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Breast pain

Breast pain and its clinical name “mastalgia” can result in various pain indicators: tenderness, throbbing, sharp pain, stabbing, burning, or tightness in breast tissue. The pain can persist or it might come and go. It can be caused by cyclical hormonal triggers (referred to as “cyclic breast pain”) or from other causes (“non-cyclic breast pain”). 

Throughout a woman’s life, breast pain may accompany menstruation, pregnancy, post-delivery, peri-menopause, and post-menopause. As most women worry about their risk of developing breast cancer, there is a tendency to assume that breast pain may be cancer related. You can feel reassured that mastalgia is not a common breast cancer symptom. Breast pain is a symptom that tends to subside once a woman is post menopausal, but in the meantime there are effective treatment options available.

The vast majority of women will experience breast pain at some point during their reproductive or post-menopausal years. When breast pain is reported, 75% of women receive a diagnosis of cyclic mastalgia. Read more on this in the next section.

The Lowdown on Breast Pain

Why does this happen, how does it impact you, how is it diagnoses and common triggers/ risk profiles.

Cyclical mastalgia is the most common form of breast pain, with non-cyclical mastalgia being diagnosed less frequently. Cyclic breast pain occurs due to fluctuating hormones and can surface during menopause. Non-cyclic mastalgia occurs for non-hormonal reasons and may indicate the presence of undiagnosed health conditions unrelated to menopause. Occasionally, a woman is diagnosed as having fibrocystic breast tissue due to an elevated occurrence of dense tissue and benign cysts. This condition can be classified as either cyclic or non-cyclic, depending on a woman’s health circumstances.

Cyclic

As part of your body’s menstrual cycle, the production and utilization of estrogen and progesterone stimulate the quantity and individual size of your breasts’ ducts and lobules (milk glands). Hormones also affect your breast tissue’s retention of water.

Cyclical breast pain can involve swelling, tenderness, or lumpiness, particularly in the top and outer sections of your breast tissue, your armpit, and your arm. During pre-menopause, symptoms will end when menstruation ends, under a cyclical pattern. During peri-menopause, your hormone levels can spike and dip without predictability and, therefore, pain can be experienced differently and more frequently. Cyclical pain can last into post-menopause, particularly for women on low-dose contraceptive pills or hormone replacement therapy (HRT) for relief of other menopause-related symptoms.

Non-cyclic

Non-cyclic pain is less predictable than cyclic mastalgia and is not related to a woman’s hormones or menstrual cycle. The pain may be sharp or widespread, it can be in a precise area or regional, it can be constant or intermittent. Non-cyclical breast pain often indicates a further medical problem, such as a breast cyst, physical trauma, previous surgery, arthritis in the neck or back, or a tumor. Non-cyclic pain should be investigated to establish its root cause. However, in terms of menopause, it is unlikely that there is a direct correlation. 

The connection between fatty tissue and hormone changes is not fully understood. It may be that fatty acids allow for pain sensations, possibly through hormonal change indicators and increased nerve sensitivity. The normal operations of dopamine through the pituitary gland may be inhibited. Due to your hormonal fluctuations during menopause, it is possible that there is a direct relationship between menopause, fatty acid changes, and breast pain.

As breast pain causes unease and concerns regarding breast cancer, it is important to receive an accurate diagnosis. However, breasts that are sore or hurting are rarely due to breast cancer and are more commonly related to a benign (non-cancerous) condition.

Breast pain does not typically cause or lead to other health concerns.

If you experience recurrent or constant breast pain through one to two menstrual cycles, it is important to receive an accurate medical diagnosis. If you experience pain after menopause, it is important to speak to your healthcare provider about your symptoms, as this type of pain is likely non-cyclic and stems from a root cause unrelated to menopause and is unlikely to away on its own.

If you notice any lump (painless or painful) in your breast, skin rashes around your nipple, a retracted nipple, or bloody discharge from your nipple, it is important to contact your doctor for further testing.

When investigating the root cause of your breast pain, your doctor will review your medical history first, in order to establish whether a non-cyclic source may be responsible. You will also receive a breast cancer screening, through a manual examination which includes your breast tissue, chest wall, underarms, and adjoining areas. For women without a recent mammogram result, a new test may be ordered. For women who have a lump in their breast tissue, further testing, including an ultrasound, may be required to determine an accurate diagnosis and appropriate treatment.

