Breast pain

Last updated
Breast pain
Other namesMastodynia, mastalgia, breast tenderness
Specialty Gynecology
TypesCyclic, non-cyclic [1]
Causes Menstrual cycle related, birth control pills, hormone therapy, psychiatric medication, breast cancer [1]
Diagnostic method Examination, medical imaging [1]
Differential diagnosis Gallstones, thoracic outlet syndrome, costochondritis [2]
TreatmentReassurance after ruling out cancer, medications [2] [1]
Medication Paracetamol, NSAIDs [1]
Prognosis >75% resolve without treatment [1]
Frequency70% of women [2]

Breast pain is the symptom of discomfort in either one or both breasts. [2] Pain in both breasts is often described as breast tenderness, is usually associated with the menstrual period and is not serious. [1] [3] Pain that involves only one part of a breast is more concerning, [1] particularly if a hard mass or nipple discharge is also present. [3]

Contents

Causes may be related to the menstrual cycle, birth control pills, hormone therapy, or psychiatric medication. [1] Pain may also occur in those with large breasts, during menopause, and in early pregnancy. [1] [3] In about 2% of cases breast pain is related to breast cancer. [4] Diagnosis involves examination, with medical imaging if only a specific part of the breast hurts. [1]

In more than 75% of people the pain resolves without any specific treatment. [1] Otherwise treatments may include paracetamol or NSAIDs. [1] A well fitting bra may also help. [3] In those with severe pain tamoxifen or danazol may be used. [1] About 70% of women have breast pain at some point in time. [2] Breast pain is one of the most common breast symptoms, along with breast masses and nipple discharge. [1]

Causes

Breast pain linked to the menstrual cycle is called cyclic breast pain or cyclic mastalgia. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS). [5] Cyclic breast pain is often associated with fibrocystic breast changes or duct ectasia and thought to be caused by changes of prolactin response to thyrotropin. [6] [7]

Breast pain that is not linked to a menstrual cycle is called noncyclic breast pain. Noncyclical breast pain has various causes and is harder to diagnose and frequently the root cause is outside the breast. Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause and during pregnancy. [5] After pregnancy, breast pain can be caused by breastfeeding. [5] Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis and medications such as digitalis, methyldopa (an antihypertensive), spironolactone, certain diuretics, oxymetholone (an anabolic steroid), and chlorpromazine (a typical antipsychotic). [5] Also, shingles can cause a painful blistering rash on the skin of the breasts. [5]

Breast cancer

Some women who have pain in one or both breasts may fear breast cancer. However, breast pain is not a common symptom of cancer. The great majority of breast cancer cases do not present with symptoms of pain, though breast pain in older women is more likely to be associated with cancer. [2] [8] [5]

Diagnosis

Diagnosis involves breast examination, with medical imaging if only a specific part of the breast hurts. [1] Medical imaging by ultrasound is recommended for all ages, as well in those over 35 it is recommended together with mammography. [1]

Ruling out the other possible causes of the pain is one way to differentiate the source of the pain. Breast pain can be due to:

Medications can be associated with breast pain and include:

Diagnostic testing can be useful. Typical tests used are mammogram, excisional biopsy for solid lumps, fine-needle aspiration and biopsy, pregnancy test, ultrasonography, and magnetic resonance imaging (MRI). [8]

Treatment

In more than 75% of people the pain resolves without any specific treatment. [1] Otherwise treatments may include paracetamol or NSAIDs. [1] A well fitting bra may also help. [3] In those with severe pain tamoxifen or danazol may be used. [1]

Bromocriptine may be used as well. [14]

Spironolactone, low dose oral contraceptives, and low-dose estrogen have helped to relieve pain. Topical anti-inflammatory medications can be used for localized pain. Vitamin E is not effective in relieving pain nor is evening primrose oil. Vitamin B6 and vitamin A have not been consistently found to be beneficial. Flaxseed has shown some activity in the treatment of cyclic mastalgia. [8]

Pain may be relieved by the use of nonsteroidal anti-inflammatory drugs or, for more severe localized pain, by local anaesthetic. [2] [5] Pain may be relieved by reassurance that it does not signal a serious underlying problem, and an active life style can also effect an improvement. [2]

Information regarding how the pain is real but not necessarily caused by disease can help to understand the problem. Counseling can also be to describe changes that vary during the monthly cycle. Women on hormone replacement therapy may benefit from a dose adjustment. Another non-pharmacological measure to help relieve symptoms of pain may be to use good bra support. Breasts change during adolescence and menopause and refitting may be beneficial. Applying heat and/or ice can bring relief. Dietary changes may also help with the pain. Methylxanthines can be eliminated from the diet to see if a sensitivity is present. Some clinicians recommending a reduction in salt, though no evidence supports this practice. [8]

See also

Related Research Articles

<span class="mw-page-title-main">Breast</span> Region of the torso of a primate that in females serves as a mammary gland

The breast is one of two prominences located on the upper ventral region of the torso among humans and other primates. Both sexes develop breasts from the same embryological tissues. The relative size and development of the breasts is a major secondary sex distinction between males and females.

