Breast pain

Breast pain (mastalgia) is a common type of discomfort among women — affecting as many as seven in 10 women at some point in their lives.

About 10 percent of women have moderate to severe breast pain more than five days a month. In some cases, severe breast pain lasts throughout the menstrual cycles. Postmenopausal women can experience breast pain, but the symptom occurs more frequently in younger, premenopausal women and perimenopausal women. When it’s severe, breast pain can have a major impact on daily activities, work and relationships.

Breast pain alone rarely signifies breast cancer. Still, if you have unexplained breast pain that persists, causes worry about breast cancer or otherwise disrupts your life, get checked by your doctor.

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. The fact that cyclic breast pain often decreases or disappears with pregnancy or menopause lends support to the theory 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 can reduce these symptoms. Breast surgery itself, however, also causes pain, which may linger after the incisions have healed.

Most cases of breast pain are classified as either cyclic or noncyclic. Each type of breast pain has distinct characteristics. Cyclic 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

Noncyclic breast pain:

  • 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 in their 40s and 50s

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, if your breast pain seems to be getting worse over time or if your breast pain interferes with daily activities.

Also see your doctor for evaluation if you have pain in one particular area within your breast. Although it’s not a common symptom of breast cancer, breast pain does occur in about 2 to 7 percent of women with breast cancer.

Tests to evaluate your condition may include:

  • Clinical breast exam and physical exam. During this exam, your doctor checks for unusual areas 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 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 a focused area of pain, you need to undergo mammography — an X-ray exam of your breast tissue. Even if your physical exam is normal, your doctor may recommend mammography if you’re age 30 or older, to double-check for suspicious areas in your breast 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. Younger women — those under age 30 — might undergo ultrasound to evaluate a focused area of pain even if the physical exam 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.

Often, breast pain resolves on its own within a few months. Very few women require specific treatment.

Treatment for breast pain may include:

  • Eliminating the underlying cause or aggravating factors, which may involve a simple adjustment, such as wearing a bra with extra support, or a significant change, such as switching birth control methods.
  • Using a topical nonsteroidal anti-inflammatory medication, applied directly to the area affected by noncyclic breast pain.
  • Taking an oral contraceptive, or adjusting the dose if you already take one.
  • Reducing the dose, or stopping the medication completely, if you’re taking postmenopausal hormone therapy.
  • Taking a prescription medication, such as danazol, bromocriptine or tamoxifen for relieving severe cyclic breast pain.

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, 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.