Breast Pain

Breast pain (mastalgia), a common ailment among women can range from mild to severe discomfort. It includes breast tenderness, sharp burning pain or tightness in your breast tissues.

The pain may be constant or sometimes occur occasionally. There are various reasons for breast pain. Hormonal changes during menstruation and pregnancy often cause breast tenderness.

Some women with pain in one or both their breasts may suspect breast cancer. But, breast pain is not a common sign of cancer. Mild tenderness and swelling of breasts just before having your periods is normal. Breast pain may occur:

• Just for few days in a month, particularly, in the two to three days leading up to your period.
• A week or longer every month, which starts before your period and continues through your menstrual cycle.
• All throughout the month, not related to your menstrual cycle.

Postmenopausal women too have breast pain, but breast pain is more common in younger women who have not attained menopause. However, unexplained breast pain that does not go away after one or two menstrual cycles or that persists even after menopause needs to be evaluated by your doctor.

Breast pain is divided into cyclic or noncyclic type of pain and each type of breast pain has distinct symptoms.

Breast pain characteristics.

Cyclic breast pain.

• Clearly linked to the menstrual cycle
• Dull, heavy or aching type of pain
• Usually associated with breast swelling or lumpiness
• Affects both breasts, particularly the upper, outer portions, and may radiate to the underarms
• Intensifies during the two weeks leading up to the start of your period, then eases up afterward
• More likely to affect young women in their 20s and 30s as well as women in their 40s who are transitioning to menopause

Noncyclic breast pain.

• Unrelated to the menstrual cycle
• Tightness, burning sensation or soreness
• Constant or intermittent
• Affects one breast, at a localized area, but may spread diffusely across the breast
• Most likely to affect postmenopausal women

Extramammary breast pain

The term "extramammary" is nothing but, "outside the breast." Extramammary breast pain feels as if it originates in the breast tissue, but actually its source lies somewhere else. For instance, pulling a muscle in your chest may cause pain in your chest wall or rib cage that spreads (radiates) to your breast.

When to see a doctor:

Make an appointment with your doctor to evaluate the cause of your breast pain if it:

• Continues daily for more than 2 weeks
• Occurs at one specific area of your breast
• Seems to be getting worse with time
• Hampers your daily activities
• Although the risk of having breast cancer is low in women with breast pain as their main symptom, if your doctor has recommended an evaluation, it is very important to follow through.

Sometimes, breast tenderness is a normal phenomenon and in some cases, it is not possible to identify the exact cause of breast pain. The contributing factors may include one or more of the following:

Reproductive hormones: Cyclic breast pain appears to have a strong relation to hormones and your menstrual cycle. Cyclic breast pain often decreases or disappears with pregnancy or menopause.

Breast structure: Noncyclic breast pain often results from changes that occur in the milk ducts or milk glands. This can result in the development of breast cysts. Breast trauma, prior breast surgery or other factors localized to the breast can lead to breast pain. Breast pain may also start outside the breast — in the chest wall, muscles, joints or heart, for example — and radiate to the breast.

Breast size: Women with larger breasts may experience noncyclic breast pain that is related to the size of their breasts. Neck, shoulder, and back pain may occur along with breast pain due to large breasts.

Breast surgery: Breast pain associated with breast surgery and scar formation can sometimes linger after incisions have healed.

Medication use: Certain hormonal medications, including some infertility treatments and oral birth control pills, may cause breast pain. Also, breast tenderness is a possible side effect of estrogen and progesterone hormone therapies that are used after menopause. Breast pain may be associated with certain antidepressants, including selective serotonin reuptake inhibitor (SSRI) antidepressants.

Fatty acid imbalance: A long-standing imbalance of fatty acids in the cells affect the sensitivity of breast tissue to the circulating hormones.

Shingles: It can lead to pain in the breast if the painful blisters appear on the skin of your breasts.

Fibrocystic breast changes: These are a common cause of breast pain. Fibrocystic breast tissues are lumps or cysts that tend to be much more tender just before your the onset of your menstrual periods.

No specific diagnosis is needed for breast pain.

You may consult your doctor for an evaluation if you have developed a breast pain that you never had before or if it persistently affects a specific part of your breast or if it significantly affects your quality of life. In some cases, when you call to set up an appointment, you may be referred to a breast health specialist.

What you can do:

The initial evaluation of your breast pain primarily focuses on your medical history. Your doctor will ask questions regarding the location of your breast pain, its relation to your menstrual cycle, and other relevant aspects that might reveal the cause of your pain. In order to be prepared for this discussion:

• Make a note of all your symptoms, even if those seem unrelated to your breast pain. Try rating the severity of your pain on a scale of 1 to 10, with 1 being no pain and 10 being the worst pain imaginable.
• Note down your key personal information, including major stresses or recent life changes.
• Make a list of all your regular medications, vitamins, and supplements.
• List the questions you want to ask your doctor, in the order of the most important to least important.

For breast pain, basic questions to ask your doctor include:

• What is the most likely cause of my symptoms?
• What kind of tests will I need?
• What treatment approach will be recommended for my condition?
• Are there any home remedies that I can try?

