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Dr Reddys Foundation for Healthcare Educati on Occasionally, pain from other conditions can be felt in the breast, for example, angina (tightness across the chest) or gallstones. This is known as Contents
referred pain. In this instance your Doctor or specialist will advise you on the most appropriate treatment.
Types of breast pain
What this means for you
Cyclical breast pain
Breast pain can be very distressing, and many women are anxious that they may have breast cancer. In most cases breast pain will be the result of normal changes that occur in the breasts. While you may feel relief at being told that it is normal and you do not have breast cancer, the pain often persists. This can be very upsetting, especially if your specialist is unable to tell you the exact cause of your breast pain.
Women affected by breast pain may feel many different emotions, such as fear, frustration or helplessness, and these are all normal reactions. Understanding more about your breast pain will not cure it, but it may help you to alter the way you cope and get back some control over your life.
Non-cyclical breast pain
Having breast pain does not increase your risk of breast cancer, but it is still important to be breast aware and go back to your Doctor if you notice any other changes. You can find out more about being breast aware in our
Breast awareness booklet.
What this means for you
This booklet is for women who have Breast pain, which is also known as Treatment for true breast pain
mastalgia. It talks about the types of pain you might have, how a diagnosis is made and how breast pain can be treated. Diet and lifestyle changes
Breast pain can cause a lot of anxiety, and many women worry that they True non-cyclical breast pain is not easy to treat. In the first place, your may have breast cancer. You may find it helpful to know that breast pain Doctor may suggest simple things you can try, such as reducing your intake alone is not usually a sign of breast cancer. We hope the information will of caffeine, chocolate and red wine and increasing the amount of fresh fruit help you understand more about breast pain and reassure you.
and vegetables you eat. You may also be advised to wear a well supporting bra day and night.
Types of breast pain
Your Doctor may advise you try evening primrose oil, which is also used to Breast pain is very common in women of all ages, for example; treat breast pain linked to the menstrual cycle (see page 2).
approximately two out of three pre-menopausal women will experience it at sometime in their lives. There are two main types of breast pain. Anti-inflammatory medicines
Anti-inflammatory painkillers such as ibuprofen can also help this type of
Breast pain that is part of a woman’s normal menstrual cycle is known as pain. These are particularly effective if applied directly to the affected area, cyclical breast pain. Women may experience it as discomfort and
but can also be taken in tablet form. However, before considering using this lumpiness in their breasts a week or so before their period. The pain can type of treatment, you should be assessed and advised by your Doctor on vary from mild to severe and breasts can also be tender and sore to touch. the correct dose, how long you should use it for and any possible side It often goes away once the period starts.
effects. It may take some time to find out what works best for you and there may be other practical things you can try that are relevant to your Other women can have lasting pain felt in the breast that is not related to their menstrual cycle or is actually coming from elsewhere in the body. This
is known as non-cyclical breast pain.
Treatment for pain from elsewhere
Pain coming from elsewhere can be associated with an underlying problem
Both types of breast pain can be treated, so if you have breast pain that is such as inflammation (swelling) of the chest wall. This is called severe or long lasting and affecting your daily life, you may want to talk to costochondritis or Tietze’s syndrome. The pain comes from the parts of the ribs called costal cartilages. Your Doctor or specialist may be able to feel that this costal cartilage is more painful if pressure is put on it. Sometimes Cyclical breast pain
this inflammation can feel similar to heart pain. You may feel tightness of the chest and a severe, sharp pain. The pain may also spread down the arm and What is cyclical breast pain?
Cyclical breast pain is linked to the menstrual cycle and affects women who You may find it helpful to rest and avoid sudden movements that increase haven’t been through the menopause (change of life). Normal hormonal the pain. Painkillers such as paracetomol or ibuprofen may help. If the pain changes take place throughout the menstrual cycle. These make the breast is, you should see a Specialist who may suggest injecting the painful area tissue oversensitive, which in turn can cause breast pain.
with a local anaesthetic and steroid. It is thought that smoking makes the inflammation worse, so if you smoke you may find that your pain improves if you cut down or stop altogether.
You may experience a burning, prickling, stabbing or drawing-in pain. It can Non-cyclical breast pain
affect either one or both breasts and can spread to the armpit, down the arm and to the shoulder blade. This type of pain often stops after the What is non-cyclical breast pain?
menopause when the ovaries stop working. However, women who are There are two types of non-cyclical breast pain: taking hormone replacement therapy (HRT) after their menopause can also experience breast pain. This is because the HRT keeps them in a pre- • true breast pain that comes from the breast but is not linked to the • extra mammary pain that is felt in the area of the breast but is actually coming from elsewhere, such as the muscles, bones and joints. This may be What causes cyclical breast pain?
referred to as musculoskeletal pain.
