Breast pain, or mastalgia, is considered a normal change in the body, affecting roughly 70% of women at some point in their lives. Extremes of these changes can have a significant impact on comfort and daily living for some women; however, it is important to note that breast pain is not typically a sign of breast cancer.
Accompanying symptoms often include breast tenderness, fullness, lumpiness, heaviness or increased breast size. If breast pain is a new symptom for you, it is important to mention to your doctor.
Cyclical Breast Pain
Roughly two thirds of breast pain varies with the menstrual cycle. This pain generally occurs in pre-menopausal women, most often in their 20s or 30s.
Cyclical breast pain most often affects the upper outer quadrants of both breasts, though may be felt more strongly on one side. Typically occurring in the week leading up to each period, it normally settles down upon menstruation.
Pain may last longer than one week, and is often accompanied with nodules or “lumpiness”, and a sensation of heaviness or dragging. A similar sort of pain is often experienced by women taking hormone therapy following menopause.
It may help to keep track of which days in the month you experience pain in a pain chart, in order to determine whether your breast pain follows a cyclical or non-cyclical pattern in relation to your menstrual cycle.
Non-Cyclical Breast Pain
Non-cyclical breast pain, accounting for roughly one third of breast pain, does not vary with the menstrual cycle, and is more common in women in their 40s or older.
This type of pain is often restricted to one side and localised to one part of the breast, frequently under the nipple or on the inner aspect of the breast. It is usually defined by a burning, throbbing or stabbing quality.
Pain felt in the breast but not linked to the menstrual cycle can be due to a benign abnormality in the breast, such as fibroadenomas, cysts or age-related changes to the milk ducts, or injury or inflammation in the chest wall. Most commonly, no specific cause is identified.
Pain from the muscles, ligaments and ribs can be felt most prominently in the breast, without any injury or abnormality in the breast tissue. This may occur following physical exercise or after an injury. Conditions such as costochondritis, or inflammation of the cartilage joining the ribs to the sternum (often termed Teitze syndrome) may also produce a pain felt predominantly on the inner aspect of the breast.
Management of Breast Pain
On assessment, most often doctors will find no serious cause for breast pain. For many women, the simple reassurance that their pain is not due to cancer is enough, and no further treatment or management is required. For some, however, the severity of pain is to such a degree as to inhibit their daily function, and management strategies should be discussed.
Often, cyclical breast pain will occur in an “on-and-off” pattern, disappearing spontaneously, without treatment, for months or even years before returning.
Supporting, well-fitting bras
In women whose breasts are sensitive to movement or feel heavy, a well-fitting bra (such as a sports bra), fitted by trained staff, can substantially reduce pain. Up to 70% of women are estimated to wear improperly-fitted bras. In pregnancy-related breast pain, firm, supportive bras can help substantially.
Diet and vitamin supplements
Whilst some women may find dietary changes and vitamin supplementation useful, it is important to recognise that there is no strong evidence supporting the use of specific dietary changes, such as reducing caffeine intake, or taking vitamins B1, B6 and E. High doses of vitamin B6 have been found to cause neurological symptoms if taken over a long period.
Many women find that evening primrose oil is useful in relieving their symptoms. 1000mg tablets taken 4 times per day over 3-6 months has been found to be effective, although generally results will not be found until one month after commencing therapy. In order to avoid nausea, it is best to take the tablets with food.
According to early studies, roughly 50% of patients responded to this therapy, although these figures have not been replicated in later research. Additionally, women are not advised to take evening primrose oil if pregnant (or trying to fall pregnant), or if they have epilepsy as it may interact with the medications they take for epilepsy.
Pain medication
Paracetamol (Panadol) or other simple painkillers may help to reduce the severity of breast pain. This is often particularly beneficial for women who experience mastalgia only a few days in each month, related to their menstrual cycle. It is important to follow the dosage advice written on the packet, due to the dangers of long-term use and high dosage of paracetamol.
Anti-inflammatories, whether oral tablets or gels applied directly to the breast, may be effective for some women.
Oral contraceptive pill
Cyclical mastalgia may be improved using a low dose oral contraceptive pill, although some women find that this worsens their symptoms.
Complementary therapies
The effectiveness of other therapies, such as relaxation therapy and acupuncture, is unclear, particularly in conjunction with standard medical treatments. It is important to discuss complementary therapies with your doctor, particularly any medications or supplements, as these may interfere with other medications that you are taking.
Other medications
Very severe breast pain that affects daily life may be treated using hormonal medications, such as danazol, bromocriptine and tamoxifen. The use of these drugs must be strictly monitored by your general practitioner, in conjunction with a specialist, as patients may experience significant side effects.
Cysts can be aspirated and Fibroadenomas may be excised in order to relieve pain if they are the associated with breast pain however, these are uncommon causes of breast pain.
