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Breast Pain

(Mastalgia)

By Mary Ann Kosir, MD

Many women experience breast pain (mastalgia). Breast pain may occur in one or both breasts.

Causes

Likely causes depend on whether the pain is felt in a particular place or throughout the whole breast. If pain occurs in one area, it may be caused by

If pain affects the whole breast, it may be caused by

Breast pain is the first symptom in only a few women with breast cancer.

Changes in the levels of the female hormones estrogen and progesterone can cause breast pain. Levels of these hormones increase just before or during a menstrual period and during pregnancy. When these levels increase, they cause the milk glands and ducts of the breasts to enlarge and the breasts to retain fluid. The breasts then become swollen and sometimes painful. Such pain is usually felt throughout the breasts, making them tender to touch. Pain related to the menstrual period may come and go for months or years. Taking birth control pills (oral contraceptives) or hormone therapy after menopause can also cause hormone levels to increase and cause this kind of pain.

Evaluation

Warning signs

Certain symptoms and characteristics are cause for concern:

  • Severe pain, redness, and swelling

When to see a doctor

Women with warning signs may have a breast infection and should see a doctor within a day or two.

Breast pain that persists (for example, that lasts for more than 1 month) should be evaluated (see Overview of Breast Disorders : Evaluation).

What a doctor does

Doctors ask the woman to describe the pain. They also ask about other symptoms, disorders, and drugs (such as birth control pills) that may suggest a possible cause. They examine the breast and nearby tissues for abnormalities, such as changes in the skin, lumps, and tenderness.

A pregnancy test is done if the woman has symptoms that suggest pregnancy, such as a missed menstrual period and early-morning nausea. Other tests may be done based on the woman's other symptoms.

Treatment

Mild breast pain usually disappears eventually, even without treatment. Pain that occurs during menstrual periods can usually be relieved by taking acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID).

For breast pain related to pregnancy, wearing a firm, supportive bra, taking acetaminophen, or both, can help.

For severe pain during menstrual periods, danazol (a synthetic hormone related to testosterone ) or tamoxifen (a drug used to treat breast cancer) may be used. These drugs inhibit the activity of the female hormones estrogen and progesterone , which can make the breasts swell and be painful. If taken a long time, these drugs have side effects and are thus usually used for only a short time.

Stopping use of birth control pills or hormone therapy may help relieve symptoms.

Some evidence indicates that evening primrose oil, a nutritional supplement, may help relieve breast pain related to menstrual periods or pregnancy in some women.

If a specific disorder is identified as the cause, the disorder is treated. For example, if a cyst is the cause, draining the fluid from the cyst usually relieves the pain.

Key Points

  • The cause of breast pain depends on whether it occurs in one area (usually caused by cysts) or the whole breast (caused by hormonal changes, fibrocystic changes, or large breasts).

  • Pain is the first symptom in only a few women with breast cancer.

  • Breast pain that is severe or that lasts for more than 1 month should be evaluated.

  • Whether testing is needed depends on the woman's other symptoms.

  • Treatment depends on the cause, but drugs such as acetaminophen or NSAIDs, can sometimes help relieve the pain.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • CRINONE
  • DELATESTRYL
  • NOLVADEX
  • No US brand name
  • TYLENOL

* This is the Consumer Version. *