Mastalgia (breast pain)
Mastalgia is breast pain, described as any tenderness, throbbing, tightening, stabbing, or burning sensation in the breast tissue. Breast tenderness and discomfort can range from mild to severe, in some cases.
Breast pain is usually from benign conditions
Many people fear breast soreness is an indication of breast cancer. However, breast pain is rarely linked to breast cancer: it may be a possible symptom but is much more likely to be another benign breast condition.
What causes mastalgia?
Breast pain can affect anyone due to a variety of reasons, but are classified into two main types:
- Cyclical breast pain. The pain is linked to menstrual periods.
- Noncyclic breast pain. The pain may come from the breast, or from somewhere else, such as nearby muscles or joints, and may be felt in the breast. This pain can happen anytime and is not related to the menstrual cycle.
Cyclic v. noncyclic breast pain
Cyclic mastalgia: a hormonal connection
The most common type of breast pain is linked to the menstrual cycle, known as cyclic breast pain, and is nearly always based on hormonal fluctuations.
Some people begin to have cyclic pain around the time of ovulation, continuing until the start of their menstrual period. Breast pain that is cyclic can also affect those in menopause based on the changing levels of estrogen and progesterone, as well as pregnant people. The pain may be barely noticeable, or so severe that you can’t wear tight-fitting clothing or handle close contact of any kind. The pain may be felt in only one breast, or as a radiating feeling in the underarm area.
Some healthcare providers have people chart their breast pain to figure out if the pain is cyclical mastalgia or not. After a few months, the link between the menstrual cycle and breast pain will appear.
Researchers continue to study the role that hormones play in cyclic mastalgia. One study has suggested that some people with this condition have less progesterone than estrogen in the second half of the menstrual cycle. Other studies have found that an abnormality in the hormone prolactin may affect breast pain. Hormones can also affect cyclical breast pain due to stress or anxiety, by increasing or changing the pattern of pain when your stress levels are too high.
Hormone levels may not provide the total answer to cyclical pain, because the pain is often more severe in one breast than in the other. Hormones would tend to affect both breasts equally. Many researchers believe that the answer may be a combination of hormonal change and something in the breast tissue that responds to this activity. More research is needed.
Non-cyclical mastalgia is less common
Non-cyclical breast pain is fairly uncommon, feels different than cyclical mastalgia, and does not vary with the menstrual cycle. Generally, the pain is present all the time and manifests in a single location.
One cause of noncyclic pain is trauma, such as a blow to the breast tissue, or sometimes the residual impacts of having some kind of breast surgery (be it breast implants or a mastectomy). Breastfeeding can also cause breast pain. Other causes can include having abnormal nipple discharge indicating a breast infection (mastitis), or arthritic pain in the chest wall and neck which radiates down to the breast.
Non cyclical breast pain can also be caused by a condition called gynecomastia, referring to an increase in the amount of breast tissue caused by an imbalance of estrogen and testosterone. It can unevenly affect both breasts.
Hormone replacement therapy can also be a cause of breast pain, either as the developing breasts begin to grow or as the hormone changes continue to shift.
What are the symptoms of different types of breast pain?
Based on if the breast pain is cyclic or noncyclic, each type of breast pain typically has different characteristics.
Cyclical breast pain symptoms
- Changing hormone levels clearly related to the menstrual cycle.
- Pain intensifying two weeks before a menstrual period as classic premenstrual symptoms, then easing after menstruation is done.
- Sore breasts feeling dull, heavy, and achy.
- Breast swelling, fullness, or lumpiness.
- Both breasts being affected in the upper and outer portions, sometimes near the armpit.
Non-cyclical breast pain symptoms
- A tight, burning, aching, or stabbing sensation.
- Constant or intermittent pain.
- No relation to the menstrual cycle.
- One breast being affected in a localized area.
Sometimes breast pain can be felt outside the breast, as extramammary breast pain. These symptoms can feel like they are present in the breast tissue, but actually start outside of the breast. Arthritis can affect the chest wall cartilage and cause pain; a pulled muscle in the chest can also cause pain in the chest wall or rib cage that spreads to the breast tissue.
