Mastalgia: Benign Breast Pain
June S., a Boston-area writer, takes to her bed with a heating pad on her left breast at least once a month. Judith, her sister, takes herbal supplements to ease the breast pain that accompanies her period. They are just two of the millions of women that suffer from mastalgia—breast pain that is not of cancerous origin.
Many women experience breast pain and tenderness as a routine part of their monthly menstrual cycle. But if the pain seems unbearable, or occurs during mid-cycle, it may be time to take action.
When faced with breast pain on a monthly basis, some of us suspect the worst and immediately think "cancer." Others simply accept the pain as something we have to live with. But neither scenario is necessarily correct. Any persistent, sudden or severe breast pain warrants a visit to your doctor to rule out a serious illness. But if nothing is found (which is likely to be the case), your healthcare practitioner can work with you to discover the real cause of your discomfort and find a suitable remedy.
A Proper Diagnosis
Your doctor may not seem overly concerned when you report pain in your breasts. In fact, most breast pain is caused by problems that are not life-threatening, and only 10% of diagnosed breast cancers present with pain as a symptom. Physical exam of the breast is usually the first step in a diagnosis. This will help reassure you that your concerns are being taken seriously, although your situation is likely to be normal. If the physical exam is normal, your doctor can use his or her screening expertise to make a decision about whether testing, such as ]]>mammography]]> or ]]>sonography (ultrasound)]]>, is warranted.
You'll then be taught to determine whether your pain is cyclic or noncyclic. Keeping a daily chart of breast changes and pain can help you understand your body's changes and what might be causing the pain. Cyclic and noncyclic pain can be caused by a wide array of factors and sometimes can be alleviated by simply eliminating an irritating dietary component or medication.
Cyclic pain is probably caused by the hormonal fluctuations—especially the estrogen surge—that are a part of your menstrual cycle. As the body prepares for a possible pregnancy, or a menstrual period, the number of milk-producing cells and amount of breast fluid increases. In fact, your breasts can retain as much as 3-6 teaspoons of fluid prior to your menstrual cycle.
The resulting enlargement causes a pain that has been described as dull and aching. It is usually greatest in the upper and outer portion of the breast, closest to the armpit where most of the milk duct tissue is. The pain is often felt more acutely in one breast, although both are usually involved. As June describes it, "I feel as if someone has punched out the top, inner half of my left breast."
Monitoring the Pain
Keeping a record of your pain and its intensity will help you determine whether the pain corresponds with your menstrual cycle, and may offer some psychological relief when you realize that the onset of menstruation relieves the pain. At this point, you can begin experimenting with a range of possible remedies.
Finding Dietary Causes
Three dietary culprits are believed to increase breast pain, although at the present time there is little or no scientific evidence to back this up. Some women claim to get symptomatic relief with simple dietary modifications:
- Caffeine and chocolate (which contain chemicals called xanthines) may aggravate your breast pain, and you may want to eliminate them completely.
- Salt and high-sodium diets in general can increase your fluid retention in your breasts and exacerbate cyclic pain.
- High-fat diets may also be a factor in breast pain, as they increase the production of estrogen and stimulate hormone production.
Some women (approximately 40%-60%) get relief from a regular dose of ]]>evening primrose oil]]>. However, before you embark on a self-prescribed regimen of supplements, you should discuss your plans with your doctor or nurse practitioner. Mechanical interventions such as a properly-fitted support bra, hot and cold applications during intense pain, and breast massage—which helps move excess fluid through the lymphatic system—may also relieve your pain.
If you have no success with these remedies, medication may be recommended. Nonsteroidal anti-inflammatory drugs, such as ]]>ibuprofen]]>, are sometimes recommended for breast pain. Side effects include stomach upset or ulcer. ]]>Bromocriptine]]> and ]]>danazol]]> are sometimes prescribed, but have fairly significant side effects, so most health practitioners use them only as a last resort.
Discovering the Thyroid's Role
Severe cyclic breast pain may also indicate a thyroid condition, and you may want to have this checked if the above interventions don't work.
Note: All treatments mentioned under cyclic pain are used for noncyclic pain. The treatment for both conditions is usually the same or similar.
As with cyclic pain, you should keep a daily record of your discomfort and the level of intensity to help determine the cause. Noncyclic pain is usually localized in a specific area in one breast and is not related to the hormonal fluctuations of your menstrual cycle. Benign changes in the breast include cysts, fibroadenomas, duct ectasia (widening), mastitis (inflammation), injury, and breast abscesses. All require medical evaluation. In fact, if your breast pain is accompanied by redness of the skin, fever, or warmth in the breast, you should see your health practitioner immediately. This could indicate infection.
If these problems are not the source of your pain, you might have a musculoskeletal condition, such as a pinched nerve in the back, or ]]>costochondritis]]> , an inflammation of the cartilage connecting the ribs to the sternum. Noncyclic breast tenderness and pain can also be caused by medications prescribed for hormonal conditions, ]]>high blood pressure]]> , and heart and gastrointestinal problems. Some women even find their pain is exacerbated by herbal products, particularly those products that are actually recommended to eliminate premenstrual symptoms.
Know Your Body
For many women, breast pain significantly affects the quality of everyday life. It is a condition that women find painful, and physicians often find frustrating to treat. Many women suffer in silence. And when you do finally seek treatment and are reassured that you don't have cancer, it still may take time to identify the source of your pain.
The steps to understanding and coping with breast pain are within your reach. Monthly self-breast exams, awareness of any breast changes, and keeping track of your pain will help you know your own body, and will let you know when to seek a medical opinion. It may take time to fully manage your pain, but take heart in the knowledge that many women have found relief with the help of an understanding and persistent healthcare practitioner.
The American College of Obstetricians and Gynecologists
Women's Health Matters
American Academy of Family Physicians website. Available at: http://www.aafp.org/ .
Last reviewed May 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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