Mastalgia (Breast Pain)

What is mastalgia (breast pain)?

Mastalgia is breast pain and is generally classified as either cyclical (associated with menstrual periods) or noncyclic. Noncyclic pain may come from the breast or may come from somewhere else, such as nearby muscles or joints, and may be felt in the breast. Pain can range from minor discomfort to severely incapacitating pain in some cases. Many women with mastalgia worry more about the consequences of cancer than about the pain itself.

What is cyclical breast pain?

The most common type of breast pain is associated with the menstrual cycle and is nearly always hormonal. Some women begin to have pain around the time of ovulation which continues until the beginning of their menstrual cycle. The pain can either be barely noticeable or so severe that the woman cannot wear tight-fitting clothing or tolerate close contact of any kind. The pain may be felt in only one breast or may be felt as a radiating sensation in the under-arm region.

Some physicians have women chart their breast pain to determine if the pain is cyclical or not. After a few months, the relationship between the menstrual cycle and breast pain will emerge.

Physicians continue to study the role that hormones play in cyclical mastalgia. One study has suggested that some women with cyclical mastalgia have a decreased ratio of progesterone to estrogen in the second half of the menstrual cycle. Other studies have found that an abnormality in the hormone prolactin may affect breast pain. Hormones can also affect cyclical breast pain as a result of stress - breast pain can increase or change its pattern with the hormone changes that occur during times of stress.

Hormones may not provide the total answer to cyclical breast pain, since pain is often more severe in one breast than in the other (hormones would tend to affect both breasts equally). Many physicians believe that a combination of hormonal activity and something in the breast that responds to this activity may hold the answer. However, more research is necessary in order to draw this conclusion.

Treatment for cyclical breast pain:

Specific treatment for cyclical breast pain will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatments vary significantly and may include the following:

• caffeine avoidance
• vitamin E
• Evening Primrose Oil (a naturally occurring triglyceride)
• a low-fat diet

In some cases, various supplemental hormones and hormone blockers are also prescribed. These may include:

• birth control pills
• Bromocriptine (which blocks prolactin in the hypothalamus)
• Danazol, a male hormone
• thyroid hormones
• Tamoxifen®, an estrogen blocker

Supplemental hormones and hormone blockers may have side effects. In addition, the risks and benefits of such treatment should be carefully discussed with your physician.

What is noncyclic breast pain?

Noncyclic breast pain is fairly uncommon, feels different than cyclical mastalgia, and does not vary with the menstrual cycle. Generally, the pain is present all the time and is in only one specific location.

One cause of noncyclic breast pain is trauma, or a blow to the breast. Other causes can include arthritic pain in the chest cavity and in the neck, which radiates down to the breast.

Treatment for noncyclic breast pain:

Determining the appropriate treatment for noncyclic breast pain is more difficult, not only because it is hard to pinpoint where the pain is coming from, but also because the pain is not hormonal. Specific treatment for noncyclic breast pain will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Generally, physicians will perform a physical examination and may order a mammogram. In some cases, a biopsy of the area is also necessary. If it is determined that the pain is caused by a cyst, the cyst will be aspirated. Depending on where the pain originates, treatment may include analgesics, anti-inflammatory drugs, and compresses.

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