Mastalgia: Benign Breast Pain

Many women experience mastalgia—breast pain that is not of cancerous origin. Breast pain and tenderness may be a routine part of the monthly menstrual cycle. But if the pain seems unbearable, or occurs during mid-cycle, it may be time to take action.

When faced with breast pain on a monthly basis, some women suspect the worst and think cancer. Others simply accept the pain as a burden. But neither scenario is necessarily correct. Any persistent, sudden, or severe breast pain warrants a visit to your doctor to rule out a serious illness. If nothing is found, which is often the case, your doctor can work with you to discover the real cause of your discomfort and find a remedy that works for you.

A Proper Diagnosis

Your doctor may not seem overly concerned when you report pain in your breasts. In fact, most breast pain is caused by problems that are not life-threatening, and only a small percent of diagnosed breast cancers present with pain as a symptom. Physical exam of the breast is usually the first step in a diagnosis. If the physical exam is normal, your doctor will make a decision about whether testing, such as mammography or ultrasound studies are needed.

You will be asked to determine whether your pain is cyclic or noncyclic. Keeping a daily chart of breast changes and pain can help you understand your body's changes and what might be causing the pain. Cyclic and noncyclic pain can be caused by a wide array of factors and sometimes can be reduced by changing your diet, clothing, or medication.

Cyclic Pain

Cyclic pain is probably caused by the hormonal changes—especially the estrogen surge—that are a part of your menstrual cycle. As the body prepares for a possible pregnancy, or a menstrual period, the number of milk-producing cells and amount of breast fluid increases.

The resulting enlargement causes a pain that has been described as dull and aching. It is usually greatest in the upper and outer portion of the breast, closest to the armpit where most of the milk duct tissue is. The pain is often felt more acutely in one breast, although both are usually involved.

Keeping a record of your pain and its intensity will help you determine whether the pain occurs before your upcoming menstrual cycle. It may offer some psychological relief when you realize that the onset of menstruation relieves the pain. At this point, you can begin experimenting with a range of possible remedies.

Some studies have shown that relief may start with simple dietary modifications:

• A low-fat, high-carbohydrate diet may decrease breast tenderness and swelling before your period.
• Adding a soy protein drink to your diet might help cyclic breast pain.

Mechanical interventions such as a properly-fitted support bra, hot and cold applications during intense pain, and breast massage may also relieve your pain.

If you have no success with these remedies, medication may be advised. Nonsteroidal anti-inflammatory drugs, such as ibuprofen, are sometimes recommended for breast pain. Prescription medicines like danazol, tamoxifen, and bromocriptine are sometimes prescribed. Because they can have significant side effects, most health practitioners use them only as a last resort.

Noncyclic Pain

As with cyclic pain, you should keep a daily record of your discomfort to help determine the cause. Noncyclic pain is usually localized in a specific area in 1 breast and is not related to the hormonal fluctuations of your menstrual cycle. Benign changes in the breast include cysts, fibroadenomas, duct ectasia (widening), mastitis (inflammation), injury, and breast abscesses. Fibrocystic disease, a common and benign condition, is also possible. All require medical evaluation. In fact, if your breast pain occurs with redness of the skin, fever, or warmth in the breast, you should seek medical attention right away. This could point to an infection.

If these problems are not the source of your pain, you might have a musculoskeletal condition causing your pain, such as costochondritis, an inflammation of the cartilage connecting the ribs to the sternum. Noncyclic breast tenderness and pain can also be caused by medications prescribed for hormonal conditions, high blood pressure, and heart and gastrointestinal problems. Some women even find their pain is made worse by herbal products, particularly products that are marketed as reducing premenstrual symptoms.

Know Your Body

For many women, breast pain significantly affects quality of life. It is a condition that women find painful, and physicians often find frustrating to treat. Many women suffer in silence. And when you do finally seek treatment and are reassured that you do not have cancer, it still may take time to identify the source of your pain.

The steps to understanding and coping with breast pain are within your reach. Awareness of any breast changes and keeping track of your pain will help. It may take time to fully manage your pain, but take heart in the knowledge that many women have found relief.

Revision Information

• Reviewer: Michael Woods, MD
• Review Date: 02/2015
• Update Date: 03/08/2013