Pain in mammary glands: Breast pain Information | Mount Sinai
Breast pain Information | Mount Sinai
Pain – breast; Mastalgia; Mastodynia; Breast tenderness
Breast pain is any discomfort or pain in the breast.
The female breast is either of two mammary glands (organs of milk secretion) on the chest.
Breast pain can be due to many possible causes. Most likely breast pain is from hormonal fluctuations from menstruation, pregnancy, puberty, menopause, and breastfeeding. Breast pain can also be associated with fibrocystic breast disease, but it is a very unusual symptom of breast cancer.
There are many possible causes for breast pain. For example, changes in the level of hormones during menstruation or pregnancy often cause breast pain. Some swelling and tenderness just before your period is normal.
Some women who have pain in one or both breasts may fear breast cancer. However, breast pain is not a common symptom of cancer.
Some breast tenderness is normal. The discomfort may be caused by hormone changes from:
- Menopause (unless a woman is taking hormone replacement therapy)
- Menstruation and premenstrual syndrome (PMS)
- Pregnancy — breast tenderness tends to be more common during the first trimester
- Puberty in both girls and boys
Soon after having a baby, a woman’s breasts may become swollen with milk. This can be very painful. If you also have an area of redness, call your health care provider, as this may be a sign of an infection or other more serious breast problem.
Breastfeeding itself may also cause breast pain.
Fibrocystic breast changes are a common cause of breast pain. Fibrocystic breast tissue contains lumps or cysts that tend to be more tender just before your menstrual period.
Certain medicines may also cause breast pain, including:
- Chlorpromazine and other antipsychotic medicines
- Water pills (diuretics)
- Digitalis preparations
- Oral contraceptives
- Estrogen replacement therapy
- Selective serotonin reuptake inhibitors, such as fluoxetine
Shingles can lead to pain in the breast as there is a painful blistering rash that appears on the skin of your breasts.
If you have painful breasts, the following may help:
- Take medicine such as acetaminophen or ibuprofen
- Use heat or ice on the breast
- Wear a well-fitting bra that supports your breasts, such as a sports bra
There is no good evidence to show that reducing the amount of fat, caffeine, or chocolate in your diet helps reduce breast pain. Vitamin E, thiamine, magnesium, and evening primrose oil are not harmful, but most studies have not shown any benefit. Talk to your provider before starting any medicine or supplement.
Certain birth control pills may help ease breast pain, although in other cases it may cause breast pain. Ask your provider if this therapy is right for you.
When to Contact a Medical Professional
Contact your provider if you have:
- Bloody or clear discharge from your nipple
- Given birth within the last week and your breasts are swollen or hard
- Noticed a new lump that does not go away after your menstrual period
- Persistent, unexplained breast pain
- Signs of a breast infection, including redness, pus drainage, or fever
What to Expect at Your Office Visit
Your provider will perform a breast examination and ask questions about your breast pain. You may have a mammogram or ultrasound.
Your provider may arrange a follow-up visit if your symptoms have not gone away in a given period of time. You may be referred to a specialist.
Family Practice Notebook website. Medication causes of mastalgia: breast pain due to medication. fpnotebook.com/Gyn/Sx/Mstlg.htm. Accessed January 1, 2023.
Klimberg VS, Hunt KK. Diseases of the breast. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 35.
Sandadi S, Rock DT, Orr JW, Valea FA. Breast diseases: detection, management, and surveillance of breast disease. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 15.
Sasaki J, Geletzke A, Kass RB, Klimberg VS, Copeland EM, Bland KI. Etiology and management of benign breast disease. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 5.
Last reviewed on: 10/10/2022
Reviewed by: Jonas DeMuro, MD, Diplomate of the American Board of Surgery with added Qualifications in Surgical Critical Care, Assistant Professor of Surgery, Renaissance School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
11 common causes of breast pain and how to manage them
Breast pain, or mastalgia, is very common. Possible causes of breast pain include hormonal changes, an incorrect bra fit, and infections.
Pain in the breast affects approximately two-thirds of females during their reproductive years, and it is one of the most frequent complaints of those aged 15–40 years.
Breast pain is not commonly a symptom of breast cancer, but if a person has pain alongside other breast changes, such as a lump or discharge, they should speak with a doctor.
Keep reading to learn more about some of the possible causes of breast pain and get tips on how to manage this symptom.
