Types of breast pain
Doctors distinguish three options. Cyclic mastalgia is associated with hormonal fluctuations, usually bilateral, feels like fullness and heaviness, often in the upper outer parts and can radiate to the armpit. Non-cyclic is often one-sided and local, it can be burning or stabbing. Extramammary pain does not come from the gland: with osteochondrosis, inflammation of the costal cartilages, stretching of the pectoral muscles, intercostal neuralgia. Separation is important because examination and treatment depend on it.
- Cyclic - intensifies 3-7 days before menstruation
- Non-cyclical - without connection with the cycle, most often after 40 years
- Extramammary - from muscles, ribs, nerves
- Pain during pregnancy and feeding - a separate group
Possible reasons
Cyclic pain is explained by the sensitivity of the gland tissue to estrogen and progesterone: in the second half of the cycle, the tissue swells and hardens. It can be enhanced by fibrocystic changes. Non-cyclic pain is caused by cysts, inflammation, trauma, breast surgery, and some medications. Insufficient support for heavy breasts leads to tension in the ligaments and pain in the evening. Tumors rarely manifest themselves only as pain, but it is necessary to exclude them in case of local persistent pain.
- Hormonal fluctuations in the menstrual cycle
- Fibrocystic changes, cysts
- Mastitis and lactostasis
- Hormonal contraception and replacement therapy
- Some antidepressants
- Uncomfortable bra, large breast size
What may accompany the pain
With cyclic mastalgia, the pain is accompanied by engorgement, sometimes fine granularity of the tissue, which goes away after menstruation. Signs not related to the cycle are alarming: dense nodular formation, change in breast shape, discharge from the nipple, redness of the skin. It is useful to mark the days of pain and its severity on a calendar for two to three months - such a diary helps the doctor distinguish cyclical from non-cyclical pain.
- Engorgement and swelling of the glands
- Increased nipple sensitivity
- Tissue grain before menstruation
- Heaviness and pain in the evening
- Referring pain to the armpit or arm
Survey
The mammologist finds out the connection between pain and the cycle, the use of hormonal drugs, heredity, and examines the glands, nipples and lymph nodes. Women under 35–40 years old usually start with an ultrasound of the mammary glands, older women - with mammography, often in combination with ultrasound. Examination and ultrasound are best performed in the first half of the cycle, when the tissue is less swollen. If a mass is found, the doctor decides whether a biopsy is needed. If chest wall pain is suspected, consultation with a neurologist or an ECG may be required.
- Examination and palpation of the mammary glands
- Ultrasound of the mammary glands
- Mammography by age
- Biopsy if a suspicious formation is identified
- ECG for chest pain
Treatment and relief
If the examination does not reveal changes, most often it is enough to calm down and change habits. A well-fitted, supportive bra, including a sports bra and one for sleeping on pain days, will noticeably reduce discomfort. For relief, you can use topical gels with non-steroidal anti-inflammatory drugs as recommended by your doctor. If pain occurs due to hormonal medications, the gynecologist can adjust the regimen. For severe, cyclical pain that disrupts your life, your doctor will discuss other drug treatment options. Cysts and inflammation are treated according to individual indications.
- Comfortable, supportive bra
- Local NSAIDs as prescribed by a doctor
- Correction of hormonal therapy by a gynecologist
- Limit caffeine if association noted
- Regular examination by a mammologist and mammography according to age
