An Overview of Mastalgia

The Incidence and Management of Cyclic and Non-Cyclic Mastalgia

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women with mastalgia, the medical term for breast pain
Fibromyalgia Symptoms Can Include Breast Pain. http://fibromyalgianewstoday.com/

Mastalgia is a medical term used to describe breast pain. Breast pain can be cyclical, and related to the menstrual cycle, or non-cyclical. There's also breast pain that doesn't originate in the breast. Breast pain is very common (research shows that 70 percent of women see a doctor about it at some point in their lives), and is most often not associated with breast cancer. That said, it can interfere with a woman's quality of life, so an accurate diagnosis should be made. When diagnosed, a number of treatment options are available.

Symptoms

Depending on the cause, mastalgia can include breast tenderness, sharp burning pain, or tightness in your breast tissue. The pain may be constant or it may occur only occasionally. It can range from mild to severe.

Causes

Mastalgia can be broken down into three separate categories:

Cyclic Mastalgia

Cyclic mastalgia is breast pain that's related to the hormonal variations associated with the menstrual cycle, which affect how your breasts feel and change over the course of a month. Normal fibrocystic changes can cause breast pain, swelling, or thick areas. If hormones are causing these symptoms, they should decrease as you travel through your monthly cycle.

Cyclic mastalgia is often worst shortly before the cycle begins, decreasing on the day menses (a woman's period) starts, and then going away over the next few days. The pain is often described as a dull, heavy aching without localization, and occurring in both breasts and into the armpit areas. Since this type of pain is linked to menstruation, premenopausal women are most likely to experience it. In post-menopausal women, most breast pain is noncyclical mastalgia.

Fibrocystic breast changes, which can cause breast pain, swelling, or thick areas,  involve the lobes, ducts, and connective tissue.

Noncyclic Mastalgia

Noncyclic mastalgia is breast pain that doesn't vary with the menstrual cycle or with hormonal changes. Noncyclical breast pain is often related, instead, to internal anatomical changes, such as an injury, surgery, infections, or a breast fibroadenoma or breast cyst.

The pain may be described as sharp or burning and is often localized to one breast and one particular area of that breast (it's also known as "trigger zone" breast pain because you can point to where it hurts). It's most common in women between the ages of 30 and 50.

Large breasts (either from obesity or genetics) may also be a source of noncyclic mastalgia. They can be especially painful if a supportive bra is not worn. This is due to the stretching of Cooper's ligaments, which are bands of connective tissue that support and shape breast tissue.

Extramammary Mastalgia 

The term "extramammary" ("outside the breast") describes the pain that's felt in the breast but is referred (originates) from another location, such as the lungs, the heart, the chest wall, or the esophagus. For example, Tietze's disease, a syndrome of inflammation of the joints connecting the ribs may give rise to this type of pain. Any time a woman has unexplained pain in the region of her breasts, it's important to consider the possibility of heart disease. The symptoms of heart disease in women are different from those found in men and are often vague and atypical. Extramammary mastalgia may also be related to conditions in other structures of the chest (costochondritis) and upper abdomen, such as the lungs, esophagus (GERD), or gallbladder and stomach.

Diagnosis

The diagnosis of mastalgia is most often made based on symptoms and a physical breast exam, though imaging studies may be done to evaluate abnormalities noted during a physical exam. The chance of mastalgia being a symptom of breast cancer is quite low, but it's important to screen women who are at risk.

Breast cancer is often painless, but breast pain can be a symptom of the disease. Research has found that around one in five or one in six women experiences breast pain in the 90-day period leading up to their diagnosis. 

Treatment

Cyclic and noncyclic pain

Reassurance that she's normal and doesn't have breast cancer is often all a woman will need when it comes to treatment for this type of pain. In one study, once they were reassured about the possibility of cancer, most women with mastalgia felt they didn't need pain treatment.

For those who do, many home remedies have been tried to decrease cyclic and noncyclic pain, sometimes with good results. They include:

  • Wearing a well-fitting bra. This can help contain painful breasts and keeping them from bouncing.
  • Practicing stress relief. Increased stress can increase hormone levels and cause excess discomfort.
  • Exercising. Physical activity decreases estrogen but it's difficult to tell from studies if it really decreases mastalgia.
  • Taking vitamin E and vitamin B6. They've been tried with mixed results. The same is true of evening primrose oil, which has been studied in dosages of 3,000 milligrams a day.
  • Easing pain with nonsteroidal anti-inflammatory drugs (NSAIDs) like Tylenol (acetaminophen) or Advil (ibuprofen)
  • Reducing caffeine in the diet and eating a low-fat diet. Studies are mixed on how well this works, but it may help some women.
  • Keeping a journal can be helpful, especially if you're trying to see a pattern in your symptoms, which is the best way to determine the kind of breast pain you have.

If these first-line interventions don't help, your doctor may suggest prescription medications like Nolvadex (tamoxifen), Danocrine (danazol), and Parlodel (bromocriptine). All of these drugs have side effects of their own. Studies appeared to show the greatest benefit with tamoxifen, but Danocrine is the only medication approved by the Food and Drug Administration for mastalgia at this time.

Extramammary Mastalgia

When this pain happens, it can be very hard to pinpoint its location. Try taking an NSAID for the pain, and if it doesn't respond, call your doctor for a breast pain appointment. You may need antibiotics or further testing to diagnose and treat the cause of your pain.

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