What Is Mastalgia?

Mastalgia is a medical term for breast pain. It’s a common affliction in women, with discomfort ranging in intensity from relatively mild to severely distressing. Breast pain may originate in a single spot, in several locations, or be referred from another part of the body, typically the chest, rib cage, or underarms. Mastalgia has a variety of causes, sometimes linked to hormone production and sometimes independent of it. The source of the pain is typically benign and often clears up on its own; cancer is only rarely involved. 

A number of treatment options are available for breast pain, depending on a woman’s age, health, medical history, and whether there are associated symptoms. To learn more about mastalgia, including diagnosis and treatment options, turn to the women’s health team at Baptist Health.

Symptoms 

Mastalgia is a condition that impacts many women and causes breast pain. It is quite common for women to visit a doctor about breast pain. And it is important to note, that more often than not, the breast pain is not associated with breast cancer. Symptoms of mastalgia include:

• Breast tenderness
• Sharp or burning pain
• Tightness in breast tissue
• The experience of pain will vary in severity and may come and go, or feel more constant.

Types of Mastalgia?

There are two primary forms of mastalgia, and their symptoms vary accordingly:

Cyclical Mastalgia

Cyclical mastalgia is linked to the hormonal fluctuations of the menstrual cycle. Pain is reoccurring, typically beginning a week or more before the start of a woman’s period. The breasts are tender and swollen but improve following menstruation. Cyclical mastalgia is the most common form of the condition, primarily affecting women during their reproductive years. 

The symptoms of cyclical breast pain are:

• A dull or achy pain that occurs at the same point in the menstrual cycle every month 
• Swelling
• Heightened sensitivity of the upper and outer parts of both breasts
• Allied pain in the underarm region

Noncyclical Mastalgia

Noncyclical mastalgia occurs without any relation to the menstrual cycle. It is most frequent in women after menopause. The pain may be continual or episodic. Noncyclical breast pain appears to have a number of potential causes, including costochondritis, which is an inflammation of the interface between bone and cartilage in the rib cage. 

The symptoms of noncyclical mastalgia are:

• Breast pain unrelated to the menstrual cycle
• Constant or intermittent discomfort, described as breast soreness or a burning sensation
• Localized pain affecting only one breast (hormone-driven pain tends to affect both).

Causes

The precise cause of breast pain isn’t always identifiable. Medical research has indicated a variety of possible contributing factors:

• Breast size: Large breasts overtax ligaments in the chest, while also stressing the shoulders, neck, and upper back. 
• Breast structure: Changes in breast structure, including breast ducts and glands, or from traumatic tissue injury or the development of cysts, can be a source of pain. 
• Breast surgery: Invasive surgical procedures, especially those that lead to scarring, can result in noncyclic discomfort. 
• Chest wall pain: Activities that irritate chest muscles, including the pectoralis major, can radiate pain to the breasts. 
• Diet: Fat imbalances and caffeine consumption have both been tied to increases in breast sensitivity and pain.
• Hormones: Cyclic mastalgia is strongly linked to the imbalance of hormone levels or hormonal fluctuations of the menstrual cycle. 
• Medications: Certain medications, including infertility treatments, birth control pills, and over-the-counter antidepressants, may contribute to mastalgia. 
• Pregnancy: Pregnancy is a frequent source of breast pain. 
• Smoking: Smoking increases epinephrine levels, which sensitize the body to pain.

Diagnosis

Diagnosing mastalgia requires eliminating other possible explanations for breast pain. Diagnosis typically involves the following steps:

• Physical examination: Your OB-GYN will ask about your symptoms and record your medical history, including information about ovulation, etc. He or she will want to know the location, intensity, and frequency of the pain that you’re feeling.  
• Breast exam: The second step is a breast exam. Your physician will look for changes in breast structure or appearance, which may indicate the presence of a cyst or tumor. In case your breasts feel lumpy, your healthcare provider may check for fibrocystic breast changes. He or she will also examine the lymph nodes in your underarms and neck for swelling or tenderness.  
• Mammogram: A mammogram may be performed if your physician finds a lump or thickening of the breast, or an area of concentrated pain. 
• Ultrasound: An ultrasound can provide visual images of the breast that supplement the findings of the mammogram. 
• Breast biopsy: On occasion, your physician may also collect a breast tissue sample for biopsy in a medical lab. This will be done only if he or she sees evidence of a serious medical condition, for example, a possible cancerous lesion or lump. 

The diagnosis of mastalgia will be made if no other cause for breast pain can be identified. 

Treatment

Mastalgia treatment involves:

• Elimination of physical factors: Selecting a bra that provides good structural support of the breasts reduces physical fatigue and irritation.  
• Use of anti-inflammatory medications: Taking a nonsteroidal anti-inflammatory (NSAID) medication can help control pain. NSAIDs are available in both pill and cream form. 
• Changes in birth-control medication: Birth-control medications have been linked to breast pain so changes in prescription or usage may have a positive impact. 
• Taking a prescription medication: The Food & Drug Administration (FDA) has approved the use of danazol for the treatment of mastalgia. Also utilized is tamoxifen, a breast-cancer medication. Both of these drugs carry the risk of serious side effects. 
• Altering intake of menopausal hormone therapy: Changes in dosage, or stopping hormone therapy altogether, may lead to a desirable outcome. 

Absent an underlying pathology such as cancer, the outlook for breast pain is mostly favorable. According to one source, remission of symptoms often occurs within three months to three years of the condition’s onset, though recurrence does sometimes occur.

Prevention

There are a number of things you can do to lessen the likelihood of mastalgia or to improve your prospects for treatment. These include:

• Wearing a bra that provides adequate support, including sports bras for physical exercise
• Following a diet that substitutes complex carbohydrates for fats
• Stopping tobacco use
• Reducing caffeine consumption
• Utilizing relaxation therapy techniques especially during your menstrual period
• Applying hot or cold compresses during flareups
• Documenting when and where you experience breast pain, to share with your physician when undergoing diagnosis

Learn More About Mastalgia from Baptist Health

For more information about mastalgia diagnosis and treatment, schedule an appointment with your primary care physician or gynecologist.