Breast Pain (Mastalgia)

There are two types of breast pain - cyclic and non-cyclic. The former is associated with your menstrual cycle, while the other refers to breast pain due to any other cause.

• Cyclic breast pain
  Cyclic breast pain is the most common type of breast pain experienced by women. It happens because of the hormonal changes during menstrual cycles. You may experience this pain a few days before your period starts.
• Non-cyclic breast pain
  Non-cyclic pain is not related to your periods. This kind of pain may be felt anytime irrespective of the period date. It is most commonly associated with elderly women who have attained menopause.

Read more: Early and premature menopause

The symptoms of breast pain depend on the type of your breast pain. Cyclic and non-cyclic breast pains present with different signs and symptoms.

Cyclic breast pain

The following symptoms are usually associated with cyclic breast pain:

• The pain is felt in both the breasts.
• It is usually dull and aching.
• Lumpiness in breasts may also be felt sometimes.
• It starts a few days before your periods and lasts for at least a week.
• It does not continue once your period is over.
• The pain is usually felt in the upper outer side of the breasts but may also spread to other areas when it intensifies.
• Cyclic pain most commonly occurs in younger women.

Non-cyclic breast pain

Non-cyclic breast pain may be suspected on the basis of the following symptoms:

• It is usually seen in elderly women, especially after menopause.
• This type of breast pain is not associated with menstrual cycles and you may experience it irrespective of your period dates.
• Usually, it is felt in one of the breasts and has specific areas where the pain is felt.
• The pain may increase after exercising or by applying pressure on the affected area.
• It is continuous and troublesome.
• You may also experience lumps or nodes in your armpits, pain in your shoulder, arm, back, etc.
  
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A variety of factors may lead to breast pain. Most commonly it happens a few days before the start of the menstrual cycle or due to hormonal imbalance. However, there could be other reasons as well. Some of them are explained below.

Hormone imbalance

• The three major phases when hormonal fluctuation occurs is menarche (when a girl gets her period for the first time), pregnancy, and menopause (cessation of menstrual cycles). During these phases, you may experience changes in your breasts which may cause pain, heaviness, and lumpiness in breasts. 
• The main cause of cyclic breast pain is your menstrual cycle. However, many studies have conflicting results. In some studies women with cyclic breast pain were found to have changes in the levels of estrogen, progesterone, and prolactin hormone in their body. The pain occurs during the luteal phase of the cycle which starts after ovulation (release of an egg from the ovaries).
• A systematic review of medical literature on causes of breast pain suggested that women who undergo hormone replacement therapy after menopause are at a higher risk of developing breast cancer. Hence, they can also experience a significant increase in breast pain.

Breast cysts

Presence of abnormal fluid-filled sacs in the breasts may also cause pain, discomfort, and heaviness in your breast. You should consult your doctor if you suspect cysts in your breasts and get yourself treated.

Breastfeeding

A study conducted on breastfeeding women with chest pain suggested that the most common cause of breast pain in them was blockage of milk ducts. Researchers found that this blockage had resulted in breast pain.

Hence, if left untreated, it may cause swelling and infection in the affected breast.

Pain in chest muscle

Sometimes, breast pain may also be felt when there is an injury, inflammation or infection of the underlying chest wall muscle. The pain can radiate from the chest muscle to your breast. Visit your doctor to get complete treatment.

Trauma

Any sudden blow or injury to your breast may cause constant breast pain. The affected area acts as a trigger point that causes pain on touching or applying pressure.

Fibrocystic disease

A lot of women have fibrocystic disease, in which breast tissues develop small fluid-filled cysts that cause lumpiness and pain in the breasts. This condition is non-cancerous and is very common. In fact, many doctors have stopped using the term "fibrocystic disease", and prefer calling it "fibrocystic breasts" instead.

Read more: Benign fibrocystic breasts symptoms

Other causes of breast pain: Here are some other causes of breast pain:

• Lateral chest wall pain
  Breast pain may be experienced when there is swelling, injury or infection of the muscles on the sides of your chest just below your armpits. This pain may radiate to the breasts also.
• Costochondritis
  Inflammation of the cartilage of ribs due to increased pressure is known as costochondritis. This pain originates in the chest but may also be felt in the breasts.
• Lifestyle factors
  A study conducted in 2016 found that lifestyle factors like stress, anxiety, and coffee consumption are some of the factors that may lead to breast pain.
• Ill-fitting bra
  A large number of women wear an ill-fitting bra, which may also be associated with pain in breasts. Make sure you wear a comfortable bra with the right measurements. To get the right measurement, use a measuring tape: You can also take help from a friend or a professional to do the measurement.
  • Band size: Measure the underbust by placing the measuring under your bust. 
  • Bust / Cup size (A, B, C or D): Measure the bust at its fullest part, which is usually at the nipple level.
• Smoking and alcohol consumption
  Substance abuse such as tobacco, alcohol, drugs, etc may also cause breast pain. They cause imbalances in the sex hormone levels in your body put you at a higher risk of developing breast problems including breast cancer. 
• Cancer
  Rarely, breast pain may be associated with breast cancer. According to the UK's NHS, breast pain usually isn't a symptom of breast cancer. The other causes mentioned above are much more likely to be the real reason behind pain in breasts. However, if you notice a lump in your breast along with pain, you should get it checked by a doctor immediately.
• Other medical conditions
  Some other conditions in which pain may radiate to your breasts include angina (heart-related chest pain), rib fracture, coronary artery disease, anaemia, stomach ulcers, among others.

