arms.
- Breast pain is most common in perimenopausal and premenopausal females.
- Breast pain is normally defined as "cyclic" (cyclical) or "non-cyclic" (non-cyclical).
- Clinical breast examination can determine whether there are any lumps, changes in nipple appearance, or nipple discharges.
- Further tests can be requested if a lump or unusual thickening of tissue is detected, or a specific area of breast tissue is particularly painful.
- Sometimes it may not be possible to determine precisely why breast pain occurs.
- It is usually possible to solve cyclical breast pain by wearing well-fitted bras and taking simple painkillers.
- Doctors may recommend a prescription drug if suggested therapies are unable to alleviate the symptoms.
Symptoms of breast pain
A symptom is felt by the patient and described to the doctor, nurse, friends or family. A sign can be seen or detected by other people. An example of a symptom is pain, while a sign could be a skin rash.
Breast pain is usually classified as "cyclic" (cyclical) or "non-cyclic" (non-cyclical).
Symptoms of cyclical breast pain
Breast pain, also known as mastalgia, mammalgia and mastodynia, is common and may include a dull ache, heaviness, tightness, a burning sensation in the breast tissue, or breast tenderness.
- 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 quadrant 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).
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
If a woman is pre-menopausal, the doctor will try to determine whether the breast pain might be cyclical. The patient will probably be asked:
- 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 physician 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.
A mammogram may be used to provide an X-ray exam of the breast.
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 - this is an X-ray exam of the breast. Also known as mammography
- 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.
What causes breast pain?
It is not always possible in every case to determine exactly why breast pain occurs. The following factors are associated with possible 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, e.g. for 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. You need to take the capsules daily in order to feel any benefits, which may take two to three months to appear. 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."
The Society of Obstetricians and Gynaecologists of Canada says that caffeine does not cause breast pain. Even though many women say their symptoms of pain are reduced when they cut out caffeine, no studies have been able to back this up. (Outside the USA, 'Gynecologist' is spelled 'Gynaecologist.').
The following contain caffeine - some OTC cold or pain medications, cocoa, chocolate, cola drinks, green and black tea, and coffee.
Flaxseed for breast pain - in its Clinical Guidelines for Mastalgia, the Society of Obstetricians and Gynaecologists of Canada (SOGC) quotes a Canadian study on 116 women with severe cyclical mastalgia. Half of them ate 25 grams of flaxseed in a muffin each day for four menstrual cycles. The other half ate an "identical" muffin with no flaxseed.
In this double-blind trial (neither the doctors nor the participants knew which muffin they were eating) breast pain was reduced significantly more among the women eating flaxseed. According to the SOGC, "This one study shows promise and merits further research."
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. Patients may experience the following side effects - hair growth on the face (hirsutism), acne, deepening voice (possibly permanent), weight gain, skin rash, nausea and dizziness.
Approved for breast cancer treatment. Tamoxifen is also prescribed off-label for mastalgia. Possible side effects include hot flashes (UK: hot flushes), vaginal bleeding, vaginal discharge, higher risk of endometrial cancer and thromboembolism.
Also approved for breast cancer therapy and used as an off-label treatment for mastalgia. Side effects may include depression, decreased sex drive, hot flashes and vaginal dryness.
Another breast cancer drug that is used off-label for breast pain. Possible side effects include DVT (deep vein thrombosis), vaginal bleeding, vaginal discharge, hot flashes, and nausea.
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.
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.