Breast pain

Other names| Mastodynia, mastalgia, breast tenderness
File:Breast pain hariadhi.svg
Specialty| Gynecology, General surgery
Types| Cyclic, non-cyclic[1]
Causes| Menstrual cycle related, birth control pills, hormone therapy, psychiatric medication, breast cancer[1]
Diagnostic method| Examination, medical imaging[1]
Differential diagnosis| Gallstones, thoracic outlet syndrome, costochondritis[2]
Treatment| Reassurance after ruling out cancer, medications[2][1]
Medication| Paracetamol, NSAIDs[1]
Prognosis| >75% resolve without treatment[1]
Frequency| 70% of women[2]

Breast pain is the symptom of discomfort in either one or both breasts.[2] Pain in both breasts is often described as breast tenderness, is usually associated with the menstrual period and is not serious.[1][3] Pain that involves only one part of a breast is more concerning,[1] particularly if a hard mass or nipple discharge is also present.[3]

Causes may be related to the menstrual cycle, birth control pills, hormone therapy, or psychiatric medication.[1] Pain may also occur in those with large breasts, during menopause, and in early pregnancy.[1][3] In about 2% of cases, breast pain is related to breast cancer.[4] Diagnosis involves examination, with medical imaging if only a specific part of the breast hurts.[1]

In more than 75% of people, the pain resolves without any specific treatment.[1] Otherwise treatments may include paracetamol or NSAIDs.[1] A well fitting bra may also help.[3] In those with severe pain tamoxifen or danazol may be used.[1] About 70% of women have breast pain at some point in time.[2] Breast pain is one of the most common breast symptoms, along with breast masses and nipple discharge.[1]

## Contents

* 1 Causes
* 1.1 Breast cancer
* 2 Diagnosis
* 3 Treatment
* 4 See also
* 5 References
* 6 Further reading
* 7 External links

## Causes

Breast pain linked to the menstrual cycle is called cyclic breast pain or cyclic mastalgia. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS).[5] Cyclic breast pain is often associated with fibrocystic breast changes or duct ectasia and thought to be caused by changes of prolactin response to thyrotropin.[6][7]

Breast pain that is not linked to a menstrual cycle is called noncyclic breast pain. Noncyclical breast pain has various causes and is harder to diagnose, and frequently the root cause is outside the breast. Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause, and during pregnancy.[5] After pregnancy, breast pain can be caused by breastfeeding.[5] Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis and medications such as digitalis, methyldopa (an antihypertensive), spironolactone, certain diuretics, oxymetholone (an anabolic steroid), and chlorpromazine (a typical antipsychotic).[5] Also, shingles can cause a painful blistering rash on the skin of the breasts.[5]

### Breast cancer

Some women who have pain in one or both breasts may fear breast cancer. However, breast pain is not a common symptom of cancer. The great majority of breast cancer cases do not present with symptoms of pain, though breast pain in older women is more likely to be associated with cancer.[2][8][5]

## Diagnosis

Diagnosis involves breast examination, with medical imaging if only a specific part of the breast hurts.[1] Medical imaging by ultrasound is recommended for all ages, as well in those over 35, it is recommended together with mammography.[1]

Ruling out the other possible causes of the pain is one way to differentiate the source of the pain. Breast pain can be due to:

* angina pectoris
* bra[9][5]
* blocked milk duct
* breastfeeding[9]
* chest wall muscle pain
* costochondritis (sore ribs)
* cutaneous Candidiasis infection[10]
* duct ectasia (often with nipple discharge)
* engorgement
* fibroadenoma
* fibrocystic breast changes[9]
* fibromyalgia
* gastroesophageal reflux disease[8]
* herpes infection[11]
* hormone replacement therapy[9]
* mastitis or breast infection[8][5]
* menopause[5]
* menstruation and Premenstrual syndrome[9][5]
* perimenopause[9]
* neuralgia
* pregnancy[9][5]
* physical abuse
* pituitary tumor (often with nipple discharge)
* puberty in both girls and boys[5]
* sexual abuse
* shingles
* sore nipples and cracked nipples[12][13]
* surgery or biopsy
* trauma (including falls)

Medications can be associated with breast pain and include:

* Oxymetholone
* Chlorpromazine
* Water pills (diuretics)
* Digitalis preparations
* Methyldopa
* Spironolactone[5]

Diagnostic testing can be useful. Typical tests used are mammogram, excisional biopsy for solid lumps, fine-needle aspiration and biopsy, pregnancy test, ultrasonography, and magnetic resonance imaging (MRI).[8]

## Treatment

In more than 75% of people, the pain resolves without any specific treatment.[1] Otherwise treatments may include paracetamol or NSAIDs.[1] A well fitting bra may also help.[3] In those with severe pain tamoxifen or danazol may be used.[1]

Bromocriptine may be used as well.[14]

Spironolactone, low-dose oral contraceptives, and low-dose estrogen have helped to relieve pain. Topical anti-inflammatory medications can be used for localized pain. Vitamin E is not effective in relieving pain nor is evening primrose oil. Vitamin B6 and vitamin A have not been consistently found to be beneficial. Flaxseed has shown some activity in the treatment of cyclic mastalgia.[8]

Pain may be relieved by the use of nonsteroidal anti-inflammatory drugs or, for more severe localized pain, by local anaesthetic.[2][5] Pain may be relieved by reassurance that it does not signal a serious underlying problem, and an active lifestyle can also improve the pain.[2]

