Mastalgia is the medical term for breast pain and tenderness. This pain and tenderness may come and go with monthly menstrual cycles (cyclic) or may not follow any pattern (noncyclical).
- Cyclic pain is the most common type of breast pain. It is caused by the normal monthly changes in hormone levels in a woman’s body. This pain more typically occurs in both breasts. It is generally described as a heaviness or soreness that radiates to the arm and armpit (axilla). The pain is usually most severe before a menstrual period and is often lessened at the end of the period. Cyclic breast pain occurs more often in younger women. Most cyclic pain is mild enough to not require treatment and dissipates at menopause.
- Noncyclical pain is more common in women 30 to 50 years of age. It may occur in only one breast. It is often described as a sharp or even a burning pain that occurs in one focal area in the breast. Occasionally, this type of pain can be caused by a large cyst or fibroadenoma (benign mass).
Breast pain may worsen with changes in your hormone levels or changes in the medicines you are taking. Stress can also affect breast pain pretty substantially. Mastalgia is more common in premenopausal patients.
Breast pain is rarely a sign of breast cancer. However, sometimes very large breast cancers can cause pain.
TREATMENTS FOR MASTALGIA
Anti-inflammatory medicines are great for breast pain, but may not relieve it entirely. Ibuprofen, acetaminophen, and other NSAIDS give many women relief from their mastalgia. Danazol and tamoxifen citrate are prescription medicines used for the treatment of severe cyclic breast pain. However, Danazol has significant side effects that women find unfavorable and tamoxifen is actually not FDA approved for mastalgia treatment.
A suggested combination of therapies is necessary to lessen mastalgia, though it may never fully go away:
- Wear a supportive bra, even at night. A supportive bra (even a sports bra) takes pressure of the suspensory ligaments in the breast (Cooper’s ligaments) and may lessen mastalgia.
- Limiting caffeine consumption from coffee, tea, and soda. Researchers have suggested that some women get breast pain because of overstimulation of breast cells by methylxanthines as a result of high caffeine. However, one study found identical serum caffeine concentrations in women with and without mastalgia, and some trials have failed to demonstrate a benefit for caffeine restriction. However, limiting caffeine consumption seems very reasonable as a first line therapy for mastalgia.
- Reducing dietary fat to 15% or less of your dietary intake can possibly reduce breast pain over time. A small study has shown that making this long-term dietary change significantly reduces breast pain.
- Using birth control pills (oral contraceptives). These may help reduce cyclic breast pain and breast swelling before periods. But breast pain is also a known side effect of birth control pills, so this decision would be make by you and your gynecologist.
- Evening primrose oil (EPO) has been suggested by many to lessen mastalgia, but strong scientific evidence for this remains lacking. EPO is a natural anti-inflammatory, working on alpha linoleic acids, and might lessen a woman’s breast pain. It is not unreasonable to try this supplement for 8-12 weeks to see if your breast pain lessens. The dose of EPO for breast pain is 1000mg 3-4 times daily. If you are on blood thinners, EPO may increase the risk of bleeding. EPO should not be used if you are pregnant.
- If your kidney function is normal, a trial of oral magnesium supplements for cyclic breast pain is worth attempting. Magnesium supplements taken in the second half of the menstrual cycle (usually the 2 weeks before the next period) may relieve cyclic breast pain as well as other premenstrual symptoms such as hot flashes. Patients with severe heart or kidney disease should not take magnesium, and it has several drug interactions; you should consult with your pharmacist if you are on other medications. The trial dose of Magnesium for breast pain is 500mg daily.