Understanding Breast Pain

Article originally posted May 2020.

Overview

Breast pain or mastalgia is any pain or discomfort in your breast or underarm region, and it may occur for a number of reasons. Generally, breast pain is not a sign of breast cancer.

Most breast pain is due to hormonal fluctuations or benign breast conditions. A healthcare provider’s exam and a mammogram can be helpful in finding the cause of your breast pain. It may also be helpful to keep a record of your pain on a daily basis and make notes about your menstrual cycle. Breast pain may be described as cyclical or noncyclical.

Causes

Breast pain can occur for a variety of reasons – many related to changes in hormone levels. Some common causes of breast pain include:

• Puberty
• Menstruation or premenstrual syndrome (PMS)
• Fibrocystic breasts (lumpy breast tissue)
• Diet
• Smoking
• Pregnancy
• Milk coming in during the days following childbirth
• Mastitis due to breastfeeding
• Injury or breast abscess
• Musculoskeletal causes
• Menopause

Medications

Some prescription medicines and over-the-counter medicines may be linked to breast pain. The most common include hormones and medicines to treat high blood pressure, heart disease, pain, depression and gastrointestinal conditions. Do not stop taking any prescription drug without talking to your doctor. Be aware that several over-the-counter herbal products may be linked to breast pain.

Symptoms

Cyclical breast pain is related to fluctuations in female hormones (estrogen, progesterone and prolactin) and may begin at ovulation and continue until the menstrual period ends. Generally, cyclical pain is felt in both breasts. Often, the pain is dull or aching and greatest from the nipple back toward the underarm. Menopause relieves the symptoms you take hormone therapy.

Noncyclical breast pain is not related to the menstrual cycle or changes in hormone levels. Discomfort may be constant or may only occur from time to time, and is most often noted in one specific area in one breast. Noncyclical breast pain is often described as a sharp, stabbing or burning feeling.

Noncyclical breast pain may be linked to a variety of different causes:

• Fluid-filled cysts, fibroadenomas, duct ectasia, mastitis, injury or breast abscess. Treatment may include removal of cyst fluid, surgery to remove fibroadenoma, or antibiotics.
• Musculoskeletal causes – most commonly a pinched nerve in the back or neck. Often, a history of back injury, scoliosis, arthritis or osteoporosis is involved. This pain usually radiates to one breast.
• Large breasts, which may put stress on the ligaments in the breast and cause neck and shoulder discomfort as well.
• Tietze Syndrome, which is inflammation of the cartilage between the sternum and the ribs. This pain is felt near the middle of the chest; tenderness is noted when pressure is placed on the breastbone, when the rib cage moves, or when you take a deep breath.

Diagnosis and Testing

Your breast pain will first be evaluated through a physical exam. Your healthcare provider will conduct a breast exam to ensure that there are no suspicious lumps. A mammogram or ultrasound may also be needed, depending on the type and location of pain, the physical exam results, your age or the date your last imaging screening.

Treatment

Lifestyle Changes

• Use less salt
• Wear a supportive bra
• Apply heat to the local area of the pain
• Limited use of over-the-counter pain relievers, as needed
• Reduce or avoid caffeine
• Try Vitamin E, evening primrose oil or Omega-3 fatty acid. Always check with your healthcare provider before taking any supplements.
• Give it time – often breast pain will resolve on its own after a few months.

Prescription Medicines

For some women, low-dose birth control pills, which cause the hormone levels in the body to remain more consistent, may relieve cyclical pain. In other women, birth control pills stimulate breast pain. Other drugs with similar effects include: Danazol®, bromocriptine, or progestrone (pills, creme or lozenge). Talk to your doctor about whether use of birth control pills or other drugs may be helpful for you.

If you notice any changes in your breasts, contact your healthcare provider.

For more information about our women’s health services, contact the women’s health nurse navigator at 740-687-2727.