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The most common breast problem that women experience is breast pain, also known as Mastalgia. 70% women will experience it at some time in their life. Pain in your breast may happen because of menstrual cycles, infections, inflammation (swelling), breastfeeding etc. You may feel the pain in one or both the breasts.

Usually, breast pain is not a serious condition. Often women worry that this may be a symptom of breast cancer, but this is rarely so.

However, immediate diagnosis and treatment is advisable. Doctors will ask you to get tests done as necessary. Treatment depends on the underlying cause and may include counselling in cases of mild pain, and medication or steroid injections if the pain is more severe. Surgery is rarely ever needed. 

Read on to learn in detail about the symptoms, causes and treatment of breast pain.

  1. Breast pain types
  2. Breast pain symptoms
  3. Causes of breast pain
  4. Breast pain prevention
  5. Breast pain diagnosis
  6. Breast pain treatment

There are two types of breast pain - cyclic and non-cyclic. The former is associated with your menstrual cycle, while the other refers to breast pain due to any other cause.

  • Cyclic breast pain
    Cyclic breast pain is the most common type of breast pain experienced by women. It happens because of the hormonal changes during menstrual cycles. You may experience this pain a few days before your period starts.
     
  • Non-cyclic breast pain
    Non-cyclic pain is not related to your periods. This kind of pain may be felt anytime irrespective of the period date. It is most commonly associated with elderly women who have attained menopause.

The symptoms of breast pain depend on the type of your breast pain. Cyclic and non-cyclic breast pains present with different signs and symptoms.

Cyclic breast pain

The following symptoms are usually associated with cyclic breast pain:

  • The pain is felt in both the breasts.
  • It is usually dull and aching.
  • Lumpiness in the breasts may also be felt sometimes.
  • It starts a few days before your periods and lasts for at least a week.
  • It does not continue once your period is over.
  • The pain is usually felt in the upper outer side of the breasts but may also spread to other areas when it intensifies.
  • Cyclic pain most commonly occurs in younger women.

Non-cyclic breast pain

Non-cyclic breast pain may be suspected on the basis of the following symptoms:

  • It is usually seen in elderly women, especially after menopause.
  • This type of breast pain is not associated with menstrual cycles and you may experience it irrespective of your period dates.
  • Usually, it is felt in one of the breasts and has specific areas where the pain is felt.
  • The pain may increase after exercising or by applying pressure on the affected area.
  • It is continuous and troublesome.
  • You may also experience lumps or nodes in your armpits, pain in your shoulder, arm, back, etc.

A variety of factors may lead to breast pain. Most commonly it happens a few days before the start of the menstrual cycle or due to hormonal imbalance. However, there could be other reasons as well, as explained below.

Hormone imbalance

  • The three major phases when hormonal fluctuation occurs is menarche (the when a girl gets her period for the first time), pregnancy, and menopause (cessation of menstrual cycles). During these phases, you may experience changes in your breasts which may cause pain, heaviness, and lumpiness in your breasts. 
     
  • The main cause of cyclic breast pain is your menstrual cycle. However, many studies have conflicting results, women with cyclic breast pain were found to have changes in the levels of estrogen, progesterone, and prolactin hormone in their body. The pain occurs during the luteal phase of the cycle which starts after ovulation (release of an egg from the ovaries).
     
  • A systematic review of medical literature on causes of breast pain suggested that women who undergo hormone replacement therapy after menopause are at a higher risk of developing breast cancer. Hence, they can also experience a significant increase in breast pain.

Breast cysts

Presence of abnormal fluid-filled sacs in the breasts may also cause pain, discomfort, and heaviness in your breast. You should consult your doctor if you suspect cysts in your breasts and get yourself treated.

Breastfeeding

A study conducted on breastfeeding women with chest pain suggested that the most common cause of breast pain in them was blockage of milk ducts. Researchers found that this blockage had resulted in breast pain.

Hence, if left untreated, it may cause swelling and infection in the affected breast.