There are a couple of triggers which can cause breast pain. Your healthcare provider will consider these factors as well, when determining an appropriate course of action for assessment, diagnosis, and treatment.

  • Women with large breasts tend to experience more non-cyclic breast pain than women who have a smaller breast size. Large breasts can cause pain in the breast area, as well as in the neck, shoulders, and back.
  • Experiencing a fatty acid imbalance due to hormone fluctuations (including during menopause) can cause nerve sensitivity changes resulting in feelings of pain. Unfortunately, it is unclear how these triggers can be prevented.
  • Prescription medications can cause breast tissue pain as well. Hormone replacement therapy (HRT) involves prescribed estrogen and progesterone and may lead to breast tenderness as a side effect. Some antidepressants (SSRIs) and medications prescribed for blood pressure treatment also carry the risk of breast pain side effects. Both HRT and SSRI are commonly prescribed to treat other symptoms of peri- and post-menopause.
Menopause does not cause breast cancer, nor vice versa. However, as the risk of getting breast cancer (just like other cancers) increases with age, there is a possibility that breast cancer and menopause will coincide. This brings with it a few additional risks and limitations in treatment methods - please read this article for in depth information on this.

Physical health

Breast pain and tenderness

Menopause does not cause breast cancer, nor vice versa. However, as the risk of getting breast cancer (just like other cancers) increases with age, there is a possibility that breast cancer and menopause will coincide. This brings with it a few additional risks and limitations in treatment methods. If your healthcare provider does not talk to you about this, ask them about it particularly if (breast) cancer runs in your family.

Prevention and Treatment

Learn more about your options for prevention, management and treatment of breast pain and tenderness. This is not an exhaustive list of the treatment options available, but a good start.

Over-the-counter pain suppression medication can help to ease breast pain. However, the prevalence of mastalgia, both pre-menopause and during peri-menopause, means that breast pain is highly likely. OTC products may not always be sufficient. In rare cases of non-cyclic mastalgia, breast reduction surgery (reduction mammoplasty) may be recommended.

  • Although colloquial wisdom feels that caffeine and smoking increase the occurrence of breast pain, there is no clinical research showing a posisitve correlation. 
  • Heavy breasts are often associated with high body weight and it is important to remember that several menopause symptoms, as well as other medical risks, can be significantly reduced in terms of severity and frequency by maintaining an advisable weight. Eating a healthy, balanced diet, with fatty acids and complete nutrients and minerals, is recommended. A common diet recommended for the mitigation of menopausal health concerns is the Mediterranean diet (fish, nuts, whole grains, fruit, vegetables, and beans).
  • Depending on the severity of your pain, its specific location, and your breast size, you may find that vigorous exercise exacerbates your discomfort. As an alternative, consider moderate or light aerobic activities such as walking or swimming. Also consider appropriate, supportive sports apparel (such as a size-specific sports bra), as you prioritize the significant menopausal health benefits a regular exercise regime provides to you.
  • Yoga, stretching, and mindfulness-centered activities may also provide relief or comfort. Massage, cold or warm compresses, ice packs, or neck rotation exercises may all provide temporary relief as well.
  • In a small trial study, women treated for cyclic mastalgia with dopaminergic vitex agnus-cactus supplements showed positive results.
  • Chamomile extract (matricaria chamomilla) is an ancient and common supplemental flower product that has many beneficial health properties. There is reasonably strong evidence of efficacy for pain reduction due to its anti-inflammatory qualities and this supplement has no side effects.
  • Regional, cultural influences recommend other nutritional supplements, such as vItamin E and flax seeds, for effective pain relief, although clinical proof of efficacy is lacking.
  • Healthy fatty acids in primrose oil (gamma-linolenic acid) and fish oil supplements may also be beneficial. but also lack scientific evidence.
  • Over-the-counter painkillers such as ibuprofen and acetaminophen may offer temporary pain relief.
  • Cold compress. For some women, applying a cold compress to the area of the breast experiencing pain helps to reduce discomfort. Using ice or other frozen items, a 20 minute cold compress is worth a try if you are experiencing breast pain for the first time and looking for immediate relief while you pursue an accurate diagnosis.
  • Correct Bra. As a first line of defense, it is important that every woman wears a bra size and shape that supports her breast size appropriately. If you are experiencing breast pain, consider having a professional fitting with a bra-sizing specialist. The shape, fullness and size of your breast will chance over the course of your life and it is very likely that your bra size will therefore also change. For some breast, neck, and back pain, the source of the pain can be eliminated before it begins. A lifetime of heavy breasts can cause injury to ligaments and breast tissue.