Tender or swollen breasts are usually related to the hormonal changes that take place before a period. This type of breast pain usually causes tenderness in both breasts, and it may extend to the armpit.
When breast pain is related to the menstrual cycle, it is known as cyclic breast pain. Cyclic breast pain can be part of a set of symptoms that occur before a period, known as premenstrual syndrome (PMS), or it may occur on its own.
Other symptoms of PMS include:
- mood swings
- diarrhea or constipation
- trouble sleeping
PMS is temporary, and it usually goes away several days after a period begins. In the meantime, people can treat the symptoms by taking over-the-counter (OTC) pain relievers, wearing a comfortable and supportive bra, and using gentle heat to soothe the pain.
Breast pain can also occur due to other hormonal changes, such as those that take place during pregnancy or in the first stage of menopause.
Learn why the breasts can be sore before a period.
Bras can cause breast pain if they are too tight or they contain an underwire that digs into the skin or breast tissue. If a person gets cyclic breast pain, they may also find that at certain times in their menstrual cycle, their usual bras feel too small or are uncomfortable.
People can get a bra fitting for free at many department stores to find the right size for them. They may wish to purchase non-wired, supportive, and comfortable bras if they experience soreness before their period.
Supportive bras can also help when exercising. According to a 2021 article, 60–70% of women report less breast pain when they wear a sports bra during exercise.
Fibrocystic breast changes are harmless but potentially uncomfortable symptoms that cause the breasts to feel lumpy or otherwise different in texture due to hormonal fluctuations. Fibrocystic breast disease is the most common type of noncancerous breast condition.
The symptoms may include:
- breasts that feel firmer or thicker than usual
- lumps or cysts
- sensitive nipples
The symptoms may get worse before a period, and they will usually stop after menopause.
The treatment or management of fibrocystic breasts may involve:
- taking OTC pain medication, such as acetaminophen (Tylenol) or ibuprofen (Advil)
- applying cool or warm compresses when the breasts are more painful
- avoiding a large intake of salt, caffeine, or fat in the diet
- starting or stopping birth control pills
If fibrocystic breast changes may be related to a new contraceptive, it is important to speak with a doctor before making any changes to the dosage.
Mastitis is the term for inflammation or swelling in the breasts. The usual cause is an infection. Although the condition most often affects those who are breastfeeding, it can occur in people who are not.
The symptoms of mastitis include:
- swelling, pain, and warmth in part of the breast
- general flu-like symptoms
The treatment for an infection is antibiotics. A person who is breastfeeding will also need to empty the breasts of milk. If an abscess is present, doctors will drain the pus surgically or remove it with a needle.
Some medications can contribute to the development of breast pain. These include:
- digitalis preparations, such as digoxin (Digox), which treat congestive heart failure and abnormal heart rhythm
- chlorpromazine (Thorazine), a medication for mental health disorders
- certain potassium-sparing diuretics, such as eplerenone (Inspra) or spironolactone (Aldactone)
- oxymetholone (Anadrol), which treats low red blood cell count
- methyldopa (Aldomet), which is a treatment for high blood pressure
People with breast pain should speak with a doctor to find out whether any of their medications could be causing their symptoms.
Both surgery and radiation therapy for breast cancer can cause scar tissue formation. This can result in:
- numbness or pain, if the scar tissue develops around nerves
- an increase in firmness or a rounder appearance of the breast
- formation of a lump if the scar forms around a surgical stitch
Treatment options include:
- physical therapy, if the scar tissue causes pain, stiffness, and pressure
- surgical removal of scar tissue, if it is very painful
- use of creams and ointments to lessen the appearance of scars, if a person finds them bothersome
Breast pain can originate from outside the breast, rather than within it. For example, sprains or injuries in the back, neck, or shoulder might cause pain that a person feels in the breast.
A 2020 study notes that cervical root disorders, which people sometimes refer to as a pinched nerve, can cause breast pain. These disorders involve damage to or inflammation of a nerve root in the neck.
When people perceive pain in a broader area than the site where it originates, this is known as referred pain. The treatment relies on finding the underlying problem. For example, if a person with breast pain has a pinched nerve, physical therapy or spinal surgery for the pinched nerve may improve the breast pain.
Costochondritis is inflammation of the costal cartilage, which connects the ribs to the breastbone. The condition can cause sharp chest pain and tenderness, and it may have a gradual or sudden onset.
