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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

  • Cysts

  • Uncommonly, infections, such as an abscess or mastitis

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

  • Hormonal changes

  • Fibrocystic changes

  • Large breasts that stretch supporting tissues

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 through 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

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

Drugs Mentioned In This Article

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