Mastalgia, or breast pain, is the most common reason women see a healthcare provider. Women of all ages can experience breast pain, but it is more present in pre-menopausal women.
Breast pain is the most common reason women see healthcare providers. Most breast pain is common in people who have not yet entered menopause.
There are three types of breast pain: cyclic, non-cyclic, and extramammary. Irregular menstrual cycles, emotional stress, and medication changes may increase breast pain.
Breast cancer is the primary concern of women seeing doctors for breast pain. However, breast pain alone rarely shows the presence of a mass.
If breast pain interferes with daily activities, pain medications may be prescribed. Another treatment may be supportive clothing, or changes in diet.
Three types of breast pain
Breast pain is divided into three categories. Each type affects breasts differently. A thorough history and physical examination will help identify the type of breast pain.
1. Cyclic breast pain
Cyclic breast pain is called this because it is affected by the menstrual cycle. It is a hormonal pain related to menstruation. Younger women are more likely to have cyclic breast pain than other women.
This type of breast pain is present in both breasts and sometimes can move to the armpits and arms. The pain is most intense just before the start of menstruation.
Breast pain of this type goes away when menstruation is completed, therefore treatment is often not needed. Medication may be prescribed only if the pain is severe enough to affect a woman’s daily activities.
2. Non-cyclic breast pain
Non-cyclic breast pain is most often seen in women aged 40 to 50 years old. This pain is generally in one breast and is described as sharp or burning.
Breastfeeding is a common cause of non-cyclic breast pain. Other causes of non-cyclic breast pain may be:
- Previous pregnancies
- Thrombophlebitis – inflammation in a vein that causes a blood clot and pain
- Benign tumors
- Duct ectasia – clogged milk duct
- Stretching of Cooper’s ligaments
3. Extramammary breast pain
Extramammary breast pain is when the source of the pain is outside of the breast. It is the most common reason for referrals to breast clinics.
Extramammary breast pain can be pain in the chest wall or from exercise. Causes of it can include:
- Musculoskeletal pain
- Cardiovascular pain
- Biliary and neurological reasons
- Psychological causes
Pain during exercise may result from the stretching of Cooper’s ligaments, which are connective tissues in your breasts that help uphold structure. Wearing a supportive bra may help.
Breast cancer is the primary concern
Women will most often see a healthcare provider if they have breast pain because they are concerned about the risk of breast cancer.
Breast pain alone is rarely a single indicator of breast cancer. It is sometimes a complaint of people with breast cancer, but it is not the only complaint. Most people who see healthcare providers for breast pain show no presence of a mass.
When you see a healthcare provider for breast pain, they will complete a thorough history and physical exam. The type of pain will be identified, the location will be marked, and the relation to the menstrual cycle will be noted.
If the physical exam is not normal, further screening such as an MRI or ultrasound may be ordered.
Mammograms are recommended for any patient who is 35 or more years old and has not had a mammogram in the last year. Patients under 35 years old and with an unusual physical exam may also be advised to have a mammogram.
Treatment for breast pain may vary depending on the type and cause of breast pain:
- Cyclic breast pain typically stops after menstruation. However, if the pain is excessive, pain medications may be prescribed.
- Non-cyclic breast pain is most often treated with pain medications. In the case of pain with lactation, the cause of the pain will determine the treatment.
- Extramammary pain is also treated on a case-by-case basis. Pain medications may be prescribed, and supportive clothing may be suggested.
Sometimes dietary changes may be suggested, though they are not proven with clinical data. These changes may include:
- Decreased caffeine intake
- Avoiding cocoa
- Staying away from foods containing methylxanthines, such as tea, coffee, and chocolate
Women of all ages can experience breast pain. Completing a monthly self breast exam can help with early detection of any breast issues. Consult with a healthcare provider for any breast pain or concerns. Treatment and screening will be dependent on the physical exam.