CYCLIC PAIN
Do you experience breast pain? There are many causes of breast pain and this post will explore all of
them so that you can be “in the know” when it comes to your own breast health. I’ll also explore what
you can expect when you go to a doctor through my own experience as a doctor.
The good news is that most causes of breast pain are benign (non-cancerous). We can divide breast pain into several categories:
- Physiologic-related to such things as hormones, amount of sodium in our bodies or thyroid
function - Mechanical-related to overuse of sports bras, very tight underwire bras, ill-fitting bras
- Inflammation-underlying medical conditions such as allergic reaction, underlying autoimmune
conditions - Pathologic-such as a tumor situated on a nerve or several nerves that causes breast pain
Questions Your Doctor May Ask
Many questions that I ask my patients as a physician:
- How long has the pain been present?
- Is it present in one or both breasts?
- Is it symmetric or asymmetric?
- Can you describe the intensity of the pain specifically?
- Is it a dull aching, throbbing, or sharp pain?
- Tell me about the frequency.
- Does it occur only before menstrual cycles or in the middle of the month (during ovulation)? If you are unsure about the duration of your menstrual cycle, you could always use an ovulation test to track when you are ovulating. This is also useful to know for women who are trying to get pregnant. For more information about ovulation tracking, head to the Countrywide Testing website.
- If the pain is completely new for you, is there anything you did in particular just preceding the
onset of the pain, such as a long flight (involving a time change)? - What changes the circadian rhythm of many hormones of your body?
- Was there a significant stressor such as loss of a family member or caring for a close friend or
family? - Were you just starting a new workout regimen after being less physically active?
These questions help identify one of the 4 causes of breast pain so it’s important that you pay close
attention to the pain and to your body so that you can accurately answer these questions when you visit your doctor.
Physiologic
Physiologic is usually the most common cause of pain as we cannot specifically change our hormones. This is usually the easiest to recognize when we usually find a rhythm to it, such as symptoms are worse during Mittelschmerz (time of ovulation) or right before or during our menstrual cycle. This pain typically gets better after the cycle.
Physiologic pain usually involves both breasts, more so in the upper-outer or the front of the breast
behind the nipples.
There are some factors that you can change in order to try to balance out the hormonal issues.
- Knowing that the hormones are big molecules and cause large influxes of fluid, one can try to
decrease the amount of fluid within the breasts by exercising. Even though your breasts might
be more achy, the movement of the breasts can increase lymphatic flow. - Decreasing salt intake to a physiologically normal daily level can help as well.
- Eliminating extra sugars. Note that both sugars and salt are solutes and retain water, so you
want to minimize these as much as possible. - Minimize the use of restrictive sports bras or tight underwire bras during this time.
- For my patients, I also introduce the new concept of lymphatic massage, which is a very light
upwards motion massage starting from the bottom of the breast, moving upward towards the
axilla or towards the clavicle on both sides.
All of these techniques may help to ameliorate breast pain so you may want to try them before visiting your doctor.
Mechanical
If the pain is mechanical, it is one of the most idiosyncratic and hardest category to diagnose. When
women have breast pain, they tend to try to stay in tight clothing because they think that the restrictive movement makes them feel better. This may make the breast feel better, but this is a fallacy. The temporary relief that this provides actually makes the whole condition worse by compressing the lymphatics within the breast and within the skin, which is the main egress of tiny vessels just slightly larger than the size of a hair, and primarily drains the breasts instead of veins. The veins are in a web-like structure throughout the breasts following the nerves, arteries, and veins, as well as very large concentrations around the nipple/areola and skin of the breast. Tight compressive garments tend to impede the flow of fluids, therefore increasing the amount of fluid within the breast which typically causes breast pain in the front of the breast.
Again, using the same techniques that we just discussed, but in different order, is the main remedy for this type of pain. We recommend removing the sports bra as soon as possible after exercise and replace with a comfortable supportive bra that is non-compressive and to use the breast massage technique, as instructed above with a light touch starting from the lower breast to the axilla or the clavicle. Use a whisking or paint-brush type of technique lightly painting the landscape of a canvas. Other techniques include:
- Slight bouncing
- Moving your arms
- Lowering salt and sugar intake
- Try to minimize alcohol, which not only contains a large amount of sugar, but is a diuretic and
causes fluid disturbances.
Some women may have experienced more pain when their regular supportive bra is off after a long day of work, especially in women with large breasts. In this case, there is usually a pulling sensation from the upper breast on both sides when the bra is taken off and the breast feels better when it is supported. This is a different kind of pain known as Cooper’s ligament stretch. To ameliorate these symptoms, the use of a supportive bra that is not too compressive or tight may be helpful. Sleeping in a comfortable T-shirt or stretchy Cammie at night may help as well.
Inflammation
It is surprising how many conditions can affect the water content of the breast. Any process that causes inflammation in the body may cause breast inflammation. A moderate number of my patients have underlying autoimmune conditions such as celiac disease, gluten intolerance, Hashimoto’s thyroiditis, rosacea, inflammatory arthritis, and type 1 diabetes.
There is overall increase of fibrous tissue typically in the breast which may retain more water and cause more breast discomfort. Treating the underlying medical condition usually is the best way to improve breast health and decreasing extra fluids in the breasts (often called cysts), decrease breast pain. Note that the above techniques may also be helpful in this category as well. Prediabetes/hypoglycemia is a precursor to metabolic syndrome and is becoming much more common than when I started practicing. Our diet is more to blame probably than our sedentary lifestyle and genetics plays a strong role as well. If you have had gestational diabetes or problems with hypoglycemia/hyperglycemia, you may want to watch out for this in your medical history. Good dietary and exercise habits is the primary treatment.
Pathologic
The very least common reason for breast pain is pathologic. It is more often a focal single area within
the breast, usually reproducible, especially if it is associated with any change of the breast such as
discoloration or thickening of breast tissue or breast lump and the patient should seek immediate
medical attention. Workup, depending on your age, may at least include an ultrasound and potentially a mammogram or MRI.
Although cysts are the most common reason for finding a breast lump, even the best physician cannot discern a solid breast lump or breast cyst by clinical examination alone, so further examination is necessary after clinical imaging in order to determine whether the breast lump is cystic or solid. A dominant cyst could be easily aspirated for immediate resolution of pain. A constellation of small cysts may be treated medically with the recommendations as above, as they may be too numerous to aspirate. Again, correcting underlying medical conditions such as stress or use of tight sports bras is always imperative.
Do you have any questions about breast pain? I’m happy to address them in the comments below!
The Women’s Imaging Center uses highest rated digital mammography systems made by Hologic Dimensions and Selenia. We offer breast mammography, ultrasound and other imaging services in Denver (Cherry Creek), Lakewood, Highlands Ranch and Westminster.
Call 303-321-CARE (2273) to schedule an appointment or make an on-line appointment request.
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