Breast pain, clinically known as mastalgia, is a prevalent condition characterized by discomfort, tenderness, or aching sensations in the breast tissue. This pain can manifest in various ways, including throbbing, sharp, stabbing, burning, or a feeling of tightness. It may be constant or intermittent and can affect individuals of all genders, including men, women, and transgender people.
The intensity of breast pain can vary significantly, ranging from mild to severe and can present in different patterns:
- Cyclic Breast Pain: Occurring for a few days each month, typically 2-3 days before menstruation. This is often mild to moderate and affects both breasts.
- Premenstrual Breast Pain: Lasting a week or more monthly, starting before menstruation and sometimes continuing throughout the cycle. This pain can be moderate to severe and also usually affects both breasts.
- Noncyclic Breast Pain: Present throughout the month, unrelated to the menstrual cycle.
In men, breast pain is frequently attributed to gynecomastia, a condition marked by the enlargement of breast gland tissue due to hormonal imbalances between estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly.
Hormone therapy in transgender women can also induce breast pain. In transgender men, pain may arise from residual breast tissue post-mastectomy.
In most instances, breast pain is indicative of a benign breast condition and is rarely a sign of breast cancer. However, persistent, unexplained breast pain that is not linked to menstrual cycles, continues after menopause, or seems unrelated to hormonal changes warrants medical evaluation.
Symptoms of Breast Pain: Cyclic vs. Noncyclic
Breast pain is broadly categorized into cyclic and noncyclic types, each with distinct characteristics. Cyclic pain follows a regular pattern linked to the menstrual cycle, while noncyclic pain is either constant or lacks a predictable pattern.
| Cyclic Breast Pain | Noncyclic Breast Pain |
|---|---|
| – Clearly associated with the menstrual cycle and hormonal fluctuations. | – Not related to the menstrual cycle. |
| – Often described as dull, heavy, or aching. | – Described as tight, burning, stabbing, or aching. |
| – Frequently accompanied by breast swelling, fullness, or lumpiness. | – Can be constant or intermittent. |
| – Typically affects both breasts, especially the upper, outer areas, and may extend to the underarm. | – Usually localized to one breast, but can spread more widely. |
| – Pain intensifies in the two weeks leading up to menstruation and subsides afterward. | – In women, more common after menopause. |
| – More common in individuals in their 20s and 30s, and those in their 40s transitioning to menopause. | – |
Extramammary Breast Pain
Extramammary pain, meaning “outside the breast,” is pain perceived as originating in the breast but actually stemming from surrounding areas. For example, straining a chest muscle can cause pain that radiates to the breast area. Costochondritis, arthritis affecting chest cartilage, can also cause similar pain.
When to Consult a Doctor About Breast Pain
It’s important to seek medical advice if breast pain:
- Persists daily for more than a couple of weeks.
- Is concentrated in a specific area of the breast.
- Worsens over time.
- Disrupts daily activities.
- Wakes you up from sleep.
While breast cancer risk is low when breast pain is the primary symptom, it is crucial to follow through with any evaluations recommended by your doctor.
Common Causes of Breast Pain
Hormonal fluctuations are a significant factor in breast pain. Changes in hormone levels can affect the milk ducts and glands, leading to the formation of breast cysts, a common cause of cyclic breast pain. Noncyclic breast pain can result from trauma, previous breast surgeries, or other factors.
In many cases, pinpointing the exact cause of breast pain is challenging. However, certain risk factors are known to increase the likelihood of experiencing breast pain.
Risk Factors for Breast Pain
Breast pain is more frequently experienced by premenopausal individuals, although it can occur post-menopause as well. Men with gynecomastia and transgender individuals undergoing gender transition are also at higher risk.
Other contributing risk factors include:
- Breast Size: Larger breasts can contribute to noncyclic breast pain due to their weight, often accompanied by neck, shoulder, and back pain.
- Breast Surgery: Pain and scar tissue formation from breast surgery can be a source of persistent discomfort even after healing.
- Fatty Acid Imbalance: An imbalance in cellular fatty acids may heighten breast tissue sensitivity to hormonal changes.
- Medication Use: Certain hormonal medications, such as fertility treatments and oral contraceptives, are linked to breast pain. Hormone therapies containing estrogen and progesterone used post-menopause can also cause breast tenderness. Some antidepressants, particularly SSRIs, as well as medications for high blood pressure and certain antibiotics, may also contribute to breast pain.
- Excessive Caffeine Intake: While more research is needed, some individuals report reduced breast pain by limiting or eliminating caffeine.
Prevention Strategies for Breast Pain
While more research is needed to confirm effectiveness, the following strategies may help in preventing breast pain:
- Consider Avoiding Hormone Therapy: If possible, discuss alternatives to hormone therapy with your doctor.
- Review Medications: Be aware of medications known to cause or worsen breast pain and discuss alternatives if applicable.
- Proper Bra Support: Wear a well-fitted bra daily and a supportive sports bra during physical activity.
- Relaxation Techniques: Practice relaxation therapy to manage anxiety levels, which can exacerbate severe breast pain.
- Limit Caffeine: Reduce or eliminate caffeine intake to see if it alleviates symptoms, although scientific evidence is still inconclusive.
- Avoid Overexertion: Refrain from excessive or prolonged lifting activities.
- Healthy Diet: Follow a low-fat diet and increase intake of complex carbohydrates.
- Over-the-Counter Pain Relief: Consider using OTC pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), but consult your doctor for appropriate dosage and to avoid risks associated with long-term use.
By Mayo Clinic Staff
Feb. 09, 2023
References
- Golshan M, et al. Breast pain. https://www.uptodate.com/contents/search. Accessed Jan. 22, 2019.
- Mastalgia (Breast pain). Merck Manual Professional Version. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/breast-disorders/. Accessed Dec. 13, 2020.
- Sivarajah R, et al. A review of breast pain: Causes, imaging recommendations, and treatment. Journal of Breast Imaging. 2020; doi:10.1093/jbi/wbz082.
- Bland KI, et al., eds. Etiology and management of benign breast disease. In: The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Dec. 13, 2020.
- Ferri FF. Gynecomastia. In: Ferri’s Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 13, 2020.
- AskMayoExpert. Breast pain. Mayo Clinic; 2020.
- Holbrook AI, et al. ACR appropriateness criteria breast pain. Journal of the American College of Radiology. 2018; doi:10.1016/j.jacr.2018.09.014. https://acsearch.acr.org/docs/3091546/Narrative/. Accessed Dec. 8, 2020.
- Niell BL, et al. ACR appropriateness criteria evaluation of the symptomatic male breast. Journal of the American College of Radiology. 2018; doi:10.1016/j.jacr.2018.09.017.
- Vitamin E fact sheet for consumers. National Institutes of Health. https://ods.od.nih.gov/factsheets/VitaminE-Consumer/. Accessed Dec. 8, 2020.
- Pruthi S (expert opinion). Mayo Clinic. Dec. 13, 2020.