<span class="mw-page-title-main">Menstruation</span> Shedding of the uterine lining

Menstruation is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hormones. Menstruation is triggered by falling progesterone levels and is a sign that pregnancy has not occurred.

<span class="mw-page-title-main">Nipple</span> Part of the breast

The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to breastfeed an infant. The milk can flow through the nipple passively or it can be ejected by smooth muscle contractions that occur along with the ductal system. Male mammals also have nipples but without the same level of function, and often surrounded by body hair.

Premenstrual syndrome (PMS) is a disruptive set of emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve around the time menstrual bleeding begins. Different women experience different symptoms. Premenstrual syndrome commonly produces one or more physical, emotional, or behavioral symptoms, that resolve with menses. The range of symptoms is wide, and most commonly are breast tenderness, bloating, headache, mood swings, depression, anxiety, anger, and irritability. To be diagnosed as PMS, rather than a normal discomfort of the menstrual cycle, these symptoms must interfere with daily living, during two menstrual cycles of prospective recording. These symptoms are nonspecific and are seen in women without PMS. Often PMS-related symptoms are present for about six days. An individual's pattern of symptoms may change over time. PMS does not produce symptoms during pregnancy or following menopause.

<span class="mw-page-title-main">Hyperprolactinaemia</span> Medical condition

Hyperprolactinaemia also known as Hyperprolactinemia is a condition characterized by abnormally high levels of prolactin in the blood. In women, normal prolactin levels average to about 13 ng/mL, while in men, they average 5 ng/mL. The upper normal limit of serum prolactin is typically between 15 to 25 ng/mL for both genders. Levels exceeding this range indicate hyperprolactinemia.

<span class="mw-page-title-main">Mastitis</span> Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

<span class="mw-page-title-main">Nipple discharge</span> Medical condition

Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery.

<span class="mw-page-title-main">Vaginal bleeding</span> Medical condition

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

<span class="mw-page-title-main">Lactiferous duct</span> Structure carrying milk to the nipple

Lactiferous ducts are ducts that converge and form a branched system connecting the nipple to the lobules of the mammary gland. When lactogenesis occurs, under the influence of hormones, the milk is moved to the nipple by the action of smooth muscle contractions along the ductal system to the tip of the nipple. They are also referred to as galactophores, galactophorous ducts, mammary ducts, mamillary ducts or milk ducts.

<span class="mw-page-title-main">Menstrual disorder</span> Medical condition affecting menstrual cycle

A menstrual disorder is characterized as any abnormal condition with regards to a woman's menstrual cycle. There are many different types of menstrual disorders that vary with signs and symptoms, including pain during menstruation, heavy bleeding, or absence of menstruation. Normal variations can occur in menstrual patterns but generally menstrual disorders can also include periods that come sooner than 21 days apart, more than 3 months apart, or last more than 10 days in duration. Variations of the menstrual cycle are mainly caused by the immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, and early detection and management is required in order to minimize the possibility of complications regarding future reproductive ability.

Psychoneuroendocrinology is the clinical study of hormone fluctuations and their relationship to human behavior. It may be viewed from the perspective of psychiatry, where in certain mood disorders, there are associated neuroendocrine or hormonal changes affecting the brain. It may also be viewed from the perspective of endocrinology, where certain endocrine disorders can be associated with negative health outcomes and psychiatric illness. Brain dysfunctions associated with the hypothalamus-pituitary-adrenal axis HPA axis can affect the endocrine system, which in turn can result in physiological and psychological symptoms. This complex blend of psychiatry, psychology, neurology, biochemistry, and endocrinology is needed to comprehensively understand and treat symptoms related to the brain, endocrine system (hormones), and psychological health..

<span class="mw-page-title-main">Ptosis (breasts)</span> Sagging of the female breast

Ptosis or sagging of the female breast is a natural consequence of aging. The rate at which a woman's breasts drop and the degree of ptosis depends on many factors. The key factors influencing breast ptosis over a woman's lifetime are cigarette smoking, her number of pregnancies, higher body mass index, larger bra cup size, and significant weight change. Post-menopausal women or people with collagen deficiencies may experience increased ptosis due to a loss of skin elasticity. Many women and medical professionals mistakenly believe that breastfeeding increases sagging. It is also commonly believed that the breast itself offers insufficient support and that wearing a bra prevents sagging, which has not been found to be true.

<span class="mw-page-title-main">Fibrocystic breast changes</span> Medical condition

Fibrocystic breast changes is a condition of the breasts where there may be pain, breast cysts, and breast masses. The breasts may be described as "lumpy" or "doughy". Symptoms may worsen during certain parts of the menstrual cycle due to hormonal stimulation. These are normal breast changes, not associated with cancer.