The following non-hormonal medications may be prescribed to relieve breast pain:

  • Topical diclofenac is a gel based medication that is commonly prescribed to treat cyclical and non-cyclical breast pain as it is effective and the chance of side effects is significantly lower than with orally taken medications. 
  • Bromocryptine as a short course treatment for cyclical breast pain
  • Danazol take as a short course treatment for cyclical breast pain has proven to be effective for about 70% of women. However, as it comes with the risk of several side effects it is not considered to be the first line of treatment for cyclical mastalgia.
  • Prescription strength non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed to relieve pain that is not responding to OTC alternatives. 

Hormone replacement treatment (HRT) is prescribed to balance a woman’s hormone fluctuations and it may provide protection or relief from cyclic mastalgia. However, HRT is not commonly prescribed if breast pain is the only symptom you are experiencing, as effective non-hormonal treatments (OTC) are also available.

FAQs

Is breast pain a sign of breast cancer?

Throughout a woman’s life, breast pain may accompany menstruation, pregnancy, post-delivery, peri-menopause, and post-menopause. As most women worry about their risk of developing breast cancer, there is a tendency to assume that breast pain may be cancer related. However, most of the time, breast pain is not a sign of breast cancer or anything serious. But if the pain is severe or persistent and/or you are worried about it could you should see a doctor for diagnosis and treatment.

Are sore breasts common?

The vast majority of women will experience breast pain at some point during their reproductive or post-menopausal years. When breast pain is reported, 75% of women receive a diagnosis of cyclic mastalgia.

Can breast pain be caused by medication?

Yes, breast pain can unfortunately be a side effect from certain types of medication. The most common ones in this stage of your life are:
- hormone therapy (frequently prescribed during menopause)
- cardiovascular drugs
- drugs to treat anemia
- diuretics (also known as "water pills
- psychiatric drugs

When to worry about breast pain in post menopause?

Breast pain in post menopause isn’t usually a sign of breast cancer or other serious condition. However there are a few signs that you should seek an immediate medical help:
- changes to the shape and size of your breast (such as a lump)
- persistent or worsening pain
- pain that interferes with your quality of life
- suspected problems with your breast implants

If your breast pain is severe and or accompanied by one or more of the following symptoms you should also seek medical care:
- swelling, redness, or warmth
- changes to the nipple, nipple discharge
- thickening or dimpled skin
- fever or a rash

Is breast pain normal during peri menopause?

Yes - the vast majority of women will experience breast pain at some point during their reproductive or post-menopausal years.

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Sources used

Medical journals

Groen, J.-W., Grosfeld, S., Bramer, W. M., Ernst, M. F., & Mullender, M. M. (2017). Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments. European Journal of Obstetrics & Gynecology and Reproductive Biology, 219, 74–93.

İdiz C, Çakır C, Ulusoy Aİ, İdiz UO. The Role of Nutrition in Women with Benign Cyclic Mastalgia: A Case-Control Study. Eur J Breast Health. 2018 Jul 1;14(3):156-159. doi: 10.5152/ejbh.2018.3827. PMID: 30123881; PMCID: PMC6092156.

Ooi, S. L., Watts, S., McClean, R., & Pak, S. C. (2020). Vitex Agnus-Castus for the Treatment of Cyclic Mastalgia: A Systematic Review and Meta-Analysis. Journal of Women’s Health, 29(2), 262–278.

Saghafi, N., Rhkhshandeh, H., Pourmoghadam, N., Pourali, L., Ghazanfarpour, M., Behrooznia, A., & Vafisani, F. (2017). Effectiveness of Matricaria chamomilla (chamomile) extract on pain control of cyclic mastalgia: a double-blind randomised controlled trial. Journal of Obstetrics and Gynaecology, 38(1), 81–84.

Online sources

‍Harvard Health Publishing. (2020b, July 7). Breast pain: Not just a premenopausal complaint. Harvard Health

Breast pain - Diagnosis and treatment - Mayo Clinic. (2021, January 16). Mayo Clinic

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