Breast pain

Breast pain is the symptom of discomfort in the breast.[2] Pain that involves both breasts and which occurs repeatedly before the menstrual period is generally not serious.[1][3] Pain that involves only one part of a breast is more concerning.[1] It is particularly concerning if a hard mass or nipple discharge is also present.[3]

Breast pain
Other namesMastodynia, mastalgia, breast tenderness
SpecialtyGynecology
TypesCyclic, non-cyclic[1]
CausesMenstrual cycle related, birth control pills, hormone therapy, psychiatric medication, breast cancer[1]
Diagnostic methodExamination, medical imaging[1]
Differential diagnosisGallstones, thoracic outlet syndrome, costochondritis[2]
TreatmentReassurance after ruling out cancer, medications[2][1]
MedicationParacetamol, NSAIDs[1]
Prognosis>75% resolve without treatment[1]
Frequency70% of women[2]

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

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

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.[7] After pregnancy, breast pain can be caused by breastfeeding.[7] 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).[7] Also, shingles can cause a painful blistering rash on the skin of the breasts.[7]

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][7]

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, well in those over 30 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][7] 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

References
  1. Salzman, B; Fleegle, S; Tully, AS (15 August 2012). "Common breast problems". American Family Physician. 86 (4): 343–9. PMID 22963023.
  2. Iddon, J; Dixon, JM (13 December 2013). "Mastalgia". BMJ (Clinical Research Ed.). 347: f3288. doi:10.1136/bmj.f3288. PMID 24336097. S2CID 220173019.
  3. "Breast pain". NHS. 2017-10-17. Retrieved 30 October 2018.
  4. Mazza, Danielle (2011). Women's Health in General Practice. Elsevier Health Sciences. p. 189. ISBN 978-0729578714.
  5. 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. PMID 3922866.
  6. 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.
  7. This article incorporates text from this source, which is in the public domain: "Breast pain: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 14 August 2017.
  8. Cash, Jill (2014). Family practice guidelines. New York: Springer Publishing. ISBN 9780826197825., [Electronic book] Section I Guidelines, Chapter Thirteen: Gynecologic Guidelines-Breast Pain
  9. Brown, Ken. "Breast Pain Causes and Diagnosis: Johns Hopkins Breast Center". Retrieved 14 August 2017.
  10. 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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