Discover the causes and treatment options for breast pain on Meri Sehat. Find out how to manage mastalgia and improve your breast health with expert advice and guidance.

Breast Pain

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Iqra Mazhar

Overview

Breast pain, also known as mastalgia, is a common condition characterized by discomfort, tenderness, or pain in one or both breasts, often accompanied by swelling or inflammation. 
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can be alarming to experience pain in the breasts, in most cases, it is not a cause for concern. However, there are times when breast pain may indicate a more serious underlying condition, so it is essential to understand the different types of breast pain, their causes, and when to seek medical attention.

Mastalgia, or breast pain, is a common complaint among women in their reproductive age, with about 70% of women in the US experiencing it at some point in their lives. However, only 30% seek medical help for this condition<a href="#accordion">[1]</a>. 
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Breast pain can be unilateral or bilateral and can range from mild to severe. In some cases, it may be associated with the menstrual cycle. This is called cyclic mastalgia. The highest incidence of cyclic mastalgia is between the ages of 20 and 40, and it is less commonly found in postmenopausal women and those who have had early pregnancies<a href="#accordion">[1]</a>. 

Breast pain can harm a woman&#39;s life, with interference in sexual activity, physical activity, work, and social activities being common complaints. The prevalence of breast pain varies by ethnicity, with a 5% incidence in women of Asian ethnicity and a 60% incidence in British women according to studies conducted in the UK<a href="#accordion">[1]</a>. 
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Note: If you notice any sudden breast pain accompanied by chest pain or numbness in the extremities, contact a health care professional immediately. 
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Breast pain can be categorized into three types<a href="#accordion">[2]</a>: 
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<h5>Cyclic Breast Pain</h5>

Cyclic breast pain is the most common type of breast pain and is typically caused by hormonal changes during the menstrual cycle. This pain is usually felt in both breasts and may be described as a heaviness or soreness that radiates to the armpit and arm. It is most severe before the start of the period and often subsides after menstruation. Cyclic breast pain is more likely to affect younger women from the age of 20 to 50 and typically goes away on its own without treatment. It usually stops after menopause. 
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<h5>Noncyclic Breast Pain</h5>

Noncyclic breast pain is most common in women aged 30 to 50 and may occur in only one breast. Unlike cyclic pain, it is not related to hormonal changes and does not follow a pattern. This type of pain is often described as a sharp, burning sensation in one area of the breast. Noncyclic breast pain may be caused by various factors, such as injury, inflammation, or other medical conditions like fibroadenoma or cyst. Treating the underlying cause may help alleviate the pain. 
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<h5>Extramammary Breast Pain</h5>

This type of breast pain originates from a location outside of the breast, such as the heart, lung, chest wall, or esophagus. For instance, pain originating from the chest wall, as in costochondritis, or pain from gastrointestinal conditions such as <a href="https://merisehat.pk/disease/gerd-56">GERD</a>, gallbladder, or stomach disease can be referred to the breast and cause a false impression of breast pain<a href="#accordion">[1]</a>. 
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Signs and Symptoms

Breast pain can present itself in different ways depending on the underlying cause. Some common signs and symptoms of breast pain include: 
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<ul>
	<li>Pain or discomfort in one or both breasts.</li>
	<li>Aching, stabbing, or burning pain in the breast tissue.</li>
	<li>Pain that is constant or comes and goes.</li>
	<li>Pain that is typically located in the upper, outer area of the breast.</li>
	<li>Tenderness or swelling in the breast.</li>
	<li>Changes in breast size or shape.</li>
	<li>Nipple discharge.</li>
	<li>Redness or warmth in the breast.</li>
	<li>Lumps or thickening in the breast.</li>
</ul>

Although breast pain is not a common symptom of breast cancer, in some cases, painful lumps may appear due to cancer. 
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Note: If you experience any of these symptoms, it&#39;s important to see a doctor. They can help determine the underlying cause of your breast pain and recommend the appropriate treatment. In some cases, breast pain may be a sign of a more serious condition such as breast cancer, so it&#39;s important to seek medical attention if you have any concerns about your breast health. 
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Causes

Breast discomfort, also known as mastalgia, can have a variety of causes. It can either be cyclic or noncyclic. If the discomfort is cyclic, it is caused by the menstrual cycle&#39;s fluctuating hormones. Noncyclic breast discomfort can be caused by fibrocystic breast changes, traumas, sprains, or rib inflammation.