The following factors may worsen the pain:
- pressure on the chest, such as when wearing a seat belt
- physical activity
- sitting or lying in particular positions
- deep breathing, sneezing, or coughing
Treatment may include:
- avoiding activities that worsen the pain
- applying heat to the area
- taking one of the following medications:
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil
- aspirin, if older than 16 years
- corticosteroid injections, such as triamcinolone (Kenalog)
- undergoing transcutaneous electrical nerve stimulation (TENS), a procedure that applies an electric current to an area to reduce pain
A range of conditions can cause pain in the wall of the chest. This pain can sometimes feel as though it is coming from the breast, even though it is not.
The pain can vary in extent, ranging from one specific area to a wide area of the breast. A person may experience:
- burning or sharp pain
- pain that spreads down the arm
- pain that occurs when someone applies pressure to the chest wall
- pain that worsens upon movement
Possible causes include:
- fractured ribs
- autoimmune diseases, such as rheumatoid arthritis
The treatment will vary based on the cause, but it may involve pain management and avoiding movements that make the pain worse until the root cause has improved.
Breast cysts are fluid-filled sacs. They are noncancerous, relatively soft, and more common in premenopausal females. Some cysts do not produce symptoms, but others may cause pain and nipple discharge.
Unless the cysts are particularly large or painful, they do not need treatment. If treatment is necessary, it involves draining the fluid out with a needle.
Breast cancer occurs when cells in the breast mutate and begin growing uncontrollably. Pain in the breast is not usually due to cancer, but this is a possible cause. Other symptoms may include:
- a lump in the breast
- pain in any part of the breast
- any nipple discharge — bloody, clear, or otherwise
- dimpling or irritation of breast skin
- pulling in at the nipple or pain in the nipple
- flaky, inflamed skin in the nipple area
- thickening or swelling of part of the breast
- change in the shape or size of the breast
Rarely, people can develop inflammatory breast cancer, which causes different symptoms. These include:
- a painful, tender, or itchy breast
- pink, red, or purple discoloration that covers at least one-third of the breast
- swelling of the skin, making one breast look larger than the other
- pitting of the skin, similar to that of orange peel
- a retracted or inverted nipple
The treatment options for breast cancer include surgery, chemotherapy, hormone therapy, radiation therapy, and biologic therapy. People will often receive more than one of these treatments.
Cyclic pain, which is related to the menstrual cycle, and noncyclic pain have some key differences. The following table compares and contrasts the two types of pain:
|Cyclic pain||Noncyclic pain|
|varies with hormones in the menstrual cycle||does not vary with the menstrual cycle|
|common among females in their 20s, 30s, and 40s||more common after menopause|
|generally affects both breasts equally||tends to affect one or more localized areas of one breast|
|may occur alongside tenderness, swelling, or lumpiness||pain often feels sharp and burning|
If a person has cyclic pain, but the pain is worse in one breast than the other, hormones may not be the only cause.
It can help to keep a symptom diary to determine whether pain is cyclic. Alternatively, people can use apps that track menstruation and its associated symptoms to see whether there is a pattern.
In a symptom diary, it can be helpful to assign a numerical value to the pain intensity every day throughout one or more menstrual cycles. If the pain occurs or increases at the same times during each cycle, it may be cyclic. People can share this information with a doctor during an appointment.
People can take various steps to relieve the pain of mastalgia. These include:
- wearing a supportive bra that fits well
- taking OTC pain medications
- limiting the intake of chocolate, coffee, tea, and soft drinks
- applying hot or cold compresses to the breasts
- getting regular exercise
- engaging in relaxation methods to reduce stress, anxiety, and tension
It is advisable to speak with a healthcare professional before trying self-care techniques to ensure that they are appropriate. In certain circumstances, medical intervention may be necessary.
There are multiple possible causes of breast pain, or mastalgia. This symptom may be cyclic or noncyclic. If the pain is cyclic, it is related to the fluctuating hormones of the menstrual cycle.
Noncyclic breast pain can be due to PMS, fibrocystic breast changes, injuries and sprains, or inflammation around the ribs. Sometimes, cysts or infections are responsible for this symptom.
Although breast cancer is not usually a cause of breast pain, anyone with this symptom should consult a doctor to rule out this condition.
Pain in the mammary glands – causes and types, diagnosis and examination of the mammary glands in the clinic
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Pain syndrome in the mammary glands, which is also called mastalgia, occurs during the life of 75% of all female representatives. Statistics show that every tenth woman experiences at least a slight chest pain around 5 days of the month.
