Cyclical breast pain is linked to changing hormone levels during the menstrual cycle. Hormonal changes make the breast tissue more sensitive, which can cause pain. Approximately two out of three women will experience cyclical breast pain. Many women feel discomfort, pain and lumpiness in both breasts a week or so before their period. The pain can vary from mild to severe and the breasts can also be tender and sore to touch. You may experience heaviness, tenderness, a burning, prickling or stabbing pain, or a feeling of tightness. The pain usually affects both breasts, but it can affect just one. It can also spread to the armpit, down the arm and to the shoulder blade. Cyclical breast pain often goes away once a period starts. This type of pain usually stops after menopause. However, women taking hormone replacement therapy (HRT) can also have breast pain. Breast pain can also begin when patients start to take or change contraception that contains hormones.
Chest wall pain may feel as though it’s coming from the breast, but really comes from somewhere else. It’s also known as extramammary (meaning outside the breast) pain. Chest wall pain can have a number of causes, including:
- Pulling a muscle in your chest, or from increased physical conditioning or exercise
- Inflammation around the ribs, caused by a condition called costochondritis or Tietze’s syndrome
- A medical condition, such as angina or gallstones. This type of pain may also occur if pressure is applied to the area on the chest wall.
Non-cyclical breast pain is not linked to the menstrual cycle. Non-cyclical breast pain may be continuous, or it may come and go. It can affect women before or after menopause. The pain can be in one or both breasts and can affect the whole breast or a specific area. It may be a burning, prickling or stabbing pain, or a feeling of tightness. Non-cyclical breast pain often reduces or goes away by itself over time. This happens in about half the women who experience it. It’s often unclear what causes noncyclical breast pain, but it can be related to:
- A benign (not cancerous) breast condition
- Previous surgery to the breast
- Unrecognized trauma to the breast
- Having larger breasts
- A side effect from a drug treatment, such as certain antidepressant drugs and some herbal remedies like ginseng
- Stress and anxiety
Post-surgical pain (dysesthesia) is defined as pain lasting more than three to six months after surgery. The pain differs in quality and location from pain experienced prior to surgery or in the immediate post-op period. Dysesthesia is usually caused by surgical injury to a peripheral nerve.
Although all types of surgery can lead to dysesthesia, some surgeries are at higher risk of causing nerve damage. Patients who have had open breast surgery are at higher risk for pain. Research has shown a greater incidence of dysesthesia after a mastectomy with reconstruction and/or breast augmentation, compared to mastectomy alone. If you think you are experiencing chronic pain at a lumpectomy/mastectomy site, ask your primary care provider to consider a referral for you to an interventional pain specialist.
There are various options for treating this kind of pain, such as oral medications, infiltration of the painful area with anesthetics, or nerve stimulation therapy.
Some women find that eating a low-fat diet and increasing the amount of dietary fiber, as well as reducing their intake of chocolate, caffeine, salt and alcohol (especially red wine) helps to reduce breast pain. There is also weak evidence that taking vitamin B6 and folic acid will help to reduce breast pain. Wearing a supportive and well-fitting bra during the day, during any physical activity and at night can also be helpful.
Additionally, some women have found relaxation therapy useful in reducing their symptoms of cyclical breast pain. These include relaxation CDs or apps, or other complementary therapies, such as acupuncture and aromatherapy. If your pain started when you began taking a contraceptive pill, changing to a different pill may help. If the pain continues, you may want to try a non-hormone method of contraception. If your pain started or increased while taking HRT and doesn’t settle after a short time, tell your OB/Gyn or primary care provider.
Research has shown that non-steroidal anti-inflammatory pain relievers, such as ibuprofen, can help breast pain, particularly non-cyclical pain. However, before using this type of pain relief, you should be assessed and get advice from your doctor on the correct dose, how long you should use it for and any possible side effects, especially if you have asthma, stomach ulcers or any problem related to your kidneys. Topical anesthetics applied directly to the site of pain may provide relief. (e.g. Aspercreme).
