The breasts develop due to an increase in estrogen during puberty. During the menstrual cycle, various hormones cause changes in breast tissue that can lead to pain or discomfort in some women. While breasts do not typically hurt, occasional breast pain is common.
Breast pain, also called mastalgia, is a common condition among women. The pain is usually categorized as either cyclical or noncyclical.
Cyclical pain means the pain is associated with your menstrual cycle. Pain linked with the menstrual cycle tends to subside during or after your period.
Noncyclical pain can have many causes, including injury to the breast. Sometimes noncyclical pain can come from surrounding muscles or tissues rather than the breast itself. Noncyclical pain is much less common than cyclical pain, and its causes can be harder to identify.
Mastalgia can vary in intensity from a sharp pain to a mild tingling. Some women may experience breast tenderness, or their breasts may feel fuller than usual.
Causes of breast pain
Breast pain can be caused by a variety of factors. Two of the most common causes are hormone fluctuations and fibrocystic (lumpy) breasts.
Hormone fluctuations
A woman’s menstrual cycle causes hormone fluctuations in estrogen and progesterone. These two hormones can cause a woman’s breasts to feel swollen, lumpy, and sometimes painful.
Women sometimes report that this pain gets worse as they get older due to increased sensitivity to hormones as a woman ages. Sometimes, women who experience menstrual-related pain won’t have the pain after menopause.
If breast pain is due to hormone fluctuations, you will usually notice the pain getting worse two to three days before your period. Sometimes the pain will continue throughout your menstrual cycle.
To determine whether your breast pain is linked to your menstrual cycle, keep a log of your periods and note when you experience pain throughout the month. After a cycle or two, a pattern may become clear.
Developmental periods that affect a woman’s menstrual cycle and potentially cause breast pain include:
Puberty
Pregnancy
Menopause
Breast cysts
As a woman ages, her breasts experience changes known as involution. This is when breast tissue is replaced by fat. A side effect of this is the development of cysts and more fibrous tissue. These are known as fibrocystic changes or fibrocystic breast tissue.
While fibrocystic breasts don’t always cause pain, they can. These changes don’t usually cause for concern.
Fibrocystic breasts can feel lumpy and can increase tenderness. This most usually occurs in the upper and outer portions of the breasts. The lumps can also enlarge in size around the time of your menstrual cycle.
Breastfeeding is a natural and nutritious way to feed your infant, but it isn’t without its pitfalls and difficulties. You can experience breast pain while breastfeeding for several reasons. These include:
Mastitis
Mastitis is an infection of your milk ducts. This can cause severe and strong pain as well as cracked, itching, burning, or blistering on the nipples. Other symptoms include red streaks on the breasts, fever, and chills. Your doctor will treat these with antibiotics.
Engorgement
Engorgement occurs when your breasts become overfull. Your breasts will appear enlarged and your skin will feel tight and painful. If you cannot feed your baby soon, you can try pumping or manually expressing your milk.
You can do this by placing your thumb on top of your breast and your fingers underneath your breast. Slowly roll your fingers back against your chest wall and forward toward your nipples to empty your breast.
Improper latch
If your baby isn’t latching on appropriately to your nipple, you will likely experience breast pain. Signs your baby may not be latching properly include cracking nipples and nipple soreness.
A lactation consultant at the hospital where you gave birth can typically help you establish a healthier latch.
Remember: Breastfeeding doesn’t have to hurt. See your doctor or call a lactation specialist if you are having difficulty breastfeeding. You can also visit La Leche League International to find a certified lactation consultant in your area.
Breast pain can have other causes, including:
Diet
The foods a woman eats may contribute to breast pain. Women who eat unhealthy diets, such as those high in fat and refined carbs, may also, be at greater risk for breast pain.
Extramammary concerns
Sometimes breast pain isn’t because of your breasts, but because of irritation of the chest, arms, or back muscles. This is common if you’ve engaged in activities such as raking, mowing, shovelling, and waterskiing.
Breast size
Women with larger breasts or breasts that aren’t in proportion to their frames can experience discomfort in their necks and shoulders.
Breast surgery
If you’ve had surgery on your breasts, pain from scar tissue formation can linger after the incisions have healed.
Medications
Antidepressants, hormone therapy, antibiotics, and medications for heart disease can all contribute to breast pain. While you shouldn’t stop taking these medications if you have breast pain, talk to your doctor if alternative options are available.
Smoking
Smoking is known to increase epinephrine levels in the breast tissue. This can make a woman’s breasts hurt.
Is breast pain linked to breast cancer?
Breast pain is not usually linked to breast cancer. Having breast pain or fibrocystic breasts does not mean you are at higher risk of developing cancer. However, lumpy tissue may make it harder to see tumours on a mammogram.
If you have breast pain that is localized in only one area and that is consistent through the month with no fluctuations in pain level, call your doctor. Examples of diagnostic tests can include:
Mammogram. Doctors use this imaging test to identify abnormalities in your breast tissue.
Ultrasound. An ultrasound is a scan that penetrates the breast tissue. Doctors can use it to identify lumps in breast tissue without exposing a woman to radiation.
Magnetic resonance imaging (MRI). An MRI is used to create detailed images of breast tissue to identify potentially cancerous lesions.
Biopsy. A biopsy is the removal of breast tissue so a doctor can examine the tissue under a microscope for the presence of cancerous cells.
A doctor can use these tests to determine if your breast pain may be related to cancer.
What can help reduce breast pain?
Treatment will vary depending on whether your breast pain is cyclical or noncyclical. Before treating you, your doctor will consider your age, medical history, and the severity of your pain.
Treatment for cyclical pain may include:
Wearing a supportive bra 24 hours a day when pain is at its worst
Reducing your sodium intake
Taking calcium supplements
Taking oral contraceptives, which may help to make your hormone levels more even
Taking estrogen blockers, such as tamoxifen
Taking medications to relieve pain, including nonsteroidal anti-inflammatory (NSAID) medications, such as ibuprofen or acetaminophen
Treatment for noncyclical pain will depend on the cause of breast pain. Once the cause is identified, your doctor will prescribe specific related treatments.
Always talk to your doctor before starting to take any supplements to ensure they won’t interfere with the medicines you’re taking or any conditions you may have.
When to see your doctor
If your breast pain is sudden and accompanied by chest pain, tingling, and numbness in your extremities, seek immediate medical attention. These symptoms can indicate a heart attack.
Make an appointment to see your doctor if your pain:
Keeps you from daily activities
Lasts longer than two weeks
Accompanies a new lump that appears to be getting thicker
Seems to be concentrated in one specific area of your breast
Seems to get worse with time
At your appointment, you can expect your doctor to ask you about your symptoms. Questions could include:
When did your breast pain begin?
What makes your breast pain worse? Does anything seem to make it better?
Do you notice the pain getting worse around the time of your menstrual cycle?
How would you rate the pain? What does the pain feel like?
Your doctor will likely perform a physical exam. They may also recommend imaging tests, like a mammogram, to visualize your breast tissue. This could allow them to identify cysts in your breast tissue.
If you have cystic breasts, your doctor might do a needle biopsy. This is a procedure where a thin needle is inserted into the cyst to remove a small sample of tissue for testing.
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