mastodynia, mastalgia, mammalgia, breast tenderness, gynaecomastia
Pain and discomfort may range from minor to severely incapacitating. Breast pain during lactation or after weaning is not included into this definition but is usually classified as breast engorgement or mastitis.
Some women fear that breast pain is associated with breast cancer. According to the National Breast Cancer Centre, breast pain (or mastalgia) is a relatively common breast change and most women at some stage in their lives will experience it.
Breast pain alone is rarely an indication of breast cancer, however any unusual persistent pain, especially in one breast, should be carefully investigated by your local doctor. All women are at risk of developing breast cancer.
However the greatest risk factor is increasing age, with over 70 per cent of breast cancers found in women over 50. Women of all ages should be aware of their breasts so they can notice any changes and seek medical advice promptly if they are concerned at all about any changes.
Two types of breast pain
The most common type of breast pain is cyclical which occurs just prior to or during the menstrual period. This pain, which may vary in severity, is normal and relates to changes in hormone levels at this time. Non-cyclical pain may come from the breast but is unrelated to the menstrual period. It is more common in older women before and after menopause. Women should talk to their doctor if a sharp or stabbing pain begins suddenly, continues and is confined to one spot in the breast. Another form of non-cyclical pain comes from elsewhere in the body but may cause pain in the breast area. This type of pain often involves the bones, joints or muscles.
Main causes of breast pain:
Although many people only associate breast problems with women, men can also be affected. Gynecomastia (GM) is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. Gynecomastia presents with recent onset of tenderness and pain in the breast. Breast pain can also be associated with liver damage from alcoholism, injuries, medication use, shingles or mastitis.
Danazol, an estrogen biosynthesis inhibitor, tamoxifen, an antagonistic modulator of the estrogen receptor, and bromocriptine, a prolactin-lowering D2 receptor agonist, are the main drugs used in the treatment of mastodynia, and a meta-analysis of clinical trials reported that all three have been found to be significantly effective in the treatment of the condition.
Pain may be relieved by the use of non-steroidal anti-inflammatory drugs or, for more severe localized pain, by local anaesthetic. Pain may be relieved psychologically by reassurance that it does not signal a serious underlying problem, and an active life style can also effect an improvement.
Breast pain may be associated with several diseases including:
Anovulation is when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulation is a common cause of infertility. Anovulation is usually associated with specific symptoms. However, it is important to note that they are not necessarily all displayed simultaneously. Amenorrhea (absence of menstruation) occurs in about 20% of women with ovulatory dysfunction. Infrequent and light menstruation occurs in about 40% of women with ovulatory dysfunction. Another potential symptom is irregular menstruation, where five or more menstrual cycles a year are five or more days shorter or longer than the length of the average cycle. Absence of mastodynia (breast pain or tenderness) occurs in about 20% of women with ovulatory problems.
Hyperprolactinaemia or hyperprolactinemia is the presence of abnormally high levels of prolactin in the blood. Normal levels are less than 500 mIU/L [20 ng/mL or µg/L] for women, and less than 450 mIU/L for men.
Prolactin is a peptide hormone produced by the anterior pituitary gland that is primarily associated with lactation and plays a vital role in breast development during pregnancy.
Women who are not pregnant or nursing may begin producing breast milk. Some women may experience a loss of libido (interest in sex) and breast pain, especially when prolactin levels begin to rise for the first time, as the hormone promotes tissue changes in the breast.
In men, the most common symptoms of hyperprolactinaemia are decreased libido, sexual dysfunction (in both men and women), erectile dysfunction, infertility, and gynecomastia.
The great majority of breast cancer cases do not present with symptoms of pain.
Failure of the ovaries to release an oocyte over a period of time generally exceeding 3 months.
The presence of abnormally high levels of prolactin in the blood.