What to expect from your doctor?

Your doctor may ask you a few questions such as:

• Where exactly in your breast do you feel the pain?
• From how long do you have breast pain?
• How would you rate the severity of your pain on a 10-point scale?
• Do you have pain in one or both breasts?
• Does the pain seem to occur with any particular sort of pattern?
• Have you ever had a mammogram? When was your last one?
• Do you have other signs or symptoms, such as a breast lump, thickened tissue or nipple discharge?
• Do you have any skin changes, such as redness or a rash?
• Have you recently delivered a baby? Or have you experienced a miscarriage or termination?
• Does your breast pain affect your quality of life, for instance sleep, sexual activity or work? Does your pain interfere with your ability to perform daily activities?
• Have you been engaged in any activities or had injury to your chest recently that could lead to your breast pain?
• Your doctor may also assess your personal risk of breast cancer, based on factors such as your age, family medical history and prior history of precancerous breast lesions.

Clinical breast examination: Your doctor will carefully examine your breasts to check for any abnormalities, enlarged lymph nodes in your lower neck and underarm. Your doctor will listen to your heartbeat, check your chest and abdomen to determine if the pain is due to another condition. If your medical history and the breast and physical examination show nothing unusual, you may not require additional tests.

Otherewise, a number of tests may be done to evaluate your condition, which include:

Mammogram: If your doctor has found a breast lump, unusual thickening, or a focused area of pain in your breast tissue during physical examination, you will need an X-ray exam of your breast that further evaluates the area of concern detected during the breast exam (diagnostic mammogram).

Ultrasound: An ultrasound exam makes use of painless sound waves to create images of your breasts, and is often performed along with a mammogram. Sometimes, you might need an ultrasound to evaluate a focused area of pain even if your mammogram appears normal.

Breast biopsy: A biopsy will be ordered for accurate diagnosis of suspicious breast lumps, areas of thickening or unusual areas seen during imaging exams. During a biopsy, your doctor will remove a small sample of breast tissue from the area in question, which is then sent to the laboratory for analysis.

In most women with breast pain, no treatment is needed as it resolves on its own. If you do require any treatment, your doctor will recommend these measures:

Elimination of an underlying cause or an aggravating factor: This includes a simple adjustment, such as wearing a bra with good support.

Use a topical nonsteroidal anti-inflammatory (NSAID) medication: You may need to use topical NSAIDs if your pain is very severe. Your doctor may advise you to apply NSAID cream directly over the area where you feel the pain.

Adjustment of birth control pills: If you are on birth control pills, skipping the pill-free week or switching to another contraceptive method may help control breast pain symptoms.

Reduction of the dose of menopausal hormone therapy: The dose of menopausal hormone therapy may be lowered or the therapy may be stopped altogether.

Prescription medications.

Danazol is the only FDA approved prescription medication available to treat breast pain and tenderness. However, danazol may cause potentially severe side effects, such as acne, weight gain, and voice changes, which limits its use.

Tamoxifen, a prescription medication used in breast cancer treatment and prevention, may be advised in some women, but this drug carries the risk of side effects that are more annoying than the breast pain itself.

Certain alternative remedies like dietary supplements and vitamins may relieve symptoms and reduce the severity of breast pain in some women. These include:

• Evening primrose oil: This supplement acts by changing the fatty acid balance in your cells, which helps reduce breast pain.
• Vitamin E: Studies have shown a possible benefit of vitamin E in premenstrual women who experience breast pain that fluctuates during the menstrual cycle. In a study, 200 IU of vitamin E taken twice daily for about two months improved symptoms in women with cyclic breast pain. For adults above the age of 18, pregnant women, and breastfeeding women, the maximum dose of vitamin E is 1,000 milligrams per day (or 1,500 IU).

Ask your doctor about the supplement that might help you, and also ask about the doses and any possible side effects. If you are taking a supplement for breast pain, discontinue it if you do not notice any improvement in your breast pain after few months. Take just one supplement at a time so that you can clearly identify which one helps to relieve your pain.

Lifestyle modifications are necessary in order to cope with breast pain.

Although, there is very little research to prove the effectiveness of these self-care remedies, you may give them a try.

• Apply hot or cold compresses on your breasts.
• Wear a well-fitting bra that firmly supports your breasts.
• Wear a sports bra while exercising as your breasts will be more sensitive.
• Consider relaxation therapy as it can help control the high levels of anxiety associated with severe breast pain.
• Limit the intake or completely avoid caffeine containing beverages or foods, a dietary change some women find helpful, although studies on the effects of caffeine on breast pain have been inconclusive.
• Follow a diet low in fat and eat more complex carbohydrates, a strategy that has helped some women with breast pain.
• Consider taking an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) — but ask your doctor the dosage, as long-term use increases your risk of liver problems and other side effects.
• Certain birth control pills may help reduce the discomfort of breast pain. Ask your doctor if this therapy is suitable for you.
• Maintain a dairy to note down when you experience breast pain and other symptoms. This helps to determine whether your pain is cyclic or noncyclic.