The following are the common causes of breast pain<a href="#accordion">[5] [8]</a>. 
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<h5>Hormonal Fluctuations</h5>

The most common cause of breast pain in women is hormonal changes. Breasts become sore three to five days before the start of a menstrual period and stop aching once it begins. This is due to estrogen and progesterone levels spiking just before the period. These hormones produce swelling and discomfort in the breasts.

In the first trimester of pregnancy, as hormone production increases, the breasts may continue to hurt. One of many women&#39;s first prenatal symptoms is sore breasts. 
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<h5>Breast Cysts</h5>

With aging, the breast tissue is replaced by fat, causing an involution. This can lead to the development of cysts and more fibrous tissue. This is known as fibrocystic breast tissue. Fibrocystic breasts are not always painful but can feel tender. Moreover, they can enlarge during the menstrual cycle. 
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<h5>Breast Injury Or Trauma</h5>

Breasts, like any other part of the body, can be injured. This can occur as a result of an accident while participating in sports or as a result of breast surgery. At the time of the injury, women may experience sharp, shooting pain. Breast tenderness can last from a few days to several weeks after trauma. 
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<h5>Fitting Of Bra</h5>

The ligaments that link the breasts to the chest wall can become overstretched and uncomfortable by the end of the day if not properly supported. As a result, the breasts are achy and uncomfortable. This may be especially obvious during physical activity. It is important to check that the bra is the correct size and provides adequate support. 
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<h5>Breastfeeding</h5>

Breast soreness can sometimes be caused by breastfeeding. Engorgement and improper latching of the baby to the nipple can both lead to breast pain. If an individual experiences pain while breastfeeding, a lactation consultant may help ease the discomfort. They can assist in troubleshooting the issue while safeguarding the woman&rsquo;s milk supply. 
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<h5>Breast Infection</h5>

Breast infections (mastitis) are more common in breastfeeding mothers, however, they can occur in any woman. Mastitis can cause additional symptoms, such as fever and chills. 
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<h5>Side Effects Of Medicine</h5>

Breast pain can be a possible side effect of certain medications, and it&#39;s recommended to discuss with the doctor whether the medications one is taking may cause this side effect. Some drugs that are known to cause breast pain include:

<ul>
	<li>Oxymetholone for anemia</li>
	<li>Chlorpromazine for mental health issues</li>
	<li>Diuretics for kidney and heart disease and high blood pressure</li>
	<li>Hormone therapies like birth control pills</li>
	<li>Hormone replacement or infertility treatments</li>
	<li>Digitalis for heart failure</li>
	<li>Methyldopa for high blood pressure. 
	&nbsp;</li>
</ul>

<h5>Breast Surgery</h5>

Scar tissue can lead to pain even after the incisions have healed. 
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<h5>Smoking</h5>

Smoking leads to increased levels of epinephrine in the breast tissue, leading to breast pain.

In men, breast pain is commonly caused by gynecomastia. The condition results from an imbalance of testosterone and estrogen which increase breast gland tissue.&nbsp; 
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Diagnosis

There are no specific screening tests for breast pain. 
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Doctors may use the following tests to evaluate for breast pain:

<ol>
	<li>Clinical Breast Exam: The doctor will examine the breast and lymph nodes in the neck and underarm to check for any changes, followed by a check of the chest and abdomen for other related conditions.</li>
	<li>Mammogram: An X-ray of the breast is used to evaluate any areas of concern, such as a lump, thickening, or pain.</li>
	<li>Ultrasound: A test that uses sound waves to create images of the breast tissue and is often used with a mammogram to evaluate a specific area of pain, even if the mammogram appears normal.</li>
	<li>Breast Biopsy: A procedure to remove a small sample of breast tissue from suspicious lumps or areas of thickening for lab analysis to determine whether the area is cancerous or benign. 
	&nbsp;</li>
</ol>

