Make an Appointment
Talk to DoctorOverview
Mastalgia, commonly known as breast pain, can occur as either a persistent or occasional discomfort. This condition is frequently experienced by women aged 30 to 50, but it’s essential to recognize that men and transgender individuals can also be affected. Symptoms of breast pain include tenderness, throbbing, intense stabbing or scorching pain, and a feeling of tightness in the breast tissue.
Breast pain can be classified into two types.
- Cyclic breast pain: A cyclic breast pain usually corresponds to the monthly cycle. Breast pain can occur in one or both breasts and is usually caused by natural hormonal fluctuations. Cyclic breast pain goes away on its own after menstruation, but it returns during the next menstrual cycle.
- Noncyclic breast pain: Noncyclic breast pain, on the other hand, is more common in women aged 40 to 50 and has nothing to do with their monthly cycle.
Breast pain can vary in intensity from mild to severe and may manifest in different patterns: it might occur just a few days each month, typically in the two to three days leading up to a menstrual period, causing mild-to-moderate discomfort in both breasts. Alternatively, it could last for a week or longer every month, starting before a period and possibly continuing throughout the menstrual cycle, with pain ranging from moderate to severe, affecting both breasts. In some cases, the pain may persist throughout the entire month, unrelated to the menstrual cycle.
Breast pain in transgender men may be caused by the small amount of breast tissue that remains after a mastectomy. Hormone therapy may induce breast soreness in transsexual women. Whereas the primary reason for breast pain in males is typically attributed to a condition known as gynecomastia, which is an enlargement of breast gland tissue due to an imbalance in the hormone’s estrogen and testosterone.
Breast pain is typically related to noncancerous (benign) breast conditions and is rarely associated with breast cancer. Nevertheless, it is crucial to treat unexplained breast pain with seriousness. If the pain persists for more than one or two menstrual cycles, extends beyond menopause, or does not seem to be linked to hormonal changes, seeking medical evaluation and assessment is essential.
Symptoms
The symptoms of breast discomfort can differ depending on whether it is classified as cyclic or noncyclic. Cyclic breast pain tends to follow a predictable pattern, recurring at regular intervals. Conversely, noncyclic breast pain is either constant or lacks a consistent pattern.
Both cyclic and noncyclic breast pain categories exhibit distinct characteristics, signs, and symptoms. The severity of the pain experienced can vary from one individual to another.
- Cyclic breast pain: During cyclic breast pain, you will likely experience your breasts as:
- Tender
- Swollen
- Heavy
- Sore
- Noncyclic breast pain
- It is localized, affecting only a specific area within the breast.
- The pain is sharper and more intense in nature.
- A sensation of burning or stabbing may be experienced specifically in that localized area.
- Extramammary breast pain: Extramammary breast pain is characterized by discomfort within the breast tissue, but its origin is outside the breast area. This type of pain is associated with conditions occurring externally, such as pulling a chest muscle, which can cause radiating pain in the chest wall and rib cage, eventually affecting the breast area. Another potential cause of extramammary breast pain is costochondritis, a condition related to arthritis that impacts the chest cartilage and can also lead to breast pain.
If you are experiencing breast pain, it’s essential to schedule an appointment with your doctor if:
- Duration: If the pain continues daily for more than a couple of weeks.
- Specific area: If the pain is concentrated in one particular area of your breast.
- Worsening: If the pain seems to be getting worse over time.
- Daily life interference: If the pain interferes with your daily activities.
- Sleep disturbance: If the pain awakens you from sleep.
Causes
The causes of breast pain differ if it is cyclic or noncyclic. However, in many cases, the cause is unknown. Cyclic breast pain is often triggered by the natural menstrual cycle. Changes in hormone levels can affect the milk ducts or milk glands. These alterations in the ducts and glands can result in painful breast cysts.
