Mastalgia

What is Mastalgia?

Mastalgia, or breast pain, is a very common issue for women aged 15 to 40 years old. It affects about two-thirds of women at some point during their reproductive years. It can feel like a dull ache, but some women also describe it as feeling heavy, tight, uncomfortable, or like a burning sensation in the breast tissue. The pain may only affect one breast or both, and is often found in the upper outer portion of the breast. Some women may also feel this pain in the same arm as the affected breast. Mostly, women who are near or in menopause experience this, but it can also occasionally occur in women after menopause. The pain can range from mild to severe, and can happen off and on or constantly throughout the day, potentially impacting a woman’s quality of life.

Often, the exact reason for the breast pain is unknown. However, it’s generally believed that in most cases, this pain is not a sign of cancer. Even so, experts suggest getting a detailed check-up, including a physical examination, from a primary healthcare provider to make sure there is no risk of cancer.

Mastalgia can be categorized in three ways:

1. Cyclic Mastalgia: This is breast pain connected to the menstrual cycle and changes in hormones. It’s often accompanied by swelling, tenderness and lumpiness of the breasts, and usually affects both breasts. The pain gets worse a couple of weeks before periods start, lessens when bleeding starts and goes away over the next few days. This is mostly found in women who are near or in menopause.

2. Non-Cyclic Mastalgia: This pain does not relate to the menstrual cycle and doesn’t change with hormonal shifts in the body. It tends to be linked to internal physical changes, injuries, surgeries, infections, or other breast conditions, like cysts or fibroadenomas. It’s typically described as a localized, sharp, burning breast pain that affects only one breast, either constantly or intermittently, and usually affects women in their 30s or 50s.

3. Extramammary Mastalgia: This is breast pain that seems to start in the breast tissue, but actually comes from somewhere else in the body. For example, it could stem from the chest wall, epigastric pain in GERD (a digestive disorder involving chronic acid reflux), or a stomach or gallbladder condition. These other conditions can create pain that feels like it’s coming from the breast when it is not.

What Causes Mastalgia?

The exact cause of mastalgia, or breast pain, is not known. However, it has been observed that changes in hormone levels during a woman’s menstrual cycle can make breast tissue more sensitive, leading to what is called cyclic mastalgia, or pain that comes and goes with a woman’s cycle. This idea is supported by the fact that for many women, this type of pain often goes away during pregnancy or menopause, times when hormonal levels are different.

Non-cyclic breast pain, or pain that doesn’t follow a woman’s cycle, can be caused by changes in the breast or chest area. Some of these changes may include development of a breast cyst, previous injury or surgery to the breast, injury to the chest wall, muscle or joint, pain from the nerves between the ribs (intercostal neuralgia), Tietze syndrome which is an inflammation of the chest cartilage, and other conditions related to the spine which can cause pain to be felt in the breast (referred pain).

Using certain types of medicines can also cause breast pain. These may include oral contraceptive pills, estrogen and progesterone hormonal therapies, certain types of antidepressants known as selective serotonin reuptake inhibitors (SSRI), and antihistamines or allergy medicines.

Some research suggests that emotional states can contribute to breast pain. For example, having a lot of stress or anxiety, or experiencing depression, may make breast pain worse. Additionally, some studies have suggested that lifestyle factors, such as drinking caffeinated beverages, eating a diet high in fat, and smoking, can also influence breast pain.

Risk Factors and Frequency for Mastalgia

Mastalgia, or breast pain, is the most common complaint among women during their reproductive years. In the U.S., around 70% of women experience this condition at some point in their lives, but only 30% of them seek medical help. The situation is most prevalent among women between 20 to 40 years old. The likelihood of experiencing mastalgia reduces with age and after an early pregnancy. Also, it’s less common among women after menopause.

This condition can have a substantial impact on a woman’s life. Women suffering from breast pain have reported that it interferes with their sexual and physical activities as well as work and social activities. On top of this, the prevalence of mastalgia seems to vary with ethnicity. It occurs among 5% of Asian women but is reported by 60% of British women.

