How do you define breast pain?

Simply put, breast pain or breast tenderness is some level of discomfort or pain that can develop in one or both breasts. In medical terms, it is referred to as mastalgia and mastodynia.

It can occur in women of any age but is more common in younger women. It can occur even in men and transgender people.

About 70 percent of women develop breast pain at some point in their lifetime but only 15 percent require treatment.

Breast pain is more common among premenopausal women where sometimes the pain may be present throughout the menstrual cycle. However, rarely do postmenopausal women also develop this pain.

Throughout the life of a woman from the time, she develops the breasts to menopause, breast changes occur, which cause pain in the breasts. These changes occur during menstruation, pregnancy, and aging.

During menstruation and pregnancy, the pain and tenderness are due to hormonal changes.

The nature of breast pain can be described as throbbing, sharp, stabbing, or it can present as tightness in the breast tissue. The pain can be mild or severe. It can be constant, chronic, or occasional. It could also be associated with tenderness and soreness.

The duration of the pain can vary. It may occur:

  • For just a few days before a menstrual period. This pain can be mild to moderate and usually occurs in both breasts.
  • For a week or more before a period and sometimes throughout the menstrual cycle. The pain may be moderate or severe and occurs in both breasts.
  • Throughout the month and the menstrual cycle

The location of the breast pain can vary. It can occur in the left or the right breast or in both breasts. It can occur on the side of the breast or below the breast. The pain can sometimes extend beyond the breast into the chest.

The above description tells of the variations of the pain in the breast, each having its own causes, some of which are serious and some are not.

Breast pain in men is caused by gynecomastia. In this condition, there is an enlargement of a man’s breasts, usually due to hormonal imbalance or hormone therapy.

Breast pain in transgender women may be due to hormone therapy.

When should you worry about breast pain and see the doctor?

Usually, the cause of breast pain is a non-malignant condition. Moreover, breast cancers are mostly painless. However, when the breast pain is persistent and unexplained, then you should be concerned and you should see the doctor. Pain that persists for two or more menstrual cycles or after menopause should be investigated.

Secondly, if it occurs consistently in one part of the breast, gets worse over time, and awakens you from sleep are other warning signs of something that could be serious.

Types of breast pain

Breast pain can occur both before and after menopause. However, it is most common during the reproductive years.

Cyclic breast pain. Some breast swelling and breast tenderness are quite commonly seen just before menstruation. Pain associated with your menstrual cycle is called cyclic breast pain. This type of breast pain tends to subside during or after your period. Cyclic type of breast pain accounts for 75% of all such complaints.

Noncyclic beast pain. This type of pain does not follow any pattern. It can be due to various reasons including trauma to the breast. It can even originate from the surrounding tissues and muscles. Such pain that originates outside the breast is called extramammary breast pain.

The symptoms with which a patient presents herself varies and these symptoms depend on the type of breast pain – whether cyclic or noncyclic.

Symptoms of breast pain

Cyclic breast pain symptoms typically present as severe pain that starts before the menstrual period and is relieved when the period ends.

  • It is always associated with menstruation.
  • Though it is caused by hormonal changes during menstruation, its exact cause is not known.
  • It is more common in younger women between the ages of 20 to 40 years.
  • This pain usually occurs in both breasts.
  • It can be described as a mild heaviness or tenderness in the outer quadrant of the breasts, which may radiate to the axilla (armpits) or even to the arm.
  • This pain is accompanied by swelling and lumpiness.
  • Pain goes away after the menstruation stops.
  • No treatment is required for this type of breast pain and
  • It usually stops occurring after menopause.

Noncyclic breast pain symptoms are not related to your menstrual cycle.

  • This type of pain usually has a pathological cause.
  • It is mostly associated with one breast or one area of the breast.
  • This pain is commonly seen in postmenopausal women.
  • It is a constant or intermittent sharp pain, which is localized to an area of one breast only.
  • Treating the underlying cause stops the pain from occurring.

Extramammary breast pain

As the name suggests, this is the pain in the breast that occurs due to a cause, which is not present in the breast but outside the breast tissue. A common example of this type of pain is a pulled or strained muscle of the chest wall or costochondritis. This produces pain, which feels as though it is originating from the breast.

Causes of breast pain

Causes of cyclic breast pain 

Though we do not yet know why you get cyclical breast pain, it is strongly believed this pain is due to the effects of hormones on breast tissue. These effects occur because of hormonal changes that take place during menstruation.

Changing hormone levels can cause changes in the milk ducts or milk glands, which can result in breast cysts. These cysts can be painful and are a common cause of cyclic pain.

The fact that this pain disappears or decreases during the 2nd and 3rd trimester of pregnancy and after menopause only helps to confirm this theory. However, no single hormonal abnormality has been identified as a contributory factor that causes this type of pain.

