Breast Pain

Breast pain (mastalgia) is a common type of discomfort among women – affecting as many as 7 in 10 women at some point in their lives.  About 10% 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 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.

Symptoms

Most cases of breast pain are classified as either cyclic or noncyclic.  Each type of breast pain has distinct characteristics.

  • Cyclic Breast Pain
    – Clearly related to the menstrual cycle
    – Described as dull, heavy or aching
    – Often accompanied by breast swelling or lumpiness
    – Usually affects both breasts
    – Intensifies during the two weeks before the start of your period
    – Usually affects premenopausal women in their 20s and 30s and
       perimenopausal women in their 40s
  • Noncyclic Breast Pain
    – Unrelated to the menstrual cycle
    – Described as tight, burning or sore
    – Constant or intermittent
    – Usually affects one brast in a localized area
    – Usually affects postmenopausal women in their 40s and 50s

Extramammary Breast Pain

Extramammary 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 cage.

Causes of Breast Pain

  • 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, new studies have identified a particular hormonal abnormality as a contributor to cyclic breast pain.
  • Anatomical factors: The cause of noncyclic brest 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 – and radiate to the breast.
  • Fatty acid imblanace: 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 levels.
  • Medication use:  Certain hormonal medications, including some infertility treatments and oral contraceptives, may be assocaited 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 (Xoloft).
  • Breast 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.

When to 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 is not a common symptom of breast cancer, breast pain does occur in about 2-7% of women with breast cancer.

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