Breast pain (mastalgia)
Breast pain is a common problem in younger women who are still having periods (menstrual cycles). It is less common in older women. The pain can be in one breast or in both. It may come and go each month, or it may last for several weeks, or even months. Breast pain (mastalgia) is the most common breast related complaint among women; nearly 70% of women experience breast pain at some point in their lives. Breast pain may occur in one or both breasts or in the underarm (axilla) region of the body.
The severity of breast pain varies from woman to woman; approximately 15% of women require treatment. Though breast pain is not normally associated with breast cancer, women who experience any breast abnormalities, including breast pain, should consult their physicians.
There are two main types of breast pain: cyclical pain and non-cyclical pain.
Cyclical breast pain is related to how the breast tissue responds to monthly changes in a woman’s estrogen and progesterone hormone levels. If breast pain is accompanied by lumpiness, cysts (accumulated packets of fluid), or areas of thickness, the condition is usually called fibrocystic change. During each menstrual cycle, breast tissue sometimes swells because hormonal stimulation causes the breast's milk glands and ducts to enlarge, and in turn, the breasts retain water. The breasts may feel swollen, painful, tender, or lumpy a few days before menstruation. Breast pain and swelling usually ends when menstruation is over. The average age of women who have cyclical breast pain is 34 years old. Cyclical breast pain may last for several years but usually stops after menopause unless a woman uses hormone replacement therapy (HRT).
Cyclical breast pain accounts for nearly 75% of all breast complaints. Of all women who experience breast pain, two thirds experience cyclical breast pain. Physicians often have patients chart their pain to determine whether the pain is cyclical. Though cyclical breast pain is usually related to the menstrual cycle, stress may also affect hormone levels and influence breast pain. Physical activity, especially heavy lifting or prolonged use of the arms, has also been shown to increase breast pain (pectoral (chest) muscles may become sore from physical activity).
Non-cyclical breast pain is far less common than cyclical breast pain and is not related to a woman’s menstrual cycle. Women who experience non-cyclical breast pain often experience pain in one specific area of the breast(s). Woman who experience injury or trauma to the breast or those who undergo breast biopsy sometimes experience non-cyclical pain. The condition may occur in both pre-menopausal and post-menopausal women and usually subsides after one to two years. Non-cyclical pain is most common in women between 40 and 50 years of age. Usually, non-cyclical breast pain does not indicate breast cancer, though women should discuss the condition with their physicians.
Another type of non-cyclical pain called costochondritis does not actually occur in the breast; however, the condition may feel as though it is coming from the breast. This type of arthritic pain occurs in the middle of the chest where the ribs and the breast bone connect. Costochondritis may occur as the result of poor posture or aging. Women who experience costochondritis usually describe it as a burning sensation in the breast.
The key to the evaluation of breast pain is to make sure there is no underlying problem that is the source of the pain. This includes a complete breast examination as well as a mammogram and/or ultrasound depending on the woman’s age. If there is no underlying abnormality as the cause of the pain, it is generally due to hormonal stimulus.
Post-menopausal women on estrogen supplements may find a relief in their breast discomfort by lowering the dose of the supplemental estrogen or by discontinuing it entirely. For women not on supplemental estrogen, a variety of tools can be utilized to manage the pain. This may include anti-inflammatory medications such as Motrin or Aleve or or in some cases hormonal manipulation.
For women who have cyclic breast pain, controlling the breast pain may require use of oral contraceptives to modulate the hormonal changes during the menstrual cycle. In addition, the drug, Danazol, most commonly used for management of endometriosis, can be very effective in reducing breast pain. For mild cases evening primrose oil, a fatty acid supplement, can provide relief of symptoms if taken regularly over a period of several weeks.
Bromocriptine and danazol both relieve cyclical breast pain by blocking certain hormones (such as estrogen and progesterone). However, these drugs may cause serious side effects in some women. Bromocriptine is poorly tolerated by many patients; side effects include nausea, dizziness, and fertility problems. Side effects of danazol may include weight gain, amenorrhea (absence of menstruation), and masculinization (such as extra facial hair) when given high doses. Other drugs, such as tamoxifen or goserelin, have been shown to have some effect on cyclical breast pain; however, these drugs are presently only approved for use in women with breast pain in the United Kingdom.
In cases where non-cyclical pain occurs only in a specific area of the breast (localized pain), physicians may choose to inject anesthetics or corticosteriods in this "target area" to relieve the pain. In very rare cases, the painful area may be surgically removed. However, surgery usually leads to increased breast pain, and some women may develop non-cyclical breast pain at the site of previous surgeries on the breast.