Breast Pain

Breast Pain

Whether it is barely noticeable soreness or lifestyle-impairing pain, as many as 75% of women are affected by breast pain (mastalgia) at some point in their lives.  Breast pain is the most common breast-related complaint. The degree of discomfort and the location of breast pain vary among women. The pain is described in many ways including: sharp, stabbing, burning, throbbing, dull, and aching. The location may be one breast or both breasts and can even extend into the armpit areas.  While most women can treat breast pain at home with lifestyle changes and over-the-counter medications, approximately 15-20% of women have breast pain that is severe enough to require medical treatment. 

Symptoms

Breast pain is characterized by a feeling of discomfort in one or both of the breasts. They may feel swollen, heavy, painful, lumpy, tender, bloated, and sensitive to touch.  While most cases of breast pain can be treated at home, experiencing any of the following symptoms along with breast pain indicates that you should seek the immediate attention of a healthcare provider to rule out potentially series conditions:

·       Bloody or clear nipple discharge.

·       Dimpling of skin of the breasts.

·       Well-defined lumps or growths.

·       Change in shape or size of the breasts.

·       Lumps that do not disappear after the menstrual period.

·       Persistent unexplained breast pain.

·       Breast infection indicated by redness, swelling, tenderness, pus, and/or fever.

Causes

The most common and often harmless causes of breast pain include:

·       Increase in estrogen during puberty.

·       Menstruation and premenstrual syndrome (PMS).

·       Pregnancy, most often during the first trimester.

·       Following childbirth as milk comes in for breastfeeding.

·       Mastitis or breast infection.

·       Hormonal changes associated with menopause.

·       Use of certain prescription medications.

Healthcare professionals classify breast pain into two broad categories - cyclical (hormonal) and non-cyclical (non-hormonal). 

Cyclical breast pain is by far the most common type of breast pain, accounting for nearly 75% of all breast complaints. Pain typically occurs in women of reproductive age (usually between the ages 15 to 49) who are having menstrual periods. However, pain can also occur in post-menopausal women who are undergoing HRT (hormone replacement therapy). Just before a menstrual period, the body experiences a peak in estrogen and progesterone levels. This peak in hormone levels causes fluid retention and swelling of the ducts and glands in the breasts, leading to bloating and discomfort. Additionally, breasts may change in size and shape, swell, and become lumpy as a result of these hormone peaks. These changes are often referred to as fibrocystic changes and may be characterized by cysts (fluid filled pockets) in the breast tissue. Cyclical breast pain associated with menstrual periods is a self-limiting condition and typically does not last more than one week. In addition to menstruation, stress can also cause cyclical breast pain because it affects hormone levels in the body. After menopause, most women no longer experience cyclical breast pain, unless undergoing HRT.

Occurring in both pre- and post-menopausal women, non-cyclical breast pain is far less common and is not related to a woman's menstrual cycle. Women with non-cyclical breast pain often experience one-sided pain or pain localized to a specific area of the breast. Some common causes of non-cyclical breast pain include:

·       Wearing ill-fitting or poor-supporting bras.

·       Excessive caffeine intake (coffee, tea, colas, energy drinks).

·       Weight gain resulting in heavier breasts.

·       Injury or trauma to the breasts.

·       Mastitis (breast infection) or breast abscess (painful collection of pus).

·       Certain medications, such as oral contraceptives, HRT (hormone replacement therapy) or cholesterol-reducing drugs.

·       Stress.

·       Shingles causing pain in the breast area before a rash develops.

·       Physical strain on the surrounding chest and shoulder muscles due to heavy lifting or prolonged use of the arms.

·       Arthritic pain from costochondritis (where the ribs and breast bone connect), which mimics breast pain.

Is my breast pain from cancer?

This is the biggest concern and most pressing question about breast pain for many women. Although breast pain is not usually associated with cancer and does not increase a woman's risk of breast cancer, any breast symptoms or abnormalities, including breast pain, should be brought to the attention of a doctor for proper diagnosis and treatment. 

Diagnosis

To diagnose the cause of breast pain, a physician will usually perform a clinical breast examination and, if necessary, order imaging studies, such as an ultrasound or mammogram (breast x-ray), to help determine the cause of breast pain. If anything suspicious is detected, the physician may perform a breast biopsy (surgically remove a small sample of breast tissue) for analysis in a laboratory.  Physicians will look for obvious causes of pain (for example injury or trauma) and obtain a history to gather more information. A physician will most often require a history of menstrual periods, the description, duration, and location of the pain, and any supplements and/or prescription medications being used, including oral contraceptives or HRT (hormone replacement therapy). The physician will then use this information, the results of a physical examination and imaging studies to come to a diagnosis. If the pain is suspected to be cyclical in nature, physicians will often have the patient keep a log of their pain. Sometimes even all this information may fail to reveal a cause, and other conditions may need to be explored. Conditions that can mimic breast pain include: acid reflux, angina, chest wall pain, shingles, shoulder pain, and ulcers.

