Mastalgia (Breast Pain)

ByLydia Choi, MD, Karmanos Cancer Center
Reviewed/Revised Jan 2024
View Patient Education

Mastalgia (breast pain) is common and can be localized or diffuse and unilateral or bilateral.

Etiology of Mastalgia

Localized breast pain is usually caused by a focal disorder that causes a mass, such as a breast cyst, or an infection (eg, mastitis, abscess). Most breast cancers do not cause pain.

Diffuse bilateral pain may be caused by fibrocystic changes or, uncommonly, diffuse bilateral mastitis. However, diffuse bilateral pain is very common in women without breast abnormalities. The most common causes in these women are

  • Hormonal changes that cause breast tissue proliferation (eg, during the luteal phase or early pregnancy, in women taking estrogens or progestins)

  • Large, pendulous breasts that stretch Cooper ligaments

Some studies have found that a high-fat diet and caffeine intake are associated with mastalgia, but it is uncertain whether reducing these dietary factors decreases symptoms (1).

Etiology reference

  1. 1. Goyal A: Breast pain. BMJ Clin Evid 2011:0812, 2011. Published 2011 Jan 17.

Evaluation of Mastalgia

History

History of present illness should address the temporal pattern of pain and its nature (focal or diffuse, unilateral or bilateral). The relation between chronic or recurrent pain and menstrual cycle phase should be ascertained.

Review of systems should seek other symptoms suggesting pregnancy (eg, abdominal enlargement, amenorrhea, morning nausea) or fibrocystic changes (eg, presence of many masses).

Past medical history should cover disorders that could cause diffuse pain (eg, fibrocystic changes) and use of estrogens and progestins.

Physical examination

Examination focuses on the breast, looking for abnormalities such as mass, nipple inversion or discharge, skin changes including erythema, rash, eczematous appearance, edema, or dimpling (sometimes termed peau d’orange [orange peel]), and signs of infection, such as redness, warmth, and tenderness.

Red flags

The following is of particular concern:

  • Signs of infection

  • Mass, nipple inversion, or skin changes

Interpretation of findings

Absence of abnormal findings suggests that pain is due to hormonal changes or large, pendulous breasts.

Testing

Pregnancy testing should be done if pain is unexplained and has lasted less than several months, particularly if other symptoms or signs are consistent with pregnancy.

Other testing is indicated infrequently—only if breast examination detects abnormal findings.

Treatment of Mastalgia

estrogen and progesterone. If estrogen or a progestin is being taken, stopping may be necessary.

Evening primrose oil may reduce the severity of mastalgia.

Key Points

  • Diffuse, bilateral breast pain is usually caused by hormonal changes or large, pendulous breasts.

Drugs Mentioned In This Article
quizzes_lightbulb_red
Test your KnowledgeTake a Quiz!
Download the free Merck Manual App iOS ANDROID
Download the free Merck Manual App iOS ANDROID
Download the free Merck Manual App iOS ANDROID