Breast pain: Not just a premenopausal complaint
In most cases, breast pain goes along with reproductive life, and
many women expect breast pain to go away after menopause. When it doesn’t,
they may fear they have breast cancer. Fortunately, breast pain is
rarely a symptom of cancer, regardless of age. Still, that possibility
should be considered, along with a number of noncancerous conditions
that affect the breasts.
Breast pain, sometimes referred to as mastalgia, is either cyclical
(the most common type) or noncyclical. Fibrocystic changes in breast
tissue may cause cyclical or noncyclical pain in one or both breasts.
Women with this very common condition have thickened tissue or an increased
number of cysts in otherwise normal breasts.
Cyclical breast pain is linked to menstruation and apparently results
from monthly fluctuations of the hormones estrogen and progesterone.
A few days before menstruation, both breasts may swell and become tender,
painful, or lumpy. The symptoms subside when menstruation ends.
Noncyclical breast pain may be constant or intermittent, may affect
one breast or both, and may involve the whole breast or just a small
part. Noncyclical pain is usually a symptom of a specific problem, such
as a cyst, trauma, or a benign tumor.
Anatomy of the breast area
Breast pain unrelated to menstrual cycles may be caused by conditions
that affect the pectoralis major muscle, structures within the
breast, and the ribs or sternum.
Several conditions can cause breast pain that’s not related to
the menstrual cycle. Infection of the breast (mastitis), most common
in lactating women, or an abscess can cause severe pain. Some prescription
medications can also cause breast pain. Apart from hormone drugs, the
most common culprits are certain cardiovascular and psychiatric medications.
Heavy, pendulous breasts may stretch tissues in the breast, causing
pain in the shoulders, back, neck, and breasts. Strain in the pectoralis
major muscle can cause pain that feels as if it’s coming from inside
the breast. Activities that strain the pectoralis muscle include raking,
shoveling, and lifting.
Costochondritis — an inflammation of the costal cartilages which
join the ribs to the breastbone — can cause a burning sensation
in the breast. Breast pain may also be a symptom of connective tissue
disease, such as Ehlers-Danlos syndrome, an inherited disorder. Arthritis
in the neck or upper back may affect sensory nerves exiting the upper
spinal cord and cause numbness or pain in the breast.
It’s important to discuss any breast pain with your clinician.
She or he will take a careful history to try to rule out any conditions
outside the breast. Your risk for breast cancer will also be assessed,
including a breast examination and a check of your chest wall and underarms.
For breast pain arising from pectoralis muscle strain, costochondritis,
or arthritis in the spine, a short course of nonsteroidal anti-inflammatory
drugs (NSAIDs) may help, along with stretching, yoga, or neck rotation
exercises. Mastitis requires antibiotics, as does an abscess, which will
also need to be drained.
It usually helps to wear a well-fitting, supportive bra and a sports
bra for exercise (and, when the pain is particularly severe, for sleep).
Some research has shown that a very-low-fat diet (15%–20% of daily
calories from fat) can reduce breast tenderness and swelling. Although
the data are inconsistent, there’s some evidence that both cyclic
and noncyclic mastalgia are modestly improved by evening primrose oil,
which contains gamma-linolenic acid (an essential fatty acid). Some women
find that minimizing or eliminating caffeine intake can reduce breast
pain, but there is no solid scientific evidence to support this claim.
Three medications — danazol, tamoxifen, and bromocriptine — have
been shown to relieve breast pain, but these drugs can cause serious side
effects and are typically reserved for breast pain that is severe.
October 2005 Update
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