Information regarding how the pain is real but not necessarily caused by disease can help to understand the problem. Counseling can also be used to describe changes that vary during the monthly cycle. Women on hormone replacement therapy may benefit from a dose adjustment. Another non-pharmacological measure to help relieve symptoms of pain may be to use a good bra support. Breasts change during adolescence and menopause, and refitting may be beneficial. Applying heat and/or ice can bring relief. Dietary changes may also help with the pain. Methylxanthines can be eliminated from the diet to see if a sensitivity is present. Some clinicians recommend a reduction in salt, though no evidence supports this practice.[8]

## See also

* Galactagogue
* Mammoplasia
* Pain management

## References

1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 Salzman, B; Fleegle, S; Tully, AS (15 August 2012). "Common breast problems.". American Family Physician 86 (4): 343–9. PMID 22963023.
2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Iddon, J; Dixon, JM (13 December 2013). "Mastalgia.". BMJ (Clinical Research Ed.) 347. doi:10.1136/bmj.f3288. PMID 24336097.
3. ↑ 3.0 3.1 3.2 3.3 3.4 "Breast pain" (in en). 17 October 2017. https://www.nhs.uk/conditions/breast-pain/.
4. ↑ Mazza, Danielle (2011) (in en). Women's Health in General Practice. Elsevier Health Sciences. p. 189. ISBN 978-0-7295-7871-4. https://books.google.com/books?id=_Q7IO4ACO1cC&pg=PA189.
5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 One or more of the preceding sentences incorporates text from a work now in the public domain: "Breast pain: MedlinePlus Medical Encyclopedia". https://medlineplus.gov/ency/article/003152.htm.
6. ↑ Dogliotti, L; Faggiuolo, R; Ferusso, A; Orlandi, F; Sandrucci, S; Tibo, A; Angeli, A (1985). "Prolactin and thyrotropin response to thyrotropin-releasing hormone in premenopausal women with fibrocystic disease of the breast". Hormone Research 21 (3): 137–44. doi:10.1159/000180038. PMID 3922866.
7. ↑ Dogliotti, L; Orlandi, F; Angeli, A (1989). "The endocrine basis of benign breast disorders". World Journal of Surgery 13 (6): 674–9. doi:10.1007/BF01658413. PMID 2696218.
8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Cash, Jill (2014). Family practice guidelines. New York: Springer Publishing. ISBN 978-0-8261-9782-5. , [Electronic book] Section I Guidelines, Chapter Thirteen: Gynecologic Guidelines-Breast Pain
9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Brown, Ken. "Breast Pain Causes and Diagnosis: Johns Hopkins Breast Center". http://www.hopkinsmedicine.org/breast_center/breast_cancers_other_conditions/breast_pain.html.
10. ↑ One or more of the preceding sentences incorporates text from a work now in the public domain: "Thrush in newborns: MedlinePlus Medical Encyclopedia". https://medlineplus.gov/ency/article/007615.htm.
11. ↑ Walker, Marsha (2011). Breastfeeding management for the clinician: using the evidence. Sudbury, Mass: Jones and Bartlett Publishers. p. 533. ISBN 978-0-7637-6651-1.
12. ↑ Santos, Kamila Juliana da Silva; Santana, Géssica Silva; Vieira, Tatiana de Oliveira; Santos, Carlos Antônio de Souza Teles; Giugliani, Elsa Regina Justo; Vieira, Graciete Oliveira (2016). "Prevalence and factors associated with cracked nipples in the first month postpartum". BMC Pregnancy and Childbirth 16 (1): 209. doi:10.1186/s12884-016-0999-4. ISSN 1471-2393. PMID 27496088.
13. ↑ "Sore or cracked nipples when breastfeeding, Pregnancy and baby guide". National Health Services (UK). http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/sore-cracked-nipples-breastfeeding.aspx.
14. ↑ Kerri Durnell Schuiling; Frances E. Likis (2011). Women's Gynecologic Health. Jones & Bartlett Publishers. pp. 381–. ISBN 978-0-7637-5637-6. https://books.google.com/books?id=pj_ourS3PBMC&pg=PA381.

## Further reading

* Cornell, Lauren F.; Sandhu, Nicole P.; Pruthi, Sandhya; Mussallem, Dawn M. (2020). "Current Management and Treatment Options for Breast Pain". Mayo Clinic Proceedings 95 (3): 574–580. doi:10.1016/j.mayocp.2019.12.014. PMID 32138883.

## External links

Classification|

* ICD-11: GB23.5
* ICD-10: N64.4, F45.4
* ICD-9-CM: 611.71
* ICD-O: N64.4
* DiseasesDB: 22464

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External resources|

* MedlinePlus: 003152

* v
* t
* e

Breast disease (N60–N64, 610–611)

Inflammation|

* Mastitis
* Nonpuerperal mastitis
* Subareolar abscess
* Granulomatous mastitis

Physiological changes
and conditions|

* Benign mammary dysplasia
* Duct ectasia of breast
* Chronic cystic mastitis
* Mammoplasia
* Gynecomastia
* Adipomastia (lipomastia, pseudogynecomastia)
* Breast hypertrophy
* Breast atrophy
* Micromastia
* Amastia
* Anisomastia
* Breast engorgement

Nipple|

* Nipple discharge
* Galactorrhea
* Inverted nipple
* Cracked nipples
* Nipple pigmentation

Masses|

* Galactocele
* Breast cyst
* Breast hematoma
* Breast lump
* Pseudoangiomatous stromal hyperplasia

Other|

* Pain
* Tension
* Ptosis
* Fat necrosis
* Amazia

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