Breast pain (mastalgia) is the
most common breast related complaint among women; nearly 70%
of women experience breast pain at some point in their
lives. Breast pain may occur in one or both breasts or in
the underarm region of the body.
About 10 percent of women have
moderate to severe breast pain more than five days a month.
In some cases, severe breast pain lasts throughout the
menstrual cycles. Postmenopausal women can experience breast
pain, but the symptom occurs more frequently in younger,
premenopausal women and perimenopausal women. When it's
severe, breast pain can have a major impact on daily
activities, work and relationships.
Breast pain alone rarely
signifies breast cancer. Still, if you have unexplained
breast pain that persists, causes worry about breast cancer
or otherwise disrupts your life, get checked by your doctor.
The severity of breast pain
varies from woman to woman; approximately 15% of women
require treatment. Though breast pain is not normally
associated with breast cancer, women who experience any
breast abnormalities, including breast pain, should consult
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What Causes Breast Pain?
Cyclical breast pain
is related to how the breast tissue responds to monthly
changes in a woman’s estrogen and progesterone hormone
levels. If breast pain is accompanied by lumpiness,
cysts (accumulated packets of fluid), or areas of
thickness, the condition is usually called fibrocystic
change. During each menstrual cycle, breast tissue
sometimes swells because hormonal stimulation causes the
breast’s milk glands and ducts to enlarge, and in turn,
the breasts retain water. The breasts may feel swollen,
painful, tender, or lumpy a few days before
menstruation. Breast pain and swelling usually ends when
menstruation is over. The average age of women who have
cyclical breast pain is 34 years old.
Cyclical breast pain may last
for several years but usually stops after menopause unless a
woman uses hormone replacement therapy (HRT).
Cyclical breast pain accounts
for nearly 75% of all breast complaints. Of all women who
experience breast pain, two thirds experience cyclical
breast pain. Physicians often have patients chart their pain
to determine whether the pain is cyclical. Though cyclical
breast pain is usually related to the menstrual cycle,
stress may also affect hormone levels and influence breast
pain. Physical activity, especially heavy lifting or
prolonged use of the arms, has also been shown to increase
breast pain (pectoral (chest) muscles may become sore from
Non-cyclical breast pain is far less common than
cyclical breast pain and is not related to a woman’s
menstrual cycle. Women who experience non-cyclical
breast pain often experience pain in one specific area
of the breast(s). Woman who experience injury or trauma
to the breast or those who undergo breast biopsy
sometimes experience non-cyclical pain. The condition
may occur in both pre-menopausal and post-menopausal
women and usually subsides after one to two years.
Non-cyclical pain is most common in women between 40 and
50 years of age. Usually, non-cyclical breast pain does
not indicate breast cancer, though women should discuss
the condition with their physicians.
Another type of non-cyclical
pain called costochondritis does not actually occur in the
breast; however, the condition may feel as though it is
coming from the breast. This type of arthritic pain occurs
in the middle of the chest where the ribs and the breast
bone connect. Costochondritis may occur as the result of
poor posture or aging. Women who experience costochondritis
usually describe it as a burning sensation in the breast.
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Other factors that may
contribute to breast pain in some women include:
Bras that do not fit
(most painful tumors do not usually indicate breast
cancer; however, all abnormalities should be examined by
a physician. For example, some patients with
inflammatory breast cancer describe "stabbing pains" in
Most of the time, it's not
possible to identify the exact cause of breast pain. Likely
Reproductive hormones. Cyclic
breast pain appears to have a strong link to hormones. The
fact that cyclic breast pain often decreases or disappears
with pregnancy or menopause lends support to the theory that
hormones play a role.
However, no studies have identified a particular
hormonal abnormality as a contributor to cyclic breast
Anatomical factors. The cause of noncyclic breast pain
is likely to be anatomical rather than hormonal,
triggered by breast cysts, breast trauma, prior breast
surgery or other factors localized to the breast.
