Breast pain (mastalgia) is a common complaint among women. You might describe your breast pain as chronic tenderness, sharp burning or tightness in your breast tissue. The pain may be constant or it may occur only occasionally.
Some women have severe breast pain, occurring more than five days a month, Severe breast pain may even persist throughout the menstrual cycle. Postmenopausal women sometimes have breast pain, but the symptom is more common in younger, premenopausal women and perimenopausal women.
Most times, breast pain signals a noncancerous (benign) breast condition and rarely signifies breast cancer. Still, unexplained breast pain that doesn't go away after your next menstrual cycle or that persists after menopause needs to be evaluated by your doctor.
Most cases of breast pain are classified as either cyclic or noncyclic. Each type of breast pain has distinct characteristics.
Breast pain characteristics
Cyclic breast pain Noncyclic breast pain
* Clearly related to the menstrual cycle
* Described as dull, heavy or aching
* Often accompanied by breast swelling or lumpiness
* Usually affects both breasts, particularly the upper, outer portions, and can radiate to the underarm
* Intensifies during the two weeks leading up to the start of your period, then eases up afterward
* Usually affects premenopausal women in their 20s and 30s and perimenopausal women in their 40s
* Unrelated to the menstrual cycle
* Described as tight, burning or sore
* Constant or intermittent
* Usually affects one breast, in a localized area, but may spread more diffusely across the breast
* Usually affects postmenopausal women
Extramammary breast pain
Extramammary breast pain feels like it originates in the breast, but its source is actually somewhere else. Pulling a muscle in your chest, for example, can cause pain in your chest wall or rib cage.
When to see a doctor
Make an appointment with your doctor if:
* You have breast pain that persists daily for more than a couple of weeks
* Your breast pain is localized to one specific area of your breast
* Your breast pain seems to be getting worse over time
* Your breast pain interferes with daily activities
Although it's not a common symptom of breast cancer, localized breast pain is associated with breast cancer in a small percentage of women.
Most of the time, it's not possible to identify the exact cause of breast pain. Likely contributors are:
* Reproductive hormones. Cyclic breast pain appears to have a strong link to hormones and your menstrual cycle. Cyclic breast pain often decreases or disappears with pregnancy or menopause so experts theorize that hormones play a role. However, no studies have identified a particular hormonal abnormality as a contributor to cyclic breast pain.
* Anatomical factors. The cause of noncyclic breast pain is likely to be anatomical rather than hormonal, triggered by breast cysts, breast trauma, prior breast surgery or other factors localized to the breast. Noncyclic breast pain may also originate outside the breast — in the chest wall, muscles, joints or heart, for example — and radiate to the breast.
* Fatty acid imbalance. An imbalance of fatty acids within the cells may affect the sensitivity of breast tissue to circulating hormones. This theory provides the rationale for taking evening primrose oil capsules as a remedy for breast pain. Evening primrose oil contains gamma-linolenic acid (GLA), a type of fatty acid. GLA is thought to restore the fatty acid balance and decrease the sensitivity of breast tissue to circulating hormone levels.
* Medication use. Certain hormonal medications, including some infertility treatments and oral contraceptives, may be associated with breast pain. Also, breast tenderness is a possible side effect of estrogen and progesterone hormone therapy, which could explain why some women continue to have breast pain even after menopause. There have also been reports of breast pain associated with prescribed antidepressants, including selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft).
* Breast size. Women with large breasts may have noncyclic breast pain related primarily to the size of their breasts. This type of breast discomfort is typically accompanied by neck, shoulder and back pain. Some studies have shown that breast reduction surgery sometimes reduces these symptoms. Breast surgery itself, however, also causes pain, which may linger after the incisions have healed.
Preparing for your appointment
You're likely to start by seeing your family doctor, a general practitioner or other care provider. However, in some cases when you call to set up an appointment, you may be referred immediately to a breast health specialist.
What you can do
The initial evaluation of your breast pain focuses on your medical history. You'll discuss with your doctor the location of the breast pain, its relation to your menstrual cycle and any other relevant breast history that might explain the cause of your pain. You can facilitate this discussion by preparing ahead of time:
* Take note of all your symptoms, even if they seem unrelated to the reason for which you scheduled the appointment.
* Review key personal information, including major stresses or recent life changes.
* Make a list of all medications, vitamins and supplements that you regularly take.
* Write down questions to ask your doctor. List your questions from most important to least important in case time runs out.