Due to this prevalence, many women do not pay due attention to it and do not turn to specialists for diagnostic measures.
Pain in the chest can disturb both very young girls (in the premenopausal period) and in women after 45 years (in the postmenopausal period). In some cases, it is observed throughout life during periods of menstruation.
Pain symptom is divided into two types: cyclic and non-cyclic.
|Directly dependent on the menstrual cycle, felt in two mammary glands at once||Occurs only in one of the mammary glands|
|Edema, swelling possible||May extend to armpits|
|Nervous system instability||Nervous system stable|
|Feeling of heaviness and fullness in the chest||The pain is sharp, burning in nature|
|Pain peaks in the last week before menstruation||Pain may occur at any time|
|Most common in women under 40||More common in women over 40|
In some cases, chest pain may not be related to any of the types. This happens with another source of disease, such as muscle pain.
Causes of pain in the mammary glands can be:
- hormonal disorders
They are the main cause of cyclic pain. As a rule, pain stops during pregnancy, before the onset of the menstrual cycle, or after menopause. This is a consequence of the fact that at these moments hormonal changes in the body stop.
- anatomical changes in the breast
This is non-cyclical pain that can be caused by a cyst, blunt trauma, or surgery. The pain here is only on one side, mainly in the nipple area. Character – sharp, cutting. Most often permanent. In this case, you need to immediately contact a specialist.
- violation of the balance of fatty acids in the tissues of the mammary glands
The pain is due to the increased sensitivity of gland cells to hormones.
- taking certain medications
As a rule, these include hormonal substances, drugs to restore reproductive function, antidepressants.
- infectious diseases (in particular mastitis)
Local symptoms are clearly expressed: significant pain, swelling and redness. There are fever, headaches, lack of appetite, feeling of weakness.
- Benign and malignant neoplasms (mastopathy, breast cancer) Pain sensations may be completely absent here, which makes timely diagnosis difficult. A slight tumor-like formation appears, a change in color or structure (wrinkling of the skin), discharge from the nipple is possible. The risk group includes nulliparous women after 30 years of age, who initially gave birth late, the hereditary factor and overweight are also important.
- Osteochondrosis of the thoracic spine
Infectious diseases of the mammary glands are no less dangerous to health. Untimely treatment of mastitis causes an abscess (accumulation of pus), which requires surgery to remove. After the operation, the wound heals for a long time, the risk of re-inflammation and suppuration is not excluded.
To rule out the possibility of complications, you need to make an appointment at our clinic. On the basis of tests and diagnostics, specialists will conduct a course of treatment and talk about prevention methods.
Diagnostic measures for pain in the mammary glands consultation of a mammologist (the doctor collects an anamnesis, conducts a detailed survey of the patient)
- manual breast examination
- Breast ultrasound
- Breast MRI with contrast
These procedures will allow you to more accurately determine the condition of the mammary glands, the presence of benign and malignant tumors, their size and exact location. Make an appointment with a gynecologist, and qualified specialists will make a diagnosis in a short time, prescribe treatment, and advise on existing issues.
Remember that an annual visit to a mammologist can give you a guarantee of a high quality of life and confidence in a secure future.
Here are some preventative tips that will help you reduce your risk of breast pain:
- boost immunity regularly
- take care of your body from stressful situations
- have a regular sexual partner, categorically avoid abortion and breastfeed
- choose a comfortable and high-quality bra
Prices for the treatment of breast pain
|Primary appointment (examination, consultation) with an obstetrician-gynecologist||2900 ₽|
|Repeated appointment (examination, consultation) with an obstetrician-gynecologist||2700 ₽|
Mokronosov Alexey Sergeevich
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“Many-sided pain” in the mammary gland
A woman in our country is a special woman! She thinks and worries about everyone except herself – for her husband with his complaints and problems, for the children with their vaccinations, examinations and schools . .. At the very last moment, she suddenly remembers herself. Does he remember why? Something hurt! The most common complaint of women of any age and the most motivating reason for visiting a doctor is pain in the mammary gland. This is what I would like to talk to you, dear women.
Pain in the mammary gland can be characterized and divided into different manifestations: cyclic – non-cyclic; one-time – constant; sharp, dagger, dull, aching, arching, girdle, local (local), bilateral, unilateral, etc.
