Breast Pain

Breast Pain: It's Common

Breast pain (mastalgia) can be described as throbbing, tenderness, sharp, stabbing, burning pain or tightness in the breast tissue. The pain may be constant or it may occur only occasionally. It can occur in men, women and transgender people. The majority of patients with breast pain have no significant underlying disease.

Studies have shown that up to 70 percent of women in Western societies will experience it sometime during their lives. One study of nearly 1700 women surveyed by an online questionnaire found that over half had experienced breast pain.

Pain was more commonly reported among older women, those with larger breast sizes, and those less fit and/or physically active. In addition, of those who reported negative impacts 41 percent reported negative impacts from breast pain on their sexual health and 35 percent reported negative impacts on sleep. Ten percent of those symptomatic had reported breast pain as an issue for more than half of their lives.

Important Things to Know about Breast Pain

• Breast pain is rarely a sign of breast cancer
• Look out for abnormal breast changes
• Take note of cyclical changes
• Menopause is a major cause
• Exercise can influence breast pain
• Diet can make a difference

Types of Breast Pain

• Cyclical breast pain is the most common breast pain. It happens approximately one week before menses due to the hormonal fluctuations in the menstrual cycle. This typically happens in both breasts. This pain usually goes away after menses begin.
• Non-cyclical breast pain: A high-fat diet, smoking, and caffeine have been associated with non-cyclical breast pain. Hormone replacement therapy and oral contraceptive pills can have an effect on breast pain as well.
• Musculoskeletal or extra mammary pain: This includes pain originating from outside the breast. This pain could be originating from other areas of the chest or spine. Trauma or muscle strain can also cause breast pain.

In men, breast pain is most commonly caused by a condition called "gynecomastia" (guy-nuh­koh-MAS-tee-uh). This refers to an increase in the amount of breast gland tissue that's caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly.

In transgender women, hormone therapy may cause breast pain. In transgender men, breast pain may be caused by the minimal amount of breast tissue that may remain after a mastectomy.

Six Causes to Consider for Sudden Breast Pain

• Exercise
• Breast Cyst or Size
• Stress
• Injury or Trauma
• Medication
• Hormonal Fluctuations

Eight Uncommon Reasons for Breast Pain and Tenderness in Women

• Stress
• Breast Cyst
• Breast Size
• Medications
• Costochondritis
• Previous Breast Surgery
• Diet
• Caffeine

What Can I Do to Alleviate Breast Pain?

• Wear good supportive clothing, including sports bras.
• Stay active — at least 30 minutes of moderate activity most days of the week.
• Relaxation/meditation techniques have been shown to decrease pain in 60% of patients with breast pain.
• Applying cool or warm compresses and massaging over the area of pain may help decrease discomfort.
• Acetaminophen or ibuprofen may be beneficial for most. Take only as directed on the bottle. Taking too much over-thecounter pain relievers can cause other health problems.
• Flaxseed has been proven to help with cyclical breast pain. Add one and a half tablespoons to food or in a smoothie has been shown to help with breast pain.
• Taking a multivitamin complex that includes B1 and B6 may help decrease pain.
• Evening primrose oil has been trialed to decrease breast pain. If other treatments do not work to improve your breast pain, you may try three grams daily of evening primrose oil.

When to see your doctor

Most times, breast pain signals a noncancerous (benign) breast condition and rarely indicates breast cancer. Unexplained breast pain that doesn't go away after one or two menstrual cycles, or that persists after menopause, or breast pain that doesn't seem to be related to hormone changes needs to be evaluated. 

Make an appointment with your doctor if breast pain: 

• Continues daily for more than a couple of weeks
• Occurs in one specific area of your breast
• Seems to be getting worse over time
• Interferes with daily activities
• Awakens you from sleep
• Is accompanied by a mass

Tests to evaluate breast pain may include

• Clinical breast exam. Your doctor checks for changes in your breasts, examining your breasts and the lymph nodes in your lower neck and underarm. If your medical history and the breast and physical exam reveal nothing unusual, you may not need additional tests.
• Mammogram. If your doctor feels a breast lump or unusual thickening, or detects a focused area of pain in your breast tissue, you'll need an X-ray exam of your breast that evaluates the area of concern found during the breast exam (diagnostic mammogram).
• Ultrasound. An ultrasound exam uses sound waves to produce images of your breasts, and it's often done along with a mammogram. You might need an ultrasound to evaluate a focused area of pain even if the mammogram appears normal.
• Breast biopsy. Suspicious breast lumps, areas of thickening or unusual areas seen during imaging exams may require a biopsy before your doctor can make a diagnosis. During a biopsy, your doctor obtains a small sample of breast tissue from the area in question and sends it for lab analysis.

Treatment for breast pain

For most people, breast pain resolves on its own over time. Most often no treatment is needed. 

If you do need help managing your pain or if you need treatment, your doctor might recommend that you:

• Eliminate an underlying cause or aggravating factor. This may involve a simple adjustment, such as wearing a bra with extra support or eliminating underwires.
• Use a nonsteroidal anti-inflammatory (NSAID) medication. You may need to take NSAIDs when your pain is intense. Your doctor may recommend that you apply an NSAID cream directly to the area where you feel pain.
• Adjust birth control pills. If you take birth control pills, skipping the pill-free week or switching birth control methods may help breast pain symptoms, but don't try this without your doctor's advice.
• Reduce the dose of menopausal hormone therapy. You might consider lowering the dose of menopausal hormone therapy or stopping it entirely.
• Take a prescription medication. Danazol is the only prescription medication approved by the Food and Drug Administration for treating fibrocystic breasts. However, danazol carries the risk of potentially severe side effects, such as heart and liver problems, as well as weight gain and voice changes. Tamoxifen, a prescription medication for breast cancer treatment and prevention, may help, but this drug also carries the potential for side effects that may be more bothersome than the breast pain itself.