Mastalgia (Breast Pain)

Mastalgia, more commonly known as breast pain, affects many women at some point in their lives. Many women fear that pain and tenderness are early signs of breast cancer, but usually that’s not the case. You and your doctor can work together to rule out breast cancer as a possible cause — especially if you have other symptoms such as a mass, growth, or area of thickened tissue in the breast, nipple discharge, and/or inflammation.

If your pain feels focused in one area of the breast, it can be worth checking that with ultrasound. But pain is more likely the result of an underlying benign condition such as fibrocystic breast changes or a single cyst or fibroadenoma. Often a definite underlying cause can’t be found.

Generally, mastalgia can be classified as either:

• Cyclic breast pain: Cyclic mastalgia affects women in their 20s, 30s, or 40s, while they are still menstruating. This pain occurs toward the end of the menstrual cycle in the week or so before you get your period. The breasts are often painful, tender, and swollen at this time, but symptoms improve at other points in the cycle. The pain usually affects the outer and upper parts of both breasts, and it might involve your underarm area as well. Most cases of mastalgia are cyclic.
• Noncyclic breast pain: This type of pain doesn’t bear any relation to the patterns of your menstrual cycle. It often feels like a sharpness, burning, or soreness in one area (or areas) of the breast instead of a generalized feeling of pain and tenderness. This type of mastalgia is more common after menopause. The pain may be constant or it can come and go. A common cause is costochondritis, or inflammation of the junction of the bone and the cartilage portion of the rib cage, which can be treated with anti-inflammatory medication like ibuprofen (brand names: Advil, Motrin).

Tell your doctor about your symptoms, whether they worsen or improve at different times of the month, and how they affect your quality of life. You can keep a daily pain journal to record when you’re having pain and how severe it is. Tell your doctor about any medications that you use. Birth control pills, infertility medications, and hormone replacement therapies can cause breast pain, as can certain antidepressants.

Some strategies your doctor might recommend include:

• Reduce consumption of caffeine.
• Reduce fat in the diet to less than 15 percent of total calories (this may require the help of a nutritionist).
• Wear a comfortable, supportive sports bra.
• Use a topical pain-relieving gel (nonsteroidal analgesic) such as diclofenac (brand name: Voltaren).
• Take oral pain medicines such as acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin).
• Apply warm or cool compresses when the breasts are painful.
• Take a multivitamin with vitamin E.
• Try evening primrose oil.

Medications to treat the condition are under investigation. For most women, mastalgia is mild-to-moderate rather than severe and often gets better on its own without treatment.