When to see your provider
Always make sure to see your doctor if you have abnormal breast pain, specifically if it lasts longer than a few weeks, worsens over time, occurs in only one area of your breast, or interferes with your daily activities and sleep patterns.
How is breast pain diagnosed?
If your breast pain persists after menopause, doesn’t seem related to hormonal fluctuations, or doesn’t go away after one or two menstrual cycles, it should be evaluated by a professional.
Some diagnostic tests may be required to determine if your severe cyclic breast pain is caused by something more serious such as a breast infection, breast mass, or inflammatory breast cancer.
Your healthcare provider – either your primary care physician or gynecologist – will do a physical exam to listen to your heart and lungs to check if your pain may be coming from the chest or abdomen, indicating another condition. They will also perform a clinical breast exam to check for changes in your breasts and to examine your lymph nodes.
They may also go through your medical history and if the following tests and information show no abnormalities, you will not need further tests.
If your doctor feels an unusual thickening of your breast tissue or abnormalities such as painful lumps, they will order a mammogram. This is an X-ray of the breast to evaluate the area of concern found during the breast exam. A mammogram may be paired with an ultrasound imaging test to evaluate the area of pain using sound waves to produce images of the tissue.
When a biopsy is indicated
Thickening tissue or a suspicious breast lump found during imaging tests will likely require a biopsy for diagnosis. During this procedure, your doctor will take a small sample of the breast tissue and analyze it in a lab for abnormalities such as cancer cells or infection.
Treatments for mastalgia
Just as breast pain is caused by a variety of reasons, it can be treated in a variety of ways depending on the cause, and in some instances will go away on its own.
Treatments for cyclical breast pain
Treatment for cyclical breast pain will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. Treatments vary greatly and may include the following:
- Eliminating the aggravating factor. Wearing a properly fitting or supportive bra may help relieve pain if it’s caused by ill fitting undergarments.
- Diet changes. Eating a low-fat diet or restricting caffeine intake can help ease breast pain symptoms.
- Topical Nonsteroidal Anti-Inflammatory (NSAID) medications. NSAIDs help relieve intense pain, and may be recommended as a cream to apply directly to the pain point. However, NSAIDs are not recommended for people under 20 years of age, as they can increase the risk of Reye Syndrome, a rare but serious disease caused by the link of recovering from chicken pox, cold, or flu and taking aspirin during youth.
- Alternative medicine. Taking vitamin E has shown to benefit people that have breast pain associated with the menstrual cycle. Evening Primrose Oil is also theorized to change the fatty acid balance of your cells to reduce breast pain.
Other medications for cyclical breast pain
In some cases, various prescription medications or supplemental hormones and hormone blockers are also prescribed. These may include:
- Birth control pills. Changing your birth control or skipping the pill-free week may ease symptoms, but should only be done after consulting your doctor.
- Bromocriptine (which blocks prolactin in the hypothalamus).
- Danazol. This male hormone is the only FDA approved medication to help treat fibrocystic breasts.
- Thyroid hormones. These may help regulate hormonal imbalances to prevent breast pain associated with menstruation
- Tamoxifen. This estrogen blocker is primarily used as treatment for a breast cancer patient or to prevent breast cancer, but the side effects may be more problematic than the mastalgia itself.
Supplemental hormones and hormone blockers may have side effects. In addition, the risks and benefits of such treatment should be carefully discussed with your healthcare provider.
Treating non-cyclic mastalgia
It’s often more difficult to figure out the best treatment for breast pain that is noncyclic because it’s hard to know exactly where the pain is coming from. In addition, the pain is not hormonal. Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
Breast cysts. If the pain is caused by a breast cyst, then it will be aspirated: a small needle will be used to remove the liquid contents of the cyst. Many cysts might indicate fibrocystic breasts, where the breast tissue is scar-like and has a ropy texture. If that is the case, multiple aspirations will need to be done.
Depending on where the pain starts, treatment may include pain relievers, anti-inflammatory medicines, and compresses.