The type of tests used to evaluate a breast condition will depend on the patient&#39;s medical history, physical exam findings, and imaging results. The doctor will determine the most appropriate tests for the patient&#39;s specific situation. 
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Treatment

<h5>Cyclic Breast Pain</h5>

Cyclic breast pain is a normal part of the menstrual cycle, but it can still be managed with medications and lifestyle changes. Severe pain may require prescription medications, but it&#39;s important to consider their potential side effects. 
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Medications:

<ul>
	<li>Acetaminophen, ibuprofen, naproxen sodium, aspirin, and diclofenac can relieve pain.</li>
	<li>Danazol and Tamoxifen are prescription medications that may be suggested for severe pain, but their side effects should be discussed with a doctor. 
	&nbsp;</li>
</ul>

Lifestyle Changes:

<ul>
	<li>Wearing a well-fitting, supportive bra.</li>
	<li>Taking vitamin E supplements and multivitamins - A maximum dose of 1,500 IU is allowed for adults older than 18 and pregnant or breastfeeding women.</li>
	<li>Eliminating caffeine and tobacco products from the diet.</li>
	<li>Using evening primrose oil</li>
	<li>Applying heat to painful areas.</li>
	<li>Taking magnesium supplements two weeks before the period.</li>
	<li>Applying trolamine salicylate cream.</li>
	<li>Trying relaxation and complementary therapy. 
	&nbsp;</li>
</ul>

Treating Imbalanced Hormones:

<ul>
	<li>Adjust birth control pills - Women on birth control pills may experience an alleviation of their breast pain symptoms if they skip the pill-free week or switch their birth control methods. However, it should only be done after a doctor&rsquo;s advice.&nbsp;</li>
	<li>Reduce hormone therapy - Discontinuation of reducing the dose of menopausal hormone therapy can also help relieve breast pain.</li>
</ul>

Note: Consult your doctor before starting any medication or altering any hormonal treatments. 
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<h5>Noncyclic Breast Pain</h5>

Treatment may involve the same medications as cyclic pain, but finding and removing the underlying cause, such as a fibroadenoma or cyst, can relieve symptoms. 
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Breast pain itself is usually not a sign of a serious condition, but it can cause significant discomfort and distress. In some cases, breast pain may be a symptom of an underlying medical condition that requires treatment. Some potential complications of breast pain include:

<ul>
	<li><a href="https://merisehat.pk/disease/anxiety">Anxiety </a>and stress: Breast pain can cause anxiety and stress, which may further exacerbate the pain.</li>
	<li>Interference with daily activities: Severe breast pain can interfere with daily activities, such as work, exercise, and sleep.</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression</a>: Persistent breast pain can lead to depression and emotional distress.</li>
	<li>Decreased quality of life: Chronic breast pain can decrease a person&#39;s quality of life, affecting their physical and emotional well-being.</li>
	<li>Breast cancer: Breast cancer rarely causes pain, but it is not impossible. Inflammatory breast cancer frequently causes discomfort, representing 1% to 5% of breast cancer cases in the United States<a href="#accordion">[5]</a>. 
	&nbsp;</li>
</ul>
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The following factors can increase one&rsquo;s risk of breast pain.

<ul>
	<li>Age and Gender: Breast pain is more common in premenopausal people, but can also occur in postmenopausal women, men with gynecomastia, and transgender people undergoing gender reassignment.</li>
	<li>Breast Size: People with large breasts may experience noncyclic breast pain, which may also cause neck, shoulder, and back pain.</li>
	<li>Breast Surgery: Breast pain associated with breast surgery and scar formation may persist even after incisions have healed.</li>
	<li>Fatty Acid Imbalance: An imbalance of fatty acids within the cells can affect the sensitivity of breast tissue to hormones and cause breast pain.</li>
	<li>Medication Use: Certain hormonal medications, including some infertility treatments, oral birth control pills, and hormone therapies used after menopause may cause breast pain. Some antidepressants, high blood pressure medications, and antibiotics may also cause breast pain.</li>
	<li>Excessive Caffeine Use: While further research is needed, some people may experience improvement in breast pain by reducing or eliminating caffeine from their diet. 
	&nbsp;</li>
</ul>

The following actions might aid in preventing breast pain.

