Breast pain, or mastalgia, is very common. Research indicates that nearly 70% of women will experience breast pain at some point in their lives. Breast pain can occur at all ages and stages of life, although it is most commonly seen in women entering the peri-menopausal phase.
Breast pain is rarely a symptom of breast cancer. While the exact cause of breast pain is not known, many of the factors likely center around hormonal fluctuations. However, if breast pain is accompanied by redness or lumps, it could be a sign of infection, and you should make an appointment with your health care provider.
Below are the two main types of breast pain and some recommended treatments and remedies to alleviate the symptoms.
Types of Breast Pain
Cyclic Pain: This is the most common type of breast pain. It may be caused by normal monthly changes in hormones associated with the menstrual cycle and often appears in both breasts. It is described as a heaviness or soreness that radiates under the arm and is sometimes accompanied by swelling. The duration is extremely variable from woman to woman. For most women, it starts a week or two before her menstrual cycle and dissipates to go away after the menstrual period ends. For some women, it can last longer. It usually improves after menopause. One way to tell if your breast pain is related to your menstrual cycle is to keep a calendar of the days you experience pain, including the intensity in relation to your menstrual period.
Non-Cyclic Pain: This type of pain is most common in women ages 30-50. It may occur in only one breast and is usually described as a sharp or burning pain that can be felt in one area of the breast. Other causes of pain that may feel like they are in the breast but are actually in other structures may be due to pinched nerves, back pain, or inflammation of the cartilage between the ribs called “costochondritis.”
Imaging for Breast Pain
Women with breast pain who have a normal breast exam do not need diagnostic imaging as long as their regular imaging is up to date.
If a mass, skin changes, swelling, or nipple discharge is present, then diagnostic imaging with a mammogram and/or ultrasound is in order. MRI’s are usually not indicated for breast pain alone.
Treatment of Breast Pain
The good news is that most patients can be reassured that their breast pain is not due to serious medical conditions. The bad news is that there is not one quick fix to improve the symptoms. Breast pain can usually be tempered by lifestyle modifications as well as medications.
Lifestyle Modifications
- Breast size/Bra size: Women with large breasts may experience breast pain related to the size of their breasts. This pain may be associated with pain in the neck, shoulders, and back. Regardless of size, wearing a firm support bra may help minimize the discomfort. Consider a professional bra fitting session. For some women, wearing a sports bra during exercise and even while sleeping may help improve breast pain.
- Medications may cause breast pain as a side effect. Some common types include oral contraceptives (birth control pills), infertility medications, hormone replacement therapy, and some types of medications that treat depression and other psychological disorders. Before you consider eliminating these medications, you should have a conversation with the provider who prescribed the medication.
- Diet: Research is somewhat inconclusive on relationships between diet and breast pain. There is some weak data that supports a low fat, high complex carbohydrate diet. Sometimes, reducing salt intake can also help if the pain is associated with swelling.
- Nicotine has also been associated with increased breast pain.
- Compresses: During times of pain, warm or cold compresses may provide symptom relief
- Exercise, in general, helps manage stress and pain control. Exercising on a regular basis may, therefore, help to decrease breast pain.
- Caffeine: There is no scientific evidence that conclusively demonstrates a connection between caffeine intake and breast pain.
Over the Counter and Prescription Medications
- Acetaminophen (Tylenol®)
- Anti-inflammatory Medications: Ibuprofen (Advil® or Motrin®) or naproxen (Aleve®) can be taken orally or used as a gel rubbed into the affected area.
- Danazol, tamoxifen, and bromocriptine are prescription medications that can reduce breast pain but are not commonly used because the side effects often outweigh the benefits.
Supplements
- Evening Primrose Oil: Often recommended as an alternative approach to addressing breast pain, the data is not strong enough to recommend this to patients.
- Vitamin E: Studies have shown no benefit to prescribing vitamin E over a placebo and should not be recommended.
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