Pain in chest muscle

Sometimes, breast pain may also be felt when there is an injury, inflammation or infection of the underlying chest wall muscle. The pain can radiate from the chest muscle to your breast. Visit your doctor to get complete treatment.

Trauma

Any sudden blow or injury to your breast may cause constant breast pain. The affected area acts as a trigger point which causes pain on touching or applying pressure.

Fibrocystic disease

A lot of women have Fibrocystic disease, in which breast tissues develop small fluid-filled cysts that cause lumpiness and pain in the breasts. This condition is non-cancerous and is very common. In fact, many doctors have stopped using the term "fibrocystic disease", and prefer calling it "fibrocystic breasts" instead.

Other causes of breast pain

  • Lateral chest wall pain
    Breast pain may also be experienced when there is a swelling, injury or infection of the muscles on the sides of your chest just below the armpits. This pain may radiate to the breasts also.
     
  • Costochondritis
    The inflammation of the cartilage of the ribs due to increased pressure is known as costochondritis. It is related to Tietze’s syndrome. This pain originates in the chest but it may also be felt in the breasts.
     
  • Lifestyle factors
    A study was conducted in 2016 to investigate the factors affecting breast pain. It was found that stressful lifestyle, anxiety, coffee consumption, etc are related to breast pain.
      
  • Ill-fitting bra
    A large number of women wear an ill-fitting bra which may also be associated with pain in the breasts. Hence you should wear a comfortable bra with the right measurements. To get the right measurement, use a measuring tape: You can also take help from a friend or a professional to do the measurement.
     
    • Band size: measure the underbust by placing the measuring under your bust. 
    • Bust / Cup size (A, B, C or D): measure the bust at its fullest part, which is usually at the nipple level.
       
  • Smoking and alcohol consumption
    Substance abuse such as tobacco, alcohol, drugs, etc may also cause breast pain. They cause imbalances in the sex hormone levels in your body and pose you to a higher risk of developing breast problems including breast cancer. 
     
  • Cancer
    Rarely, breast pain may be associated with breast cancer. According to the UK's NHS, breast pain usually isn't a symptom of breast cancer. Also, the other causes mentioned above are much more likely to be the real reason behind pain in the breasts. However, if you notice a lump in your breast along with pain, you should get it checked by a doctor immediately.
     
  • Other medical conditions
    Some other conditions in which pain may radiate to your breasts include angina (heart-related chest pain), rib fracture, coronary artery diseaseanaemia, stomach ulcers, among others.

When to see a doctor?

If your breast pain is associated with other symptoms mentioned below, it is important that you consult your doctor immediately:

  • Suspecting a breast lump or a lump in your armpit during self-examination.
  • Discharge (watery, whitish-yellowish or bloody) from your nipples.
  • Dimpling (a visible depression) in your breast.
  • Change in the colour of your breast.
  • A deviation in the positions of your nipples.
  • An ulcer on your breast skin.
  • Sudden enlargement of one or both of your breasts.

Breast pain prevention depends on its type. As we have mentioned above, cyclic breast pain is experienced because of hormonal changes during menstrual cycles and hence, there is not much that you can do to prevent it. However, changing your lifestyle and a routine checkup may lower your chances of having breast pain. Following are a few things that you can do to prevent it:

  • Maintain a healthy weight and eat nutritious food. Regular exercise and a healthy diet will help in reducing hormonal fluctuations, infections, inflammations, and toxin accumulation in your body.
  • Do a self-examination of your breasts every month to know how your breast tissue feels. By doing this regularly, you will be able to determine the changes in your breasts.
  • Get a routine check-up done once in every three years if you are below 30 years and every year if you are above 30.

Your doctor may begin by asking a few questions to get the details of how, when, where, and since how long you’ve been experiencing this pain. He/She may also ask about the number of pregnancies, abortions (if any), if you are breastfeeding or having contraceptive pills, etc. After that, your doctor may examine your breasts to check for any swelling, pain, breast lumps, ulcers, etc. 