Breast Pain while Breastfeeding

Up to 80% of women initially experience mild breast pain when they first start breastfeeding; this type of pain will typically subsides after a few weeks. If breast pain while nursing is persistent, it may result from any of the following:

·       Improper positioning of the baby, leading to back strain and breast pain.  Finding a comfortable position for both mom and baby is essential for pain-free breastfeeding.

·       Engorgement (build up) of milk, which can be relieved with regular breastfeeding or pumping between feedings.

·       Painful milk ejection reflex. The expulsion of milk from the breast is usually a mild tingling feeling, but may be a painful tingling or stinging sensation for some women.

·       Nipple blanching (turning white) or burning sensation in the nipples, which can be relieved with warm compresses.

·       Mastitis or inflammation of the breast is benign (non-cancerous) and is a result of a bacterial infection. Dry skin commonly occurs while breastfeeding and may lead to cracking of the skin on the breast. These cracks give bacteria a direct entrance into the breast duct where they feed on breast milk.  Symptoms include a swollen, red, and tender breast. In order to prevent infections, physicians recommend keeping the breast empty of milk. Mastitis can be treated with antibiotics. Breastfeeding with mastitis is generally not harmful and may actually speed up the recovery process. 

Management

Most women with mild to moderate breast pain do not require any major treatment.

Home Remedies

Although there is no scientific evidence to establish effectiveness, the following tips and home remedies may be helpful for relief of mild to moderate cyclical breast pain and discomfort:

·       Wearing a well-fitting supportive bra. Most women are wearing the wrong size bra, which leads not only to breast pain, but also back pain. Every woman should get professionally fitted and invest in a high quality bra to reduce pain and discomfort. On days when the pain is worse, try wearing a soft athletic bra or a bra without an underwire to reduce irritation.

·       Maintaining an ideal weight will stabilize hormone levels in the body and reduce breast pain associated with hormonal peaks during menstruation.

·       Cutting caffeine (tea, coffee, colas, chocolate, energy drinks), alcohol and salt intake can reduce breast pain caused by fluid retention.

·       Quit smoking. Smoking produces free radical production and inflammation in the body, which promotes pain.

·       Maintaining a low-fat diet that is rich in fruits, vegetables, and whole grains will encourage whole-body stabilization, reduce pain and put you on the right track to achieving your ideal weight. Eating healthy will also ensure the proper nutrients needed for optimal health are obtained from the diet. 

·       Using over-the-counter pain relieving, anti-inflammatory drugs like acetaminophen or ibuprofen on occasion. Taking these drugs can help reduce pain while implementing lifestyle and dietary changes.

·       Taking a hot bath or shower to assist in relaxation and reduce body tension.

·       Using an ice pack on the breasts to reduce swelling. A heating pad may also be used to reduce pain. Always be sure to follow the “20 minutes on, 20 minutes off” rule.

·       Relaxing to reduce stress, anxiety, and tension.

It is important to talk to a physician before starting any supplements and before regularly taking medications. It is also worth discussing any prescription medication being used with a physician, since these drugs may be the cause of breast pain. 

While these home remedies and tips can be helpful for cyclical pain, it can be life-saving for a woman to be aware of changes in her breasts and to seek medical attention in a timely fashion. If breast pain is severe enough to be lifestyle-limiting, seek medical attention immediately. 

Prescription Treatment

For some women, home remedies alone are not sufficient for reducing breast pain.  In this case, a physician may prescribe prescription drugs which can be used alongside lifestyle changes. The following medical treatments are some options that can be disccused with a physican:

·      Diuretics (fluid pills) are a commonly prescribed treatment for breast pain to remove excess fluid from the body to relieve swelling and breast pain.  However, before resorting to medication, products which promote fluid retention, like caffiene, should first be removed from the diet.

·   Danazol (male hormone) and bromocriptine can relieve cyclical breast pain by blocking estrogen and progesterone (female) hormones.

Prescription drugs for breast pain can have serious side effects in some women and are poorly tolerated by many women. Side effects include: nausea, dizziness, fertility problems, weight gain, amenorrhea (absence of menstruation), and hirsutism (extra facial hair). 

Conclusion

Breast pain can be upsetting and worrisome, but many women avoid seeking medical advice because the tests and examination can be quite stressful and invasive. While it is a relief to know that breast pain is usually not a life-threatening condition, it can lead to a great deal of anxiety and frustration if untreated and unrelieved. Living with pain of any kind is difficult, but living with breast pain is especially difficult because this is a symptom that can affect a woman's sexuality, relationships, and work performance. Women should report any persistent breast pain to a physician who can make a diagnosis based on personal history, family history, as well as the location, duration, characteristics, and intensity of pain.  Breast pain is a treatable condition and women do not have to live with it or allow it to have a negative impact on their lives. For many women, simple lifestyle changes and paying close attention to dietary intake can have a significant impact on reducing breast pain and discomfort.