Mastalgia: understanding and treating breast pain

Do your breasts feel swollen, lumpy and heavy? Are you experiencing various painful symptoms even when nothing is touching them? This could be mastalgia, a chronic or temporary condition that is usually harmless and can affect many women at different stages of their lives. It is estimated that up to 70% of women experience this type of breast pain at some point in their lives. Symptoms, causes, solutions: discover everything you need to know about mastalgia so you can understand this pain and manage it as well as possible day to day.

What is mastalgia?

Mastalgia (also called breast pain) is pain affecting the breasts that is relatively common in women. It can take different forms, ranging from simple breast tenderness to a feeling of tightness and even a sharper, recurring pain resembling the symptoms of a burning sensation.

This breast pain can be continuous or intermittent, and either localised to one area or spread across the whole breast. It can also affect a single breast (in which case it is referred to as unilateral mastalgia) or both breasts (here we speak of bilateral mastalgia). While it mainly affects women, some men can also experience it to a greater or lesser degree and more or less regularly.

Cyclical or non-cyclical mastalgia: an essential distinction

To understand the origin of breast pain, specialists distinguish two main forms of mastalgia:

• cyclical mastalgia, by far the most common, is driven by the menstrual cycle. It most often occurs during the second half of the cycle (the luteal phase, between ovulation and the period), generally affects both breasts and eases when menstruation begins. It is hormonal in origin;
• non-cyclical mastalgia (or acyclic) is unrelated to the cycle. It is more often localised to a single breast and frequently results from a mechanical, dermatological or medication-related cause, or from a benign breast condition.

Identifying which form you are dealing with is a useful first step in pinpointing the cause and guiding the right care.

What are the different symptoms of mastalgia?

The breast pain felt with mastalgia can take various forms, including:

• a recurring shooting sensation in one or even both breasts, which can feel like a cramp;
• breast tension, often associated with swelling of the breasts;
• a burning and/or tingling sensation in the breasts;
• pain in the nipples;
• a lump in one breast;
• visible superficial veins;
• marked discomfort with clothing, particularly when wearing a bra.

What are the most common causes of breast pain?

These various symptoms associated with mastalgia can be explained by multiple and varied causes, which can sometimes even occur together.

The menstrual cycle

Mastalgia is very frequently associated with the premenstrual period and is often a sign that a period is on its way. In this case it is a perfectly normal bodily reaction caused by the unavoidable hormonal changes that accompany menstruation, in particular a progesterone deficiency. These uncomfortable sensations subside on their own once menstruation ends.

Contraception

Contraceptive methods such as the pill, the implant, contraceptive injections or a hormonal intrauterine device (IUD) can cause breast pain and trigger mastalgia. They are generally a sign of a treatment that is unsuited to the patient’s body. If they become too frequent or too intense, it is then necessary to consult a doctor or gynaecologist to adjust the contraception and change the prescribed dose.

The ovulation period

Women’s breasts can become noticeably larger and tenser during their fertile period, particularly in the days before ovulation begins, when the egg is released by the ovary.

Pregnancy

Pregnant women can also feel a certain tension or pain in the breasts, often the first sign of a late period and therefore of a potential pregnancy.

Stress and lifestyle

Stress, fatigue and certain lifestyle habits are also among the factors that can aggravate mastalgia. A high caffeine intake, smoking or an unbalanced diet can intensify breast sensitivity, while a poorly fitted bra keeps the discomfort going. Acting on these everyday factors often helps to ease the pain, alongside treating its main cause.

Breast cancer

Many women who feel pain in the chest area worry that it may be a symptom of breast cancer. Yet very few breast tumours present in this way, apart from inflammatory breast cancer, which affects only 1 to 5% of people with this condition. Breast cancer is in fact very often asymptomatic and requires regular screening (every 2 years), notably through a mammogram or a biopsy if it is suspected. In the vast majority of cases, mastalgia is therefore the sign of a non-cancerous condition that nevertheless still needs to be treated.

A breast nodule or fibrocystic breast disease

In most cases, breast pain is the sign of a benign condition. If the pain is accompanied by a palpable lump, an ultrasound will nonetheless be necessary to determine the origin of this mass. It may then be:

• a cyst, that is to say a fluid-filled mass, sometimes with discharge from the nipple, which is most often harmless and can appear and disappear in line with the menstrual cycle;
• an abscess containing pus, with localised pain in the breast, a fever and redness. It most often occurs after breastfeeding and can usually resolve on its own;
• a fibroadenoma, namely a firm, smooth, painless mass with no rough edges, which often affects young women, particularly before menstruation. It is then very often benign (a fibrocystic nodule). A hard, immobile and irregular lump, on the other hand, requires further investigation (imaging, biopsy) to determine whether the lesion is potentially malignant.