• Mastalgia is a common issue among women of reproductive age.
• Approximately 70% of U.S. women will experience this in their lifetime, but only 30% seek medical help.
• The condition is most common among women aged 20 to 40.
• Its frequency decreases with age and is less common among postmenopausal women.
• Mastalgia can interfere with sexual and physical activities, as well as work and social activities.
• The prevalence of the condition varies depending on ethnicity: 5% in Asian women versus 60% in British women.

Signs and Symptoms of Mastalgia

When a patient consults a doctor about body pain, the first steps the physician takes are to ask for a detailed history and conduct a physical exam. These steps are important and guide the doctor in diagnosing the cause of the pain and planning the right treatment. The history usually includes questions about the nature, location, and severity of the pain, and when it started. Sometimes, a person might be asked to keep a pain diary to record whether the pain follows a pattern or if it occurs at random times. This information can be very helpful for the doctor to reach a more accurate diagnosis.

A physical exam can reveal any unusual features that need immediate attention. The doctor will thoroughly examine the chest and the breast if the pain is in those areas, to find out if the pain is coming from outside the breast (extramammary pain) or from within the breast (mastalgia). During the physical exam, the doctor will:

• Examine each part of the breast by splitting it into 4 quadrants,
• Check the regional lymph nodes above the collarbone (supraclavicular), below the collarbone (infraclavicular), and in the armpits (axillary)
• Look for any abnormal signs such as lumps, skin changes, nipple retraction, discoloration, ulcers, swelling, or edema, inflammation, scars, or abnormal nipple discharge
• Lift the breast tissue with one hand and examine the underlying chest wall with the other hand to check for any deformities

If the doctor finds anything abnormal during the exam, they will record these observations and refer the patient to a specialist for further evaluation.

Testing for Mastalgia

If your doctor finds something unusual during a physical breast examination, they may use imaging tests like mammography or breast ultrasound. The main goal of these tests is to make sure that the unusual finding isn’t anything severe, like breast cancer. If you are a young woman with breast pain that comes and goes with your menstrual cycle, affects both breasts, and isn’t centered in one specific area, and you have no family history of breast cancer and normal previous breast screenings, you usually don’t need any additional imaging tests. But, if your doctor has a strong suspicion of serious underlying illness due to persistent, focused breast pain, you might need further investigation using an imaging test.

Sometimes women under 35 will have a breast ultrasound, which uses sound waves to create an image of the breast. It works well for these younger patients because their breast tissue is often denser. If anything unusual appears on the ultrasound, you may be advised to have a mammogram for further investigation.

A mammogram is another type of imaging test that uses high-powered, low-voltage x-rays. If you’re over 35 and your doctor identifies an unusual thickening area or breast lump during a physical exam, they will likely ask you to have a mammogram.

If any of these imaging tests reveal a suspicious breast lump or unusual thickening linked with breast pain in that area, your doctor may want to investigate further. They might do this through a procedure called a biopsy, where they take a small sample of breast tissue from the suspicious area and send it to a lab for closer examination.

Sometimes, these breast imaging tests are done to relieve patient anxiety. Many patients stop seeking additional medical help once they’ve had a negative imaging result and confirmed that there’s nothing to worry about.

Treatment Options for Mastalgia

Most people with breast pain (also called mastalgia) feel better when they are reassured that it’s not a sign of breast cancer or another serious illness. However, about 15-20% of people with breast pain need treatment either because the pain is interfering with their life or the pain is getting more intense and frequent.

The first step in treatment is to find out what’s causing the breast pain and to focus on easing the pain with conservative (non-surgical) treatment.

Some conservative treatments for mastalgia include:

– Wearing a well-fitted sports bra: This can help support heavy or tender breasts during daily activities and physical exercise. Many women report that this helps relieve their breast pain.

– Using hot and cold compresses: This can provide relief, especially when used at night before sleep.

– Relaxation therapy: This can help to relieve anxiety and depression that can be associated with mastalgia.

– Dietary modification: Eating a diet low in fat and high in vitamins and fiber may help. Reducing your intake of tea, coffee, chocolate, and carbonated soft drinks may also help. Regular exercise can help, as it decreases the release of estrogen (a female hormone) and increases its breakdown.

– Over-the-counter pain relief: Non-prescription pain relievers such as ibuprofen or acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may help. But they should be used as recommended to avoid side effects from overuse.