The most common of these is cyclic soreness. A few days before the expected menstruation, the mammary glands become engorged, become sensitive, painful when pressed. These symptoms can appear both in 14 and in 2-3 days and disappear immediately after menstruation. This is due to ovulation and the preparation of the body for the natural process – pregnancy. In the second phase of the menstrual cycle, the female body is rebuilt. The hormonal background and the rheological properties of the blood change. For example, have you ever wondered why it is recommended to visit a mammologist for an examination from the 6th to the 12th day of the cycle? Of course, these are average days for most women, and they can vary significantly depending on your personal menstrual calendar: if the discharge stops already on day 2-3, and the cycle duration is, say, 35 days, then such a patient can be extended consultative days from 4 to 17th day of the cycle. The principle should be clear: the discharge practically stops, and ovulation does not occur. On these (recommended) days, the doctor will more objectively assess the situation: the chest is in a calm state; if puffiness is observed, it is in no way connected with physiological processes. In the case when the patient comes to any day convenient for her (not according to the cycle), this threatens with overdiagnosis, sometimes even errors in diagnosis. Let me give you an example again. Patient N., 45 years old, underwent mammography two years ago. Now there are complaints of soreness of the mammary glands. The patient came for examination on the 25th day of the cycle. A mammogram was performed, which did not reveal exact data for a nodular formation, but the glandular tissue, compared to a two-year-old mammogram, became much larger. This indicates a hormonal surge, since the amount of glandular tissue should decrease over the years, and not increase. In this case, you and I knew in advance that the patient did not come according to the cycle, therefore, having repeated the study on the right days, we saw that the state of the mammary glands on the radiographs was without significant dynamics.
The same error often occurs with diagnostic punctures. First, you need to know that in the second phase of the menstrual cycle, the risk of hematomas at the biopsy site is much more serious. Therefore, surgeons try to carry out any operations for women of reproductive age during the week following menstruation, when bleeding is significantly reduced. Secondly, swelling is directly related to the swelling of each cell of the gland. The cytologist at the time of the procedure – taking a puncture – does not take into account the day of the cycle: he sees a cell that is slightly larger than the norm and – the diagnosis automatically becomes more complicated. The boundaries are very close: norm – hyperplasia – atypia – cancer. From this follows the conclusion – neither you nor the doctor need overdiagnosis.
Pain in the breast on both sides is associated with an imbalance of hormones that are not completely removed from the body by our liver, which remain on the cells of the glandular tissue of the mammary gland and attract fluid. Such a clinical picture with exacerbations in the autumn-spring period is characteristic of fibrocystic mastopathy. Sometimes there are shifts in a specific direction associated with the asymmetry of the mammary glands themselves or with a different amount of glandular tissue in the breast.
Local pain (local) inside the gland, aggravated by movement, patients often characterize as sharp, dagger, or, conversely, dull and aching. It occurs with cystic inclusions in the mammary gland. When filled, the liquid formation pushes the tissues apart, which leads to unpleasant sensations in a particular area of the gland, and the severity of complaints depends on the degree of cavity filling. Cysts are the most benign of all problems, but they are the ones that bring the most discomfort to a woman’s life.
In adolescents, cysts are often asymptomatic and do not cause any complaints. Diagnosed by ultrasound, sometimes they can be suspected when examining the gland – the appearance of a bluish color on the skin of the areola of the nipple. When screening schoolgirls, it was cysts in the mammary gland that were the most common pathology, although the girls did not complain of pain. In adolescence, untreated cysts are often complicated by inflammatory processes.
Inflammation of the mammary gland – mastitis – is manifested by pain, accompanied by reddening of the skin over the area and an increase in temperature, both local and general. The clinical picture, as a rule, develops quickly – within 1-2 days. There is a misconception that mastitis occurs only in lactating women. This is a really common complication in this group: it occurs, as a rule, in the first 2-3 weeks after childbirth, and in most cases after the first childbirth; has two causes – lactostasis and infection (as a result of infection through cracks and / or other damage to the nipples).
In our practice, we often encounter inflammation of the mammary glands in adolescents or women outside the lactation period. Change of season or a sharp temperature drop, drafts are the most common causes of mastitis. We observe a surge of such appeals in the May period. But this year, at the beginning of autumn (after unbearable heat), the number of patients with this pathology has increased dramatically. For the timely appointment of treatment, it is important to consult a doctor at the first symptoms, then, most likely, local antibacterial treatment will be sufficient.