The exact causes of cyclical breast pain are not known. Research has shown that low levels of an essential fatty acid called gamolenic acid (GLA) can Both of these can result in continuous or interrupted pain and can affect contribute to cyclical breast pain. Pain can also be associated with starting women both before and after the menopause. The pain can be in the whole to take the contraceptive pill, certain anti-depressant drugs and herbal of the breast, in a specific area or in both breasts at the same time. The pain that you have may be a burning, prickling, stabbing or drawing-in pain.
Diagnosis
What causes non-cyclical breast pain?
Your Doctor will examine your breasts and take a detailed history of the The causes of breast pain that is not linked to the menstrual cycle are often type of pain you have and how often it occurs. To check that the pain is unknown. It can sometimes be related to specific non-cancerous (benign) linked to your menstrual cycle your Doctor will generally ask you to fill in a breast conditions, previous breast surgery or underlying conditions that simple pain chart. (There is a pain chart you can use at the back of this are not directly related to the breasts.
Diagnosis
Your Doctor will examine your breasts and take a detailed history of the
Treatment
type of pain you have and how often it occurs. S/he may also ask you to fill in a pain chart. (There is a pain chart you can use at the back of this booklet.) If Diet and lifestyle changes
your Doctor thinks you may have non-cyclical breast pain, s/he may ask you In many cases your Doctor will be able to reassure you that what you are to lean forward during the examination so that your breasts fall away from experiencing is a perfectly normal part of your monthly cycle. In the first your chest. This can help her/him assess if the pain is within your breast or place, he/she may suggest simple things you can try, such as reducing your intake of caffeine, chocolate and red wine and increasing the amount of fresh fruit and vegetables you eat. You may also be advised to wear a correctly fitting and well supporting bra day and night. Some women have found relaxation therapy, such as relaxation tapes, useful in reducing the symptoms of cyclical breast pain.
If your pain started when you began taking the contraceptive pill, changing Sometimes bromocriptine may be considered. It works by lowering the to a low-dose pill or a different brand may help. If the pain continues, you level of the hormone prolactin. It is also given as a tablet and you take 2.5mg daily. Due to its potential side effects (which can include nausea, vomiting, may want to try a non-hormonal method of contraception such as dizziness, headaches and constipation) bromocriptine is only usually prescribed in very specific circumstances. Its side effects can be reduced by starting at a low dose of 1.25mg and gradually increasing to the full dose. You may find evening primrose oil helpful as it contains GLA. To get the Again, it is important to remember that you may not have any side effects.
recommended daily dose of GLA (240 milligrams) you will probably need to take about three grams. You will usually need to take evening primrose Both danazol and bromocriptine need to be taken for two to four months oil for about six months. If your pain improves during this time you may be for effects to be seen. After this time it may be possible to gradually reduce Both danazol and bromocriptine make the contraceptive pill less reliable, Evening primrose oil generally causes few side effects, but you may so if you are on the pill you should use another method of contraception. experience nausea, an upset stomach or headaches. It is not advisable to You should not take these drugs if you are pregnant, as they are harmful to take it if you are pregnant, trying to get pregnant or if you have epilepsy.
In the majority of women these treatments will be effective in settling Anti-inflammatory medicines
breast pain, but a small number may continue to have pain. If this is the case Research has shown that non-steroidal anti-inflammatory painkillers, such you may be offered other drugs such as tamoxifen and goserelin. as ibuprofen, can help this type of pain. These are particularly effective if applied directly to the affected area, but can also be taken in tablet form. Tamoxifen is a drug more commonly used to treat breast cancer. Research However, before considering using this type of treatment you should be has shown it is also effective in the treatment of cyclical breast pain. assessed and advised by your doctor on the correct dose, how long you should use it for and any possible side effects, especially if you have asthma.
Goserelin works by stopping the ovaries from producing oestrogen, resulting in a temporary menopause. This drug is commonly used as a treatment for breast and prostate cancer. Evidence has shown it can Hormone drugs
improve both cyclical and non-cyclical breast pain If your pain is severe and prolonged and hasn’t improved with any of the It is however important to note that both Tamoxifen and Goserelin
suggestions on the previous page, your Doctor or specialist may want to have side effects. You should see a Specialist before being
consider starting you on a hormonal drug. The drugs used to treat breast prescribed these drugs are prescribed so that you could be
pain are danazol, bromocriptine, tamoxifen and goserelin. These drugs do counseled and carefully monitored for any potential side effects.
have side effects so they are only suitable for use following a thorough discussion of the benefits against the potential risks.
Surgery
If you continue to experience breast pain that is so severe and long lasting
Danazol works by blocking certain hormones produced during the that it disrupts your everyday life, surgery may be an option. This would menstrual cycle. It is given as a tablet and you take 100-200mg daily. Like all mean a mastectomy (removal of the breast). Surgery would only be drugs it can have side effects, including weight gain, acne, absence of considered in extreme circumstances to improve your quality of life, and periods (amenorrhoea), facial hair growth and changes to the voice. It is you would need to discuss all the implications before making a decision.
important to remember that you may not experience any of these.

Source: http://breastcancerindia.org/images/breast_pain.pdf