Noncyclic breast pain causes may include birth control pills, breast cysts, pregnancy, inflammation, infection, costochondritis, trauma, surgical scars, among others. Noncyclic breast pain can also be caused by certain activities, such as smoking, consumption of caffeine, stress, and breastfeeding.
Risk factors
Breast pain is prevalent among individuals who have not yet completed menopause, but it may also be experienced after menopause. Additionally, breast pain can occur in men with gynecomastia and transgender individuals undergoing gender reassignment.
Certain factors can contribute to a higher risk of breast pain, such as:
- Breast size: Breast pain caused by big breasts may be accompanied by neck, shoulder, and back pain. People with large breasts may have noncyclic breast pain.
- Breast surgery: Even after the incisions have fully healed, breast pain related to breast surgery and the formation of scars may persist.
- Imbalance in fatty acids: An irregularity in the fatty acid composition within cells can impact the sensitivity of breast tissue to hormones present in the bloodstream.
- Medication: Breast pain can be linked to specific hormonal medications, including certain infertility treatments and oral birth control pills. In post-menopausal individuals, estrogen and progesterone hormone therapies may also lead to breast tenderness as a potential side effect. Additionally, breast pain might be associated with the use of particular antidepressants like selective serotonin reuptake inhibitors (SSRIs). Furthermore, medications prescribed for high blood pressure and certain antibiotics have also been known to cause breast pain.
- Excessive caffeine consumption: Some patients report that reducing or eliminating caffeine helps with breast pain. However, further research is still required to confirm this.
Diagnosis
Common tests to diagnose a breast pain include:
- Breast examination: During a breast examination, the doctor checks for any changes in the breasts and examines the lymph nodes in the lower neck and underarm. The physician also listens to the patient’s heart and lungs, and conducts a thorough examination of the chest and abdomen to rule out any other potential causes for the pain. If the medical history and the breast and physical exam show no abnormal findings, additional tests may not be necessary.
- Mammogram: A mammography is a low-dose X-ray of the breast. This is used to look for any abnormalities if one develops a new symptom, such as a lump, soreness, nipple discharge, or changes in the skin of the breast. This is often requested to analyze the area of concern discovered during the breast exam, such as a lump or atypical thickening in the breast tissue, or a focused area of pain in the breast tissue.
- Ultrasound: In cases where a mammogram shows normal results, further evaluation may be necessary to investigate a specific area of pain. An ultrasound of the breast is a noninvasive procedure commonly used to detect and identify breast lumps and cysts. It is often performed alongside a mammogram, and it utilizes sound waves to generate images of the breast tissue.
- Breast biopsy: A biopsy involves the collection of a small sample of breast tissue from the affected area, which is then sent to a laboratory for further examination. This procedure is typically requested when there are suspicious breast lumps, areas of thickening, or abnormalities observed during imaging scans. The purpose of the biopsy is to obtain a definitive diagnosis and provide more information about the condition.
Treatment
Managing breast pain can often resolve on its own without any treatment. However, if you need help, your doctor may suggest the following options:
- Eliminate causes or factors that worsen the pain: This could be as simple as wearing a bra with better support.
- Use topical nonsteroidal anti-inflammatory (NSAID) medication: When the pain is intense, your doctor may recommend applying an NSAID cream directly to the painful area.
- Adjust birth control pills: If you’re on birth control pills, your doctor might suggest skipping the pill-free week or changing the birth control method to alleviate breast pain. Remember to seek your doctor’s advice before making any changes.
- Reduce menopausal hormone therapy: If you are undergoing menopausal hormone therapy, lowering the dosage or stopping it may help relieve breast pain.
- Consider prescription medication: In some cases, your doctor may prescribe a medication called Danazol, which is approved for treating fibrocystic breasts. However, it carries the risk of severe side effects like heart and liver problems, weight gain, and voice changes. Another option is Tamoxifen, which is primarily used for breast cancer treatment and prevention but may also help with breast pain. It’s essential to weigh the potential side effects before considering this option.
