What is breast pain? What is mastalgia?

What is breast pain? What is mastalgia?

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 the 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

What are the signs and 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 symptoms is pain, while a sign could be a skin rash.

Breast pain is usually classified as "cyclic" (cyclical) or "non-cyclic" (non-cyclical).

The signs and symptoms of cyclical breast pain

The pain comes cyclically, just like the menstrual cycle does.

The breasts may become tender.

Patients describe the pain as 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 generally 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 the period comes. 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).

The signs and symptoms of non-cyclical breast pain

It generally affects just one breast, usually just within a quadrant of the breast, but may spread across the chest.

It is more 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, generally 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 actually 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

Diagnosing breast pain

If the 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.

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 diagnosis and help the doctor decide on the best therapy.

What are the causes of 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

Angina

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

Costochondritis

Cyclical breast pain

Diet - especially caffeine

Fibromyalgia

Herpes zoster

Mastitis

Medications - including digitalis, chlorpromazine, oxymetholone, some diuretics, spironolactone, and methyldopa

Peptic ulcer

Pericarditis

Pleurisy

Pregnancy

Psychological

Puberty

Pulmonary embolism

Rib fracture

Shingles

Shoulder pain

Sickle cell anaemia

Trauma to the chest wall

What are the treatment options 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. 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

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 that "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/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 that "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:

Danazol - 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, a deepening voice (possibly permanent), weight gain, skin rash, nausea and dizziness.

Bromocriptine - approved for treating certain breast conditions. Side effects may include constipation, headaches, hypotension (low blood pressure), and nausea.

Tamoxifen - 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/or thromboembolism.

Goserelin - 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.

Toremifene - 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 the woman is on a 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.

Breast Pain: Should You be Concerned?

In the video below, Dr. Katharine Lee, from the Cleveland Clinic, talks about the different types of breast pain.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today