Causes of noncyclic breast pain 

There are various causes of that give rise to this type of pain and it is harder to arrive at the exact cause. These include:

  • Fibrocystic disease, which can cause a breast cyst or a benign growth
  • Inflammation or infection, which can give rise to breast abscess
  • Large breasts give rise to noncyclic pain, especially when an ill-fitting bra is being used.
  • Inflammatory breast cancer gives rise to painful stabbing pain in the affected breast. It should be noted that breast cancers are more often than not painless.
  • After pregnancy, there can be breast pain during breastfeeding. Mastitis, which is inflammation of the breast due to excess milk or blockage of milk ducts during breastfeeding, is also another common cause of breast discomfort in pregnancy.
  • Extramammary pain, which is due to a cause situated outside the breast such as costochondritis or a pulled chest muscle can give rise to pain in the chest and breast.
  • Trauma to the breast, either surgical or otherwise can cause pain in the affected breast.
  • Shingles or herpes zoster can cause pain if the blistering rash appears over the breast.
  • Left breast pain or pain under the left breast can also occur to accumulation of gas in the stomach.

Medicines that cause breast pain

Certain medication can cause breast pain. They include:

  • Some hormonal drugs such as oral contraceptives or hormonal replacement therapy, which is given during menopause to replace the depleting hormones in the body
  • Antidepressants such as  Prozac and Zoloft and chlorpromazine can cause breast pain
  • Digitalis used in heart disease
  • Methyldopa used in high blood pressure
  • Diuretics such as spironolactone, which are used to treat heart failure and fluid retention in the body
  • Oxymetholone, which is an anabolic steroid can also cause breast pain

Tests for diagnosis of breast pain

The purpose of the diagnostic tests is to identify the cause of breast pain and treat it as such..

1) Clinical breast exam. The doctor performs the breast examination to identify a lump. If present, the nature of the lump can tell a few things about its nature. A well-defined movable lump that is not attached, more or less tells you that it is a nonmalignant tumor or a cyst. He will also look for and examine the lymph nodes in your lower neck and underarm to check if they are enlarged. If there is no lump felt, the doctor will examine for other causes that could be originating outside the breast such as a strained muscle or costochondritis, or a painful palpable liver.

2) Mammogram. A diagnostic mammogram will rule out a lump that could not be felt on the breast exam

3) Breast Ultrasound will help to evaluate a pain that is focused in one part of the breast even if the mammogram appears normal.

4) Breast Biopsy will confirm the nature of the breast lump that has been identified during imaging studies and will rule out malignancy.

5) Gene testing for breast cancer is advised for those women who have a strong family history of breast cancer.

Treatment of breast pain

Treatment of breast pain consists of treating the cause. Certain home remedies for breast pain are also explained, which can help alleviate pain.

  • Reducing dietary fat to less than 15% of the diet helps over a period of time to gradually reduce breast pain
  • Reduce caffeine intake as it has been seen to give relief from pain in some cases.
  • Birth control pills can be taken for relief from breast pain, which occurs during menstruation. However, please note that these pills are also known to cause  cyclic breast pain
  • Taking magnesium or its supplements during the fifteen days before the start of the next menstruation cycle gives relief from cyclic breast pain
  • Mild pain of mastitis can be treated by light massage and warm compresses prior to breast feeding the baby. This could help to unblock the milk ducts. In severe pain of mastitis, cold compresses should be used instead of warm compresses. Weaning mastitis can be treated by taking lactation inhibiting herbal products or medicines
  • If a bacterial infection is present, a full course of antibiotics is prescribed for 14 days.
  • Breast abscess is extremely rare and just giving antibiotics is not enough. The risk factors are a late delivery and an age above 30 years. Aspiration or making an incision and draining the abscess is the effective cure.
  • If you are already taking birth control pills, a difference in the dosage will help to relieve breast pain. Otherwise switching to another birth control method may be necessary.
  • Topical application of a non steroidal anti-inflammatory medication over the painful area of the breast will give relief from noncyclical breast pain
  • Hormone therapy induced pain can be relieved by reducing the dose or stopping the hormones completely.
  • A correctly fitting bra is necessary for proper support of the breasts to prevent or stop breast pain. Similarly wear a properly fitting sports bra during exercise and while sleeping. A sports bra holds the breasts in position and allows them to move with the chest and not individually. It is necessary to change the sports bra every six months to maintain its effectiveness.
  • Breast reduction surgery may be necessary in women with large breasts to give relief especially when the pain causes too much discomfort

Medications for breast pain

  • Danazol. This drug is approved by the FDA to treat breast pain and tenderness. It is used to treat endometriosis (a disease that causes infertility), among other disorders. It comes with a host of side effects some of which are serious such as androgenic effects, risk of stroke, and serious liver disease. It is not given to women who are pregnant or breastfeeding.
  • Tamoxifen is used to give pain relief but its side effects probably outweigh its benefit. This drug is used in treating breast cancer.
  • For pain relief, acetaminophen (paracetemol) such as Tylenol, NSAIDs such as Ibuprofen or Naproxen are used. Aspirin can also be used but is contraindicated in women under the age of 20 years for fear of developing Reye syndrome ( a disease that affects the brain and liver)

Home remedies for breast pain

  • Use hot or cold compresses on your breasts.
  • Wear a properly fitting bra that will firmly support the breasts.
  • Some doctors advise taking evening primrose oil (1000 mg thrice daily). This helps to change the fatty acid balance in the cells.
  • Vitamin E (400 I.U. thrice daily) gives relief from cyclic breast pain in premenstrual women.

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