Breast pain is divided into two basic groups. Cyclical breast pain comes and goes regularly related to the menstrual cycle (monthly period). Noncyclical breast pain is unrelated to the menstrual cycle and may occur in women (and men) who are not having menstrual periods.
This article will discuss cyclical and noncyclical breast pain, as well as other causes of pain in the breast area.
Premenopausal women may experience cyclical breast pain on a regular schedule. Most often, breast discomfort happens before the menstrual period. Breasts may feel:
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Most of the time, the pain is in both breasts (bilateral), but it may not be equal. The pain is often spread across the breast tissue, and may also include the armpit or upper arms.
Breast pain is often one of the components of premenstrual syndrome (PMS). Symptoms of PMS also include fatigue, irritability, and abnormal hormone levels.
The discomfort often begins a few days before your period starts and may continue until your period has stopped, though it often decreases in severity as time goes on.
Associated Conditions
Cyclical breast pain may also be due to benign (non-harmful) breast conditions. There are three such conditions commonly seen by healthcare providers:
Fibrocystic breast changes can make breasts feel lumpy. These harmless breast changes include fluid-filled sacs (cysts) and scar (fibrotic) tissue. Breasts can also feel tender or thick because of the changes. An ultrasound machine can be used to look at the breast tissue. Your doctor may use a fine needle biopsy to remove a small sample and to diagnose the condition. Mammary duct ectasia is another benign breast condition. The milk ducts inside the breast become clogged and then widen and thicken. This happens more often in people approaching menopause. It often causes tenderness in the nipple and areola. Oral contraceptive breast pain is a common and mild side effect of hormonal birth control (birth control pills). People taking combination pills are more likely to experience breast pain than those who take the mini-pill.
There are many causes of breast pain, including injury, weight gain, prior breast surgery, or breastfeeding. Wearing an ill-fitting bra can lead to increasing levels of breast pain. Pain that is from bras that are not supportive enough often gets worse over time.
Several drugs are also known to cause breast pain in some women, including:
Aldactone (spironolactone) Aldomet (methyldopa) Antipsychotics Digoxin Diuretics Selective serotonin reuptake inhibitors (SSRIs)
Noncyclical breast pain may occur in both breasts or only one breast. You may have pain in one specific area, or it may be generalized. The pain can vary in intensity or be constant.
Your healthcare provider may recommend certain treatments to help alleviate breast pain:
Medications: Cyclical and noncyclical breast pain may benefit from over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen). Sometimes, prescription NSAIDs like Topricin (diclofenac) can be helpful. Some doctors prescribe hormonal treatments such as Parlodel (bromocriptine) or Danocrine (danazol). Support bras: A bra fitting may go a long way toward reducing breast pain, and a supportive bra may be beneficial in people with larger breasts. A sports bra during exercise is essential. Caffeine avoidance: Some studies suggest that drinking more than two cups of coffee per day increases the risk of mastalgia. Smoking cessation: Similarly, smoking more than five cigarettes a day increases the risk of mastalgia by more than tenfold compared to non-smokers.
Sometimes, you will feel pain in the breast area that is caused by referred pain from another structure or is caused by a health condition. Nearby body parts and some medical issues can cause pain which can easily be mistaken as breast pain.
Some causes of pain in or around the chest that are not caused by breast tissue (sometimes called extramammary, or outside of the breast) are:
Costochondritis: Inflammation of the cartilage of the rib cage Fibromyalgia: An idiopathic pain disorder Gastroesophageal reflux disease (GERD): Acid reflux Muscle strain: Particularly of the pectoralis muscles of the chest Myocardial infarction: Heart attack Pericarditis: Inflammation of the lining of the heart Pleurisy: Inflammation of the lining of the chest wall Pneumonia: Lung infection Pulmonary embolism: Blockage of an artery in the lungs Rib fracture: Broken rib Shingles: When it affects a nerve string along the chest Thoracic radiculopathy: A pinched nerve in the spine that can refer pain to the chest
Reach out to your healthcare provider if you have pain in your breasts. They will be able to provide a breast exam to figure out the cause of your pain and recommend the appropriate treatment.
If your breast pain is persistent or worsening, you should see your healthcare provider about having a clinical breast exam. Certainly, if you notice a lump, changes in your skin such as redness, thickening, or an orange peel appearance, you should see your healthcare provider right away.
There are multiple ways to prevent, relieve, and treat breast pain. See your healthcare provider for any new or worsening pain symptoms.
One way to reduce those fears is to adhere to breast cancer screening guidelines issued by the Centers for Disease Control and Prevention. Screening can start as early as age 40, with recommendations varying based on your age and risk factors. Speak with your healthcare provider to discuss your screening options.
