Breast Pain.(Mastalgia)
Many women experience
breast pain. Breast pain may occur in one or both breasts.
Causes of Breast Pain
Likely causes of
breast pain depend on whether the pain is felt in a particular place or
throughout the whole breast.
If pain occurs in one
area, it may be caused by
- Breast cysts
- Uncommonly, breast infections, such
as an abscess
If pain affects the
whole breast, it may be caused by
- Hormonal changes
- Fibrocystic changes
- Large breasts that stretch supporting
tissues
- Occasionally, a widespread breast
infection
If breast pain is the
only symptom, it is usually not a sign of breast cancer.
Changes in the levels
of the female hormones estrogen and progesterone can cause
breast pain. Levels of these hormones increase just before or during a
menstrual period and during pregnancy. When these levels increase, they cause
the milk glands and ducts of the breasts to enlarge and the breasts to retain
fluid. The breasts then become swollen and sometimes painful. Such pain is
usually felt throughout the breasts, making them tender to touch. Pain related
to the menstrual period may come and go for months or years. Taking birth
control pills (oral contraceptives) or hormone therapy after menopause can also
cause hormone levels to increase and cause this kind of pain.
Evaluation of
Breast Pain
Warning signs
Certain symptoms and
characteristics are cause for concern:
- Severe pain, redness, and swelling
- Presence of a lump, an inverted nipple, or
certain changes in the skin
When to see a doctor
Women with severe
pain, redness, or swelling may have a breast infection and should see a doctor
within a day or two.
Breast pain that
persists (for example, that lasts for more than 1 month) should be evaluated
by a doctor.
What a doctor does
Doctors ask the woman
to describe the pain. They ask whether pain occurs at certain times of the
month (related to the menstrual cycle). They also ask about other symptoms,
disorders, and drugs (such as birth control pills) that may suggest a possible
cause.
Doctors examine the
breast and nearby tissues for abnormalities, such as changes in the skin,
lumps, and tenderness. If no abnormalities are present, the pain is probably
due to hormonal changes or large breasts.
A pregnancy test is
done if the woman has symptoms that suggest pregnancy, such as a missed
menstrual period and early-morning nausea. Other tests may be done based on the
woman's other symptoms.
Treatment of Breast
Pain
Mild breast pain
usually disappears eventually, even without treatment.
Pain that occurs
during menstrual periods can usually be relieved by taking acetaminophen or
a nonsteroidal anti-inflammatory drug (NSAID).
For severe pain during
menstrual periods, danazol (a synthetic hormone related
to testosterone) or tamoxifen (a drug used to treat
breast cancer) may be used. These drugs inhibit the activity of the female
hormones estrogen and progesterone, which can make the breasts
swell and be painful. If taken a long time, these drugs have side effects and
are thus usually used for only a short time.
For breast pain
related to pregnancy, wearing a firm, supportive bra, taking acetaminophen,
or both, can help.
Stopping use of birth
control pills or endocrine therapy may help relieve symptoms.
Evening primrose oil,
a nutritional supplement, may help relieve breast pain related to menstrual
periods or pregnancy in some women.
If a specific disorder
is identified as the cause, the disorder is treated. For example, if a cyst is
the cause, draining the fluid from the cyst usually relieves the pain.
Key Points
- The cause of breast pain depends on
whether it occurs in one area (usually caused by cysts) or the whole
breast (caused by hormonal changes, fibrocystic changes, or large
breasts).
- If breast pain is the only symptom, it is
usually not a sign of breast cancer.
- Breast pain that is severe or that lasts
for more than 1 month should be evaluated.
- Whether testing is needed depends on the
woman's other symptoms.
- Treatment depends on the cause, but drugs
such as acetaminophen or NSAIDs, can sometimes help
relieve the pain.