Noncyclic breast pain may also originate outside the
breast — in the chest wall, muscles, joints or heart,
for example — and radiate to the breast.
acid imbalance. An imbalance of fatty acids within the
cells may affect the sensitivity of breast tissue to
circulating hormones. This theory provides the rationale
for taking evening primrose oil capsules as a remedy for
breast pain. Evening primrose oil contains gamma-linolenic
acid (GLA), a type of fatty acid. GLA is thought to
restore the fatty acid balance and decrease the
sensitivity of breast tissue to circulating hormone
Medication use. Certain hormonal medications, including
some infertility treatments and oral contraceptives, may
be associated with breast pain. Also, breast tenderness
is a possible side effect of estrogen and progesterone
hormone therapy, which could explain why some women
continue to have breast pain even after menopause. There
have also been reports of breast pain associated with
prescribed antidepressants, including selective
serotonin reuptake inhibitor (SSRI) antidepressants,
such as fluoxetine (Prozac) and sertraline (Zoloft).
size. Women with large breasts may have noncyclic breast
pain related primarily to the size of their breasts.
This type of breast discomfort is typically accompanied
by neck, shoulder and back pain. Some studies have shown
that breast reduction surgery can reduce these symptoms.
Breast surgery itself, however, also causes pain, which
may linger after the incisions have healed.
Women should report all
complaints of persistent breast pain to their physicians.
Physicians will evaluate the pain, taking into account the
woman’s personal history, family history, the area of pain,
the intensity and duration of the pain, and the extent to
which the pain interferes with her lifestyle.
Physicians will also perform
clinical breast examinations, and if necessary, order
additional breast imaging exams (such as mammography or
ultrasound) to help determine whether the pain is related to
another breast condition or possibly cancer. If no breast
abnormality is indicated, the physician and woman should
decide together whether drug treatment is necessary.
Treating Breast Pain
Most women with moderate
breast pain are not treated with medications or surgical
procedures. The following suggestions have been shown to
reduce breast pain in some women (although there is not
sufficient scientific evidence to establish the
effectiveness of any of these suggestions):
- Wear a good,
supportive bra to reduce breast movement. Many women
with breast pain find it comfortable to also wear a bra
while they sleep.
- Limit sodium intake.
- Reduce caffeine intake
(coffee, tea, soft drinks, chocolate).
- Maintain a low fat
diet rich in fruits, vegetables, and grains.
- Maintain an ideal
weight. Losing excess weight may reduce breast pain by
stabilizing hormone levels.
breast pain can be caused by stress and may subside by
reducing anxiety and tension.
If breast pain is severe and
interferes with a woman’s daily activities, further
treatment may be necessary. Diuretics, substances that
remove excess fluid from the body in the form of urine, are
the most commonly prescribed treatment for persistent,
non-cyclical breast pain. The release of fluid in the body
helps decrease breast pain and swelling.
Herbal Treatments For
Severe Breast Pain
Most breast pain, swelling,
sensitivity is related to hormonal imbalance.
Only 10% of diagnosed breast
cancers present with pain as a symptom. Sometimes relief is
as simple as wearing a well-fitting sports bra.
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relieve breast pain and is a revolutionary new way to
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Pain While Nursing
While 80% of women experience
mild breast pain during the first few days of
breast-feeding, pain usually subsides within a few weeks.
Chronic breast pain during nursing should be reported to a
certified lactation consultant for clinical evaluation.
Persistent breast pain while
nursing may result from:
Improper positioning. Leaning over the baby can lead to
breast and back pain.
is a build-up of fluids that occurs as milk converts
from colostrum (nutrient produced during the first few
days after birth) to mature milk. Engorgement is a
temporary condition (lasting approximately 12 to 24
hours) and is most common during the first few weeks
after pregnancy. If the breasts are becoming swollen,
physicians recommend breast-feeding to avoid
Strong milk ejection
reflexes. The actual process of expelling milk from the
breast is called milk-ejection reflex. Milk is ejected
from the breast into the baby’s mouth. Normally, women
feel a mild tingling sensation during milk ejection.
However, some women have strong milk ejection reflexes
and experience a painful tingling or stinging sensation
during breast-feeding. This usually subsides after the
first few weeks of nursing.
