An Overview of Mastalgia

Understanding Breast Pain in Women

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Mastalgia is the 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 at all. Breast pain is very common (research shows that 70% of women see a doctor about it at some point in their lives), and it is not usually associated with breast cancer.

That said, breast pain can interfere with a woman's quality of life, and a number of treatment options are available—so an accurate diagnosis is important.

mastalgie
Verywell / Emily Roberts

Symptoms

Depending on the cause, mastalgia can include:

  • Breast tenderness
  • Sharp, burning pain
  • Tightness in the 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, noncyclic, and extramammary.

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 over the course of a month.

The pain is often described as a dull, heavy aching without localization, affecting both breasts and the armpit areas. Normal fibrocystic changes can cause breast pain, swelling, or thick areas.

  • Cyclic mastalgia is typically at its worst shortly before the cycle begins, decreasing on the first day of your period, and then going away over the next few days.
  • If hormones are causing these symptoms, they should decrease at certain times during your monthly cycle.

Since this type of pain is linked to menstruation, premenopausal females are most likely to experience it. Cyclical breast pain can also be associated with oral contraceptive pills and HRT.

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. In postmenopausal females, most breast pain is noncyclical mastalgia, but you can have it before menopause as well.

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 between the ages of 30 and 50.

Noncyclical breast pain is often related to:

  • An injury
  • Surgery
  • Infections
  • Breast fibroadenoma, or a breast cyst
  • Inflammatory breast cancer, associated with overlying skin changes is a rare cause

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 (meaning outside the breast) describes pain that's felt in the breast but 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 referred pain.

If you have unexplained pain in the region of her breasts, it's important to consider the possibility of heart disease. The symptoms of heart disease in females are different from those found in males and are often vague and atypical.

Extramammary mastalgia may also be related to conditions in other structures of the chest, such as costochondritis, gallbladder disease, or gastroesophageal reflux disease GERD.

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

The best treatment for your breast pain depends on what is causing it.

For cyclic and noncyclic pain, reassurance and ruling out breast cancer is often a relief. In one study, once they were reassured about the possibility of cancer, most women with mastalgia didn't want pain treatment. For those who do, there are effective treatment options.

When extramammary mastalgia occurs, it can be very hard to pinpoint its location (and, therefore, the best way to address the pain). You may need an antibiotic prescription or further testing.

Home Remedies

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 keep them from being pulled uncomfortably.
  • Practicing stress-relief: Increased stress can affect hormone levels and cause excess discomfort.
  • Exercising: Physical activity decreases estrogen, but it's difficult to tell from studies if it really decreases mastalgia.
  • Reducing caffeine and eating a low-fat diet: Studies are mixed on how well this works, but it may help some women.

Keeping a journal can also 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.

Medications

Easing pain with Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) is another option.

If these first-line interventions don't help, your doctor may suggest prescription medications like Nolvadex (tamoxifen) and Danocrine (danazol). 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 U.S. Food and Drug Administration (FDA) for treating mastalgia at this time.

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Article Sources
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