<ul>
	<li>Avoiding hormone therapy if possible.</li>
	<li>Avoiding medications associated with breast pain.</li>
	<li>Wearing a correctly fitted bra and a sports bra when exercising.</li>
	<li>Relaxation therapy to assist manage the high levels of anxiety that come with severe breast discomfort.</li>
	<li>Eliminating or limiting caffeine use in the diet.</li>
	<li>Avoiding prolonged lifting activities.</li>
	<li>Eating a low-fat diet and consuming more complex carbohydrates.</li>
	<li>Consider taking an over-the-counter pain reliever like acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil, Motrin IB). 
	&nbsp;</li>
</ul>

Note: Before taking any medication, consult a doctor about how much to take, as long-term use may increase your risk of liver issues and other negative effects. 
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Mastalgia is a common breast disorder that can cause discomfort and affect daily activities and quality of life. In a small-scale study, 130 patients with mastalgia were compared to 128 without complaints, and both groups were evaluated for anxiety and depression using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Results showed that the mastalgia group had significantly higher scores on both scales than the control group. Additionally, there was a positive correlation between the duration of mastalgia and educational level with anxiety and depression scores. Therefore, doctors should check for signs of psychological distress in patients with mastalgia and refer them to a psychiatrist if necessary<a href="#accordion">[9]</a>. 
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Key Points

<ul>
	<li>Breast pain, also known as mastalgia, is a common condition characterized by discomfort, tenderness, or pain in one or both breasts, often accompanied by swelling or inflammation.</li>
	<li>Breast pain is a common condition that affects many women at some point in their lives. While it can be alarming to experience pain in the breasts, in most cases, it is not a cause for concern.</li>
	<li>Breast pain can harm a woman&#39;s life, with interference in sexual activity, physical activity, work, and social activities being common complaints.</li>
	<li>Cyclic breast pain is the most common type of breast pain and is typically caused by hormonal changes during the menstrual cycle. It is more likely to affect younger women from the age of 20 to 50 and typically goes away on its own without treatment. It usually stops after menopause.</li>
	<li>Noncyclic breast pain is most common in women aged 30 to 50 and may occur in only one breast. Unlike cyclic pain, it is not related to hormonal changes and does not follow a pattern. It may be caused by various factors, such as injury, inflammation, or other medical conditions like fibroadenoma or cyst. Treating 
	the underlying cause may help alleviate the pain.</li>
	<li>Extramammary breast pain is a type of breast pain that is not caused by a problem in the breast itself but rather originates from a location outside of the breast, such as the heart, lung, chest wall, or esophagus. 
	&nbsp;</li>
</ul>

[1] Mastalgia - StatPearls - NCBI Bookshelf.

[2] Breast pain (mastalgia). Breast Pain (Mastalgia) | Michigan Medicine.

[3] Mastalgia (breast pain). breastcancer.org/benign-breast-conditions/mastalgia.

[4] Breast pain. Mayo Clinic. org/diseases-conditions/breast-pain/symptoms-causes/syc-20350423.

[5] Wright PA. Breast pain: 10 reasons your breasts may hurt. Breast Pain: 10 Reasons Your Breasts May Hurt | Johns Hopkins Medicine.

[6] Breast pain (mastalgia): Causes, treatment & prevention. Cleveland Clinic.

[7] Herndon J. Breast pain: Types, causes, and treatments. Healthline.

[8] 11 common causes of breast pain and how to manage them. Medical News Today.

[9] Katar MK, Başer M. Relationship Between Mastalgia And Anxiety-Depression: An Observational Study. Cureus. 2021;13(1):e12734. Published 2021 Jan 16. doi:10.7759/cureus.12734.