What to expect from your doctor
Your doctor may ask you questions about:
* How long you've experienced the breast pain
* The severity of your pain on a 10-point scale
* Whether the pain occurs in one or both breasts
* When you had your last mammogram
* Whether you have other signs or symptoms, such as a breast lump, area of thickening or nipple discharge
* If you have skin changes, such as redness or a rash
Your doctor also may assess your personal risk of breast cancer, based on factors such as your age, family medical history and prior history of precancerous breast lesions.
Tests and diagnosis
Tests to evaluate your condition may include:
* Clinical breast exam and physical exam. During this exam, your doctor checks for changes in your breasts, visually and manually examining your breasts and the lymph nodes located in your lower neck and underarm area. Your doctor will probably listen to your heart and lungs and check your chest wall and abdomen to be certain the pain originates from your breast and isn't related to some other condition. If your medical history and the breast and physical exam reveal nothing unusual, you may not need additional tests.
* Mammography. If your doctor detects a breast lump, unusual thickening in your breast tissue, or focused area of pain, you need to undergo mammography — an X-ray exam of your breast tissue. Even if your breast exam is normal, your doctor may recommend diagnostic mammography if you're age 30 or older and you're experiencing a new onset of breast pain. Diagnostic mammography focuses in on suspicious areas in your breast to double-check for lesions that may be too small to feel.
* Ultrasound. An ultrasound exam uses sound waves to produce images of your breasts and is often performed in conjunction with mammography. You might undergo ultrasound to evaluate a focused area of pain even if the mammogram appears normal.
* Breast biopsy. Suspicious breast lumps, areas of thickening or unusual areas seen during imaging exams may require a biopsy before your doctor can make a diagnosis. During a biopsy, your doctor (radiologist) obtains a small sample of breast tissue from the suspicious area and sends it for microscopic analysis.
Treatments and drugs
Often, breast pain resolves on its own within a few months. Very few women require specific treatment.
To treat breast pain, your doctor might recommend that you:
* Eliminate an underlying cause or aggravating factor. This may involve a simple adjustment, such as wearing a bra with extra support, or a significant change, such as switching birth control methods.
* Use a topical nonsteroidal anti-inflammatory medication. You apply the medication directly to the area affected by noncyclic breast pain.
* Take an oral contraceptive. If you already take an oral contraceptive, you may need a dose adjustment.
* Reduce the dose of menopausal hormone therapy. You might also consider stopping menopausal hormone therapy entirely.
* Take a prescription medication. Danazol is the only prescription medication approved by the Food and Drug Administration for treating breast pain and tenderness, but it comes with the risk of potentially severe androgenic side effects, such as acne, weight gain and voice changes, that limit its use. Tamoxifen, a prescription medication for breast cancer treatment and prevention, may be recommended for some women, but this drug also carries the potential for side effects that may be more bothersome than the breast pain itself.
Lifestyle and home remedies
Even though there is little formal research to show the efficacy of these self-care remedies, they help many women manage their breast pain. Some may be worth a try:
* Use hot or cold compresses on your breasts.
* Wear a firm support bra, fitted by a professional if possible.
* Wear a sports bra during exercise and while sleeping, especially when your breasts may be more sensitive.
* Experiment with relaxation therapy, which can help control the high levels of anxiety associated with severe breast pain.
* Limit or eliminate caffeine, a dietary change many women swear by, although medical studies of caffeine's effect on breast pain and other premenstrual symptoms have been inconclusive.
* Decrease the fat in your diet to less than 20 percent of total calories, which may improve breast pain by altering the fatty acid balance.
* Use a pain reliever (analgesic), such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), to alleviate breast pain.
* Keep a journal noting when you experience breast pain and other symptoms, to determine if your pain is cyclic or noncyclic.
Vitamins and dietary supplements lessen breast pain symptoms and severity for some women. Ask your doctor if one of these might help you:
* Evening primrose oil. This supplement appears to change the balance of fatty acids in your cells, which may reduce breast pain. Some doctors recommend taking a 1,000-milligram capsule up to three times a day.
* Vitamin E. Early studies showed a possible beneficial effect of vitamin E on breast pain in premenstrual women who experience breast pain that fluctuates during the menstrual cycle, but the medical literature to date remains inconclusive. Some doctors recommend taking 400 international units up to three times a day.
If you try a supplement for breast pain, stop taking it after two or three months if you don't notice any improvement in your breast pain.