If these conservative treatments don’t help and the pain lasts for 3 to 6 months, then medications may be considered:

– NSAIDs: These can be given orally or applied to the skin in the form of a gel or patch. They help quickly reduce the pain but should be used as prescribed to avoid side effects.

– Evening Primrose Oil and vitamin E: Some research suggests that these might help relieve breast pain. These are used as supplements and may help manage the balance of fatty acids in the cells and act as an antioxidant. These should be used under a doctor’s supervision, and if no improvement is seen after a few months, their use should be stopped.

– Prescription medications: If the pain is severe and doesn’t respond to other treatments, prescription medications may be considered. These include:

– Tamoxifen: This is primarily used for treating breast cancer. It’s given in a low dose and should be stopped after a few months if it doesn’t help the pain. Keep in mind it can have side effects like headaches, nausea, vaginal dryness, hot flashes, and joint pain.

– Danazol: This is specifically approved for treating breast pain. But, like any medication, it can also have side effects, including acne, voice changes, weight gain, hot flashes, and irregular menstrual periods. Make sure you understand potential benefits and risks before using this medication.

What else can Mastalgia be?

Many women who experience breast pain (mastalgia) naturally worry about breast cancer. However, it’s important to reassure that breast pain is actually one of the least common symptoms of breast cancer – only seen in about 0.5% to 2% of breast cancer patients. There are also many other reasons someone could experience breast pain. These can include:

• Pain from a previous surgical scar
• Chest wall pain due to a past injury
• Inflammation of the breast (mastitis) associated with breastfeeding
• Costochondritis (an inflammation of the cartilage in the rib cage)
• A cracked or broken rib
• Shingles
• Pain referred from the shoulder

Sometimes, breast pain may even signal more serious health conditions like heart disease, chest inflammation (pleurisy), or inflammation of the heart covering (pericarditis).

What to expect with Mastalgia

Mastalgia, or breast pain, can be difficult to predict because it has many potential underlying causes, both physical and psychological. However, if there is no underlying problem found in your breasts, it’s more likely that the pain will naturally disappear anywhere between 3 months to 3 years. What affects this outcome depends on factors like when the pain first started and the root cause of the issue.

For breast pain that follows a menstrual cycle (cyclic breast pain), about 60% of women see an improvement with treatment. However, the pain often comes back within two years. Between 20% to 30% of women with this type of pain will see their pain go away entirely. On the other hand, for breast pain that doesn’t follow a menstrual cycle (non-cyclic pain), treatment doesn’t usually work unless the precise cause is identified and appropriately handled. Even so, 50% of women with this type of pain see their discomfort go away on its own.

Possible Complications When Diagnosed with Mastalgia

Most of the complications associated with mastalgia, breast pain, are due to the medications used for treatment. Side effects can include nausea, bloating, headache, vaginal dryness, hot flashes, leg cramps, weight gain, and changes in menstruation. These issues are often related to the use of drugs specifically, danazol and tamoxifen. Generally, doctors should ask patients about any history of these symptoms before starting these medications.

Common Side Effects include:

• Nausea
• Bloating
• Headache
• Vaginal dryness
• Hot flashes
• Leg cramps
• Weight gain
• Menstruation changes

Preventing Mastalgia

Many women experience breast pain which can become a significant concern, either because of a fear of breast cancer or because it impacts their daily activities. However, only about 30% of women experiencing breast pain seek medical help. Therefore, it’s crucial for women to consult with healthcare professionals if they experience breast pain. Doing so allows for a detailed review of their medical history and thorough physical examination. If necessary, imaging techniques, like a mammogram or an ultrasound, can be used to accurately diagnose the cause of the pain in a timely manner. This can help alleviate unnecessary worry and reduce episodes of pain, improving the patient’s overall quality of life. In addition, it gives women the chance to learn more about their own bodies.

Encouraging open communication between the patient and the doctor strengthens their relationship and can help women better understand their condition. This aids in discussing management options such as the use of social support groups, over the counter pain relievers like acetaminophen, non-steroidal anti-inflammatory drugs (like aspirin or ibuprofen), and weighing the risks and benefits of using prescribed medications. It’s important for patients to be aware of any warning signs and to learn how to perform self-breast exams. Regular self-examination allows women to quickly identify and report any suspicious changes, leading to better outcomes.