<span class="mw-page-title-main">Breast cyst</span> Medical condition

A breast cyst is a cyst, a fluid-filled sac, within the breast. One breast can have one or more cysts. They are often described as round or oval lumps with distinct edges. In texture, a breast cyst usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Ovarian diseases refer to diseases or disorders of the ovary.

<span class="mw-page-title-main">Duct ectasia of breast</span> Medical condition

Duct ectasia of the breast, mammary duct ectasia or plasma cell mastitis is a condition that occurs when a milk duct beneath the nipple widens, the duct walls thicken, and the duct fills with fluid. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.

Estrogen dominance (ED) is a theory about a metabolic state where the level of estrogen outweighs the level of progesterone in the body. This is said to be caused by a decrease in progesterone without a subsequent decrease in estrogen.

<span class="mw-page-title-main">Breast mass</span> Localized swellings that feel different from the surrounding tissue

A breast mass, also known as a breast lump, is a localized swelling that feels different from the surrounding tissue. Breast pain, nipple discharge, or skin changes may be present. Concerning findings include masses that are hard, do not move easily, are of an irregular shape, or are firmly attached to surrounding tissue.

<span class="mw-page-title-main">Atrophic vaginitis</span> Medical condition

Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to low estrogen levels. Symptoms may include pain with sex, vaginal itchiness or dryness, and an urge to urinate or burning with urination. It generally does not resolve without ongoing treatment. Complications may include urinary tract infections. Atrophic vaginitis as well as vulvovaginal atrophy, bladder and urethral dysfunctions are a group of conditions that constitute Genitourinary Syndrome of Menopause (GSM). Diagnosis is typically based on symptoms.

Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Salzman, B; Fleegle, S; Tully, AS (15 August 2012). "Common breast problems". American Family Physician. 86 (4): 343–9. PMID   22963023.
  2. 1 2 3 4 5 6 7 8 Iddon, J; Dixon, JM (13 December 2013). "Mastalgia". BMJ (Clinical Research Ed.). 347: f3288. doi:10.1136/bmj.f3288. PMID   24336097. S2CID   220173019.
  3. 1 2 3 4 5 "Breast pain". nhs.uk. 17 October 2017. Retrieved 11 November 2022.
  4. ↑ Mazza, Danielle (2011). Women's Health in General Practice. Elsevier Health Sciences. p. 189. ISBN   978-0729578714.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 PD-icon.svg This article incorporates text from this source, which is in the public domain : "Breast pain: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 14 August 2017.
  6. ↑ Dogliotti, L; Faggiuolo, R; Ferusso, A; Orlandi, F; Sandrucci, S; Tibo, A; Angeli, A (1985). "Prolactin and thyrotropin response to thyrotropin-releasing hormone in premenopausal women with fibrocystic disease of the breast". Hormone Research. 21 (3): 137–44. doi:10.1159/000180038 (inactive 2024-08-12). PMID   3922866.{{cite journal}}: CS1 maint: DOI inactive as of August 2024 (link)
  7. ↑ Dogliotti, L; Orlandi, F; Angeli, A (1989). "The endocrine basis of benign breast disorders". World Journal of Surgery. 13 (6): 674–9. doi:10.1007/BF01658413. PMID   2696218. S2CID   7420761.
  8. 1 2 3 4 5 6 Cash, Jill (2014). Family practice guidelines. New York: Springer Publishing. ISBN   9780826197825., [Electronic book] Section I Guidelines, Chapter Thirteen: Gynecologic Guidelines-Breast Pain
  9. 1 2 3 4 5 6 7 Brown, Ken. "Breast Pain Causes and Diagnosis: Johns Hopkins Breast Center" . Retrieved 14 August 2017.
  10. ↑ PD-icon.svg This article incorporates text from this source, which is in the public domain : "Thrush in newborns: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 3 August 2017.
  11. ↑ Walker, Marsha (2011). Breastfeeding management for the clinician : using the evidence. Sudbury, Mass: Jones and Bartlett Publishers. p. 533. ISBN   9780763766511.
  12. ↑ Santos, Kamila Juliana da Silva; Santana, Géssica Silva; Vieira, Tatiana de Oliveira; Santos, Carlos Antônio de Souza Teles; Giugliani, Elsa Regina Justo; Vieira, Graciete Oliveira (2016). "Prevalence and factors associated with cracked nipples in the first month postpartum". BMC Pregnancy and Childbirth. 16 (1): 209. doi: 10.1186/s12884-016-0999-4 . ISSN   1471-2393. PMC   4975913 . PMID   27496088.
  13. ↑ "Sore or cracked nipples when breastfeeding, Pregnancy and baby guide". www.nhs.uk. National Health Services (UK). Retrieved 4 August 2017.
  14. ↑ Kerri Durnell Schuiling; Frances E. Likis (2011). Women's Gynecologic Health. Jones & Bartlett Publishers. pp. 381–. ISBN   978-0-7637-5637-6.
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