Sometimes, the clinical assessment may not be conclusive and you may be advised to get a few tests done which are as follows:   

  • Ultrasound
    It is a diagnostic test which is preferred in women who are less than 35 years of age. This test makes use of ultrasound waves which pass through your breast tissue. As this happens, an inner picture of your breasts appears on your doctor’s computer screen. This test is able to detect small cysts (if any) and the changes in your breast tissues.
     
  • Mammography
    Mammography is also a diagnostic test which is usually preferred in women above 35 years of age. In this test, low doses of X-rays are made to pass through your breast tissues and your doctor is able to detect any abnormality visible on the images. Women with a family history of breast cancer and cysts can get it done once a year as recommended by their doctor to prevent breast cancer.
     
  • MRI
    MRI or Magnetic Resonance Imaging is a very good diagnostic test which not only detects the breast tissue changes but it also tells the extent of their spread in the surrounding body parts.
     
  • Chest X-ray
    Chest X-ray helps in detecting the abnormalities related to other structures surrounding your breasts which may have caused breast pain.

The treatment of your breast pain depends on the underlying cause of it.

  • Counselling
    A mild breast pain does not usually require any treatment. A reassurance and counselling by your doctor about your breast pain might actually help you. Your physician will provide you with the details of normally occurring breast pain which has nothing to be worried about. You may also see a therapist for any emotional or psychological problem that you are going through to relieve your pain.
     
  • Evening primrose oil and Vitamin E
    A study “Vitamin E and evening primrose oil for management of cyclical mastalgia” was conducted in 2010. It found that taking 800 mg (1200 IU) of vitamin E, 3000 mg evening primrose oil or a combination of the two might reduce your cyclic breast pain. Taking them for at least a period of six months might help you get relief from breast pain. However, the evidence for the effectiveness of these supplements is still not considered to be sufficient. Hence, you should speak to your doctor before taking these supplements. Your doctor will tell you the correct dosage based on your body type, age, and medical condition.
     
  • Medicines
    Your doctor may prescribe a few medicines if your breast pain is severe. These include danazol, tamoxifen, toremifene, and oral NSAIDs (Non-steroidal anti-inflammatory drugs) such as diclofenac sodium, ibuprofen, etc. These medicines might reduce your breast pain but they also have side effects. Hence, do not pop any pills without consulting your doctor.
     
  • Local steroid or anaesthetic injection
    In cases such as costochondritis, chest wall pain, injury, etc, your doctor may give you an injection of steroid or anaesthetic (a pain-numbing medicine) on the site of pain. These injections reduce the pain immediately.
     
  • Well-fitted bra
    Wear a well-fitting brasserie to prevent breast pain in future. As explained above, you should determine the correct size for yourself.
     
  • Surgery
    Surgery is rarely indicated because there are high chances of complication.
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References

  1. Powell RW. Breast Pain. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 169.
  2. Ochonma A Egwuonwu, Stanley NC Anyanwu, Gabriel U Chianakwana, Eric C Ihekwoaba. Breast Pain: Clinical Pattern and Aetiology in a Breast Clinic in Eastern Nigeria. Niger J Surg. 2016 Jan-Jun; 22(1): 9–11. PMID: 27013851
  3. Santen RJ. Benign Breast Disease in Women. [Updated 2018 May 25]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
  4. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Breast Changes and Conditions
  5. Goyal A. Breast pain. BMJ Clin Evid. 2011 Jan 17;2011. pii: 0812. PMID: 21477394
  6. Shakuntla Gautam, Anurag Srivastava, Kamal Kataria, Anita Dhar, Piyush Ranjan, Janmejay Kumar. New Breast Pain Chart for Objective Record of Mastalgia. Indian J Surg. 2016 Jun; 78(3): 245–248. PMID: 27358525
  7. Leung SS. Breast pain in lactating mothers.. Hong Kong Med J. 2016 Aug;22(4):341-6. PMID: 27313273
  8. Pruthi S et al. Vitamin E and evening primrose oil for management of cyclical mastalgia: a randomized pilot study. Altern Med Rev. 2010 Apr;15(1):59-67. PMID: 20359269
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