When to see a doctor?

If your breast pain is associated with other symptoms mentioned below, it is important that you consult your doctor immediately:

• Suspecting a breast lump or a lump in your armpit during self-examination.
• Nipple discharge, which is watery, whitish-yellowish or bloody.
• Dimpling (a visible depression) in your breast.
• Change in the colour of your breast.
• A deviation in the positions of your nipples.
• An ulcer on your breast skin.
• Sudden enlargement of one or both of your breasts.

Read more: Gynecomastia treatment

Breast pain prevention depends on its type. As mentioned above, cyclic breast pain is experienced because of hormonal changes during menstrual cycles and hence, there is not much that you can do to prevent it. However, changing your lifestyle and a routine checkup may lower your chances of having breast pain. Following are a few things that you can do to prevent it:

• Maintain a healthy weight and eat nutritious food. Regular exercise and a healthy diet will help in reducing hormonal fluctuations, infections, inflammations, and toxin accumulation in your body.
• Do a self-examination of your breasts every month to know how your breast tissue feels. By doing this regularly, you will be able to determine the changes in your breasts.
• Get a routine check-up done once every three years if you are below 30 years and every year if you are above 30.

Read more: Health tips for women in their 30s

Your doctor may begin by asking a few questions to get the details of how, when, where, and since how long you’ve been experiencing this pain. He/She may also ask about the number of pregnancies, abortions (if any) you have had or if you are breastfeeding or having contraceptive pills. After that, your doctor may examine your breasts to check for any swelling, pain, breast lumps, ulcers, etc. 

Sometimes, the clinical assessment may not be conclusive and you may be advised to get a few tests done which are as follows:   

• Ultrasound
  An ultrasound is a diagnostic test that is preferred in women who are less than 35 years of age. This test makes use of ultrasound waves which pass through your breast tissue. As this happens, an inner picture of your breasts appears on your doctor’s computer screen. This test is able to detect small cysts (if any) and any changes in your breast tissues.
• Mammography
  Mammography is also a diagnostic test that is usually preferred in women above 35 years of age. In this test, low doses of x-rays are made to pass through your breast tissues and your doctor is able to detect any abnormality visible on the images. Women with a family history of breast cancer and cysts can get it done once a year as recommended by their doctor to prevent breast cancer.
• MRI
  MRI or Magnetic Resonance Imaging is an excellent diagnostic test which not only detects breast tissue changes but also tells the extent of their spread in the surrounding body parts.
• Chest X-ray
  Chest x-ray helps in detecting the abnormalities related to other structures surrounding your breasts that may have caused breast pain.

The treatment of breast pain depends on its underlying cause and includes:

• Counselling
  Mild breast pain does not usually require any treatment. A reassurance and counselling by your doctor about your breast pain might actually help you. Your physician will provide you with the details of normally occurring breast pain, which has nothing to be worried about. You may also see a therapist for any emotional or psychological problem that you are going through to relieve your pain.
• Evening primrose oil and Vitamin E
  A study titled “Vitamin E and evening primrose oil for the management of cyclical mastalgia” found that taking 800 mg (1200 IU) of vitamin E, 3000 mg evening primrose oil or a combination of the two might reduce your cyclic breast pain. Taking them for at least a period of six months might help you get relief from breast pain. However, the evidence for the effectiveness of these supplements is still not considered to be sufficient. Hence, you should speak to your doctor before taking these supplements. Your doctor will tell you the correct dosage based on your body type, age, and medical condition.
• Medicines
  Your doctor may prescribe a few medicines if your breast pain is severe. These include danazol, tamoxifen, toremifene, and oral NSAIDs (Non-steroidal anti-inflammatory drugs) such as diclofenac sodium, and ibuprofen. These medicines might reduce your breast pain but they also have side effects. Hence, do not pop any pills without consulting your doctor.
• Local steroid or anaesthetic injection
  In cases such as costochondritis, chest wall pain, injury, etc, your doctor may give you an injection of steroid or anaesthetic (a pain-numbing medicine) on the site of pain. These injections reduce the pain immediately.
• Well-fitted bra
  Wear a well-fitting brasserie to prevent breast pain in future. As explained above, you should determine the correct size for yourself.

Read more: How to choose the right bra

• Surgery
  Surgery is rarely indicated in case of breast pain because there are high chances of complications.