Breast Pain (Mastalgia)
Breast pain or tenderness is a very common breast symptom, experienced by up to 70% of women to varying degrees. Women with breast pain that is associated with their periods can often experience it from quite a young age, however many women find it a new symptom as they get older. The severity can vary from a feeling of heaviness or fullness, to quite excruciating pain that interferes with normal activities. Thankfully breast pain is not commonly associated with breast cancer, although women often find their breasts are more lumpy and full when their breasts feel tender. As always, you should consult your doctor with any new breast symptom.
Cyclical Mastalgia
This is breast pain that occurs on a regular basis in association with your normal menstrual cycle. It can start in your teens or early 20’s, however some women start to experience this as they approach menopause in their 40’s and 50’s. It is related to the normal hormone fluctuations during your menstrual cycle, and most women experience an increase in tenderness from the middle of their cycle, with often an abrupt improvement in symptoms once their period begins. It is commonly felt in the upper outer quadrants of one or both breasts, where the most dense breast tissue is usually located and is described as heavy, full, aching and throbbing. The breasts are often very sore to touch at this time.
Non-cyclical Mastalgia
This is breast pain that is NOT associated with your menstrual cycle, and is more common in women in their 40’s onwards. Its can come and go quite quickly, or come and stay for an extended period of time. It is often felt in one breast, or in one area of the breast. The nature of the pain can be very variable, from a burning pain to a stabbing or throbbing discomfort. Although it can sometimes be associated with a benign breast condition such as a cyst, benign fibroadenoma or duct ectasia, there is often no cause found for this pain.
Non Breast related pain (chest wall pain)
Pain that is felt in the breasts is sometimes not related to the breast tissue. Other structures in the chest wall such as muscles, ribs and cartilage can cause discomfort. Pain can also radiate from the back onto the chest wall or breast. It can be very difficult to differentiate pain from these structures from pain in the breast. For example, pain felt in the breast towards the middle of the chest can commonly be due to inflammation of the joint where the rib joins the sternum (costochondritis). And although this pain can occur after an injury, it can also happen with no history of trauma. Therapies that would normally be used for soft tissue injury such as simple analgesia (Paracetamol or Ibuprofen), heat or ice, and manual therapies such as physiotherapy may be helpful.
Management
Non-medication therapies
- Wear a well fitting bra, and get it fitted professionally. Underwire bras do no harm to the breast and are safe to wear as long as they are fitted properly and comfortable
- Stress management, gentle exercise, get good sleep, keep your weight stable
- Reduce Caffeine
Supplements and Medication
- B1, B6 and E vitamins
- Evening Primrose Oil up to 3g a day (3 x 1000mg capsules). You will often need to take for 2-3 months to notice an improvement. A symptom diary can be useful so record an improvement from month to month
- Simple analgesia such as regular Paracetamol (1g 4 x day) +/- Ibuprofen (400mg three times a day with food
- The oral contraceptive pill can be helpful in women with cyclical breast pain as it overrides the natural hormone fluctuations, although some women find it makes their symptoms worse. Different pills can be better for different women so discuss changing pill with your Doctor
- Very severe breast pain can respond to medication that block hormones such as Danazol or tamoxifen.
And remember, if you notice any changes in your breasts such as new pain, lumps, skin or nipple changes or discharge, please see your doctor for further assessment.
