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What is Breast Pain?

By Matthew Wakefield, MD

Breast pain, or mastalgia, is very common.  It is usually cyclic mastalgia.  This is pain and tenderness in both breasts before your menstrual cycle.  Breast tissue can also feel swollen or lumpy during that time.  Most commonly breast pain occurs in the upper outer portion of your breast towards your underarm.  Cyclical breast pain usually resolves after your menstrual cycle. 

Cyclical mastalgia is most common in 30s and 40s.  It can occur earlier and can occur after menopause.  This is especially true if taking hormone replacement therapy when postmenopausal.  This type of breast pain is almost never associated with breast cancer.

 

When should you see a doctor?

Breast pain that needs to be seen by your physician is pain that is not cyclical.  This pain does not occur regularly with menstrual cycle.  Pain that occurs in a specific spot in the breast also needs to be seen by your doctor.  You will need a breast exam and possibly further evaluation. 

 

What is the treatment for breast pain?

Dietary changes:

1.      Sometimes eliminating caffeine from your diet may help breast tenderness.  This may take up to six months to have relief.  Caffeine is in many things we eat and drink so must pay attention.

2.      Eliminating chocolate may have same effect as caffeine.

3.      Eating a low-fat diet can decrease estrogen levels and reduce breast pain as well as help general health.  Limiting meat and dairy products and eating more fish can be helpful.

4.      It is helpful to keep a food log to associate certain foods with breast pain also.

Lifestyle changes:

1.       Exercise can decrease estrogen levels, help with general fitness and weight and improve breast pain and tenderness.

2.      Stop smoking

3.      Make sure you have well-fitting, supportive bra

4.      Warm compresses when tenderness and pain occur

Nutritional supplements:

1.      Evening primrose oil may help reduce breast pain.  Recommend taking 3 grams per day for at least six months to see benefits. 

2.      Dietary flaxseed may reduce breast pain in some studies. (1 muffin with 25 mg)

3.      Vitamin E (200-600IU/day) and Vitamin B6 may be helpful also.  It is reasonable to try these for several months to see if they help. 

Medications:

1.       Nonsteroidal over the counter pain medications like ibuprofen are also helpful.  Sometimes a topical gel like diclofenac might be helpful also.

2.      Tamoxifen is an anti-hormonal medication used for breast cancer treatment and prevention.  For severe cases it can be used for breast tenderness but due to side effects and risks it is used sparingly.

3.      Other medications like danazol and bromocriptine have been used in past but due to significant side effects they are really not used anymore.