Nipple blanching (also
called vasospasm). The nipples turn white during and
often in between breast-feeding. Many women report
burning sensations in the nipples. Nipple blanching may
be relieved with warm compresses and good breast
Mastitis. This benign (non-cancerous) condition is
common among women who breast-feed. Cracking of the skin
around the nipple allows bacteria from the skin surface
to enter the breast duct where it grows and attracts
inflammatory cells. Inflammatory cells release
substances to fight the infection but also cause breast
tissue swelling and increased blood flow. Breasts
infected with mastitis often swell, become red in color,
and feel warm to the touch. Nasopharyngeal organisms
from the infant's mouth, sinuses and other air passages
are usually the source of breast infections in lactating
women. Physicians recommend keeping the breast empty of
milk helps to drain the culture medium (environment and
food source) that is facilitating growth of organisms.
Breast-feeding with mastitis is generally not harmful to
the infant and may actually help speed up recovery.
Mastitis is also treated with antibiotics
cases of breast pain are classified as either cyclic or
noncyclic. Each type of breast pain has distinct
- Clearly related to the
- Described as dull,
heavy or aching
- Often accompanied by
breast swelling or lumpiness
- Usually affects both
breasts, particularly the upper, outer portions
and can radiate to the underarm
- Intensifies during the
two weeks leading up to the start of your
period, then eases up afterward
- Usually affects pre
menopausal women in their 20s and 30s and
perimenopausal women in their 40s
- Unrelated to the
- Described as tight,
burning or sore
- Constant or
- Usually affects one
breast, in a localized area, but may spread more
diffusely across the breast
- Usually affects
postmenopausal women in their 40s and 50s
breast pain feels like it originates in the breast, but its
source is actually somewhere else. Pulling a muscle in your
chest, for example, can cause pain in your chest wall or rib
see a doctor?
Make an appointment with your
doctor if you have breast pain that persists daily for more
than a couple of weeks, if your breast pain seems to be
getting worse over time or if your breast pain interferes
with daily activities.
Also see your doctor for
evaluation if you have pain in one particular area within
your breast. Although it's not a common symptom of breast
cancer, breast pain does occur in about 2 to 7 percent of
women with breast cancer.
and Home Remedies
though there is little formal research to show the
efficacy of these self-care remedies, they help many
women manage their breast pain. Some may be worth a try:
or cold compresses on your breasts.
firm support bra, fitted by a professional if possible.
sports bra during exercise and while sleeping,
especially when your breasts may be more sensitive.
Experiment with relaxation therapy, which can help
control the high levels of anxiety associated with
severe breast pain.
or eliminate caffeine, a dietary change many women swear
by, although medical studies of caffeine's effect on
breast pain and other premenstrual symptoms have been
Decrease the fat in your diet to less than 20 percent of
total calories, which may improve breast pain by
altering the fatty acid balance.
pain reliever (analgesic), such as acetaminophen
(Tylenol, others) or ibuprofen (Advil, Motrin, others),
to alleviate breast pain.
journal noting when you experience breast pain and other
symptoms, to determine if your pain is cyclic or
evaluate your condition may include:
Clinical Breast Exam and Physical Exam
exam, your doctor checks for unusual areas in your breasts,
visually and manually examining your breasts and the lymph
nodes located in your lower neck and underarm area. Your
doctor will probably listen to your heart and lungs and
check your chest wall and abdomen to be certain the pain
originates from your breast and isn't related to some other
condition. If your medical history and the physical exam
reveal nothing unusual, you may not need additional tests.
doctor detects a breast lump, unusual thickening in your
breast tissue, or a focused area of pain, you need to
undergo mammography — an X-ray exam of your breast tissue.
Even if your physical exam is normal, your doctor may
recommend mammography if you're age 30 or older, to
double-check for suspicious areas in your breast that may be
too small to feel.
ultrasound exam uses sound waves to produce images of your
breasts and is often performed in conjunction with
mammography. Younger women — those under age 30 — might
undergo ultrasound to evaluate a focused area of pain even
if the physical exam appears normal.
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
(radiologist) obtains a small sample of breast tissue from
the suspicious area and sends it for microscopic analysis.