When these lumpy, swollen and tender breasts are accompanied by multiple small cysts and diffuse fibrocystic changes, this is referred to as fibrocystic breast disease (or fibrocystic breast condition). It is a very common benign condition, usually sensitive to hormonal variations, which does not in itself increase the risk of cancer but warrants regular monitoring.

A skin problem

Even if it is not the first thing that comes to mind, the pain or discomfort felt in the breasts (most often accompanied by redness) can also be caused by skin or dermatological conditions such as eczema, psoriasis or a fungal infection caused by a proliferating fungus. These symptoms are most often associated with irritation or even a burning sensation, but do not cause extreme pain except when the layers of the epidermis are excoriated.

An infection

A deeper infection of the skin on the breasts can also cause breast pain. This is most often mastitis, which occurs notably in breastfeeding women or after breast surgery (a breast augmentation with implants or breast lipofilling, a breast reduction or a breast reconstruction after cancer). It generally clears up on its own within a few days, however.

Menopause

Finally, mastalgia can also appear during a dreaded turning point in women’s lives, namely shortly before menopause. This is particularly the case when the pain is especially intense. It is also often associated with other symptoms, including a sharp increase in breast volume, redness, a feeling of heat or visible veins on the breasts. Hormone replacement therapy can also keep breast sensitivity going during this period.

When should you worry about breast pain?

The vast majority of cases of mastalgia are benign and temporary. A few signs should nonetheless prompt you to see a doctor or gynaecologist without delay:

• unilateral, persistent and unexplained pain that does not follow the rhythm of the cycle;
• the presence of a lump or a palpable mass;
• spontaneous discharge from the nipple, especially if it is bloody;
• a change in the appearance of the breast: nipple retraction, orange-peel skin, localised redness;
• pain that persists for more than a month or that intensifies.

In the absence of these warning signs, breast pain is most often harmless; in case of doubt, a professional’s opinion can provide reassurance and direct you to the right examinations (palpation, ultrasound at any age, mammogram from the age of 40).

What solutions are there to overcome breast pain?

The right solutions for mastalgia will mainly depend on the cause behind it.

For hormonal mastalgia

To relieve hormonal mastalgia related to the menstrual cycle, a painkiller such as paracetamol is generally enough to ease the pain. The same is true of infections following a breast surgery procedure, which may nonetheless sometimes require antibiotics (for mastitis in particular).

Other molecules such as danazol or tamoxifen can also be prescribed to regulate the menstrual cycle and even the ovulation period, by regulating oestrogen and progesterone. Massage or the application of essential oils (laurel, palmarosa, chasteberry) is also recommended to relieve the pain.

Natural approaches and lifestyle

For mild, cyclical forms, several simple measures can bring day-to-day relief. Wearing a well-fitted bra, without underwiring and with wide straps, limits mechanical tension, particularly before periods and during physical activity. In dietary terms, reducing caffeine (coffee, black tea, sodas) — a vasoconstrictor that is often implicated — as well as tobacco and fatty foods is frequently recommended. Some patients also turn to evening primrose oil, rich in gamma-linolenic acid, or to magnesium and vitamin E; these supplements are generally well tolerated, even though the scientific evidence on their actual effectiveness remains limited and inconsistent. It is best to discuss them with your doctor before using them.

In the event of pregnancy

If the mastalgia is explained by pregnancy, wearing a more suitable, less compressive bra without underwiring and with wide straps can help to ease the symptoms and relieve breast swelling. Applying a progesterone-based gel can also help to calm the pain.

For breast pain caused by contraception

In the case of pain related to the contraceptive method used, a new prescription from your gynaecologist is strongly recommended, notably with a change of treatment or an adjustment to the prescribed dose.

In the event of a breast nodule

When breast pain results from a cyst or a hard, relatively large fibroadenoma (3 to 4 cm), a surgical procedure to drain the nodule can be performed to relieve the patient. A cancerous tumour, for its part, will obviously require appropriate medical treatment in its own right, in some cases involving a mastectomy, sometimes followed by a breast reconstruction.

For breast pain resulting from skin problems

Finally, for mastalgia due to dermatological problems, a topical treatment in the form of an antifungal cream can be used for a fungal infection. A cortisone-based cream, meanwhile, will help to overcome psoriasis or eczema.

To conclude, most cases of mastalgia can resolve without treatment and occur in line with the menstrual cycle. However, if the pain is intense and persists for more than a month, you should see a doctor or gynaecologist promptly in order to rule out any risk of serious disease and to receive treatment suited to your situation. Finally, be aware that a diagnosis of breast cancer is only very rarely made as a result of breast pain. Self-examination and regular consultations with a specialist are in this respect the best way to protect yourself.