Breast Pain
Additional Facilities
Breast Pain We hold a nurse-led breast pain clinic run by Fiona Andersen to enable adequate time and expertise to be offered to an often neglected group of women sufferers. For appointments see contacts.
THE TYPES AND CAUSES OF BREAST PAIN
The medical term for breast pain is mastalgia and it is regarded as a symptom not a disease. Mastalgia is common and affects 50 - 70% of all women at some time in their lives.
It is the commonest symptom for breast related consultation in General Practice and for patients attending a Breast Clinic.
There are different types and patterns of breast pain which normally relate to the underlying cause.
The most common pattern is cyclical breast pain which means it shows a definite relationship to the menstrual cycle, almost always pre-menstrual, with a duration varying from a few days, up to four weeks. Women who suffer from this type of pain nearly always have nodularity of a varying degree which is usually in the upper outer part of the breast.
The severity of this type of pain also varies a great deal and a breast pain chart may be helpful in trying to obtain a more objective assessment of this, and is particularly helpful in determining the response to any treatment that might be required.
Click here for a printable chart to track any Breast Pain you may have.
A few days discomfort or pain just before the start of a period, which may be associated with a feeling of fullness, heaviness and a nodular feel to the breasts, is normal and rarely needs' any specific treatment. The reasons why some women get no cyclical pain and others may experience both intense and prolonged pain is not fully understood.
Mastalgia shows many features which suggest that it has a hormonal basis, but no consistent hormonal abnormalities have been identified.
Hormonal agents which ease breast pain act at different levels of the hypothalamic - pituitary (in the brain) - ovarian - breast pathway or axis, and this makes it likely that breast pain has different causes, with several factors inter-reacting, or that it is more simply caused by an oversensitivity of the milk glands, milk ducts and supporting tissue of the breast to hormones, especially oestrogen and prolactin. This increase in sensitivity of the breast is often linked to the pattern of fatty acids in the blood stream. Fatty acids are substances present in all fats and oils and these can affect the way the body responds to its own hormones. Women with breast pain after have low levels of a fatty acid called gamolenic acid (GLA). These low levels are not caused by dietary deficiencies, but by an inefficient conversion process in the body.
Water retention within the breast has been suggested as a cause of mastalgia, but studies have shown this is not true. Studies have also shown that diuretics (water tablets) do not help in the treatment of breast pain.
This type of breast pain is not caused by infection and antibiotics should not be taken. In the past this complaint was sometimes called chronic mastitis which made it sound like an infection, and this term has now been abandoned.
Non-cyclical mastalgia is distinguished by its lack of relationship with the menstrual cycle. Once again this can be demonstrated best by keeping a pain chart. The pain may have a random time pattern or be continuous and tends to occur in an older age group, even in post-menopausal women.
Non-cyclical breast pain tends to be more central and more often affects one breast only. It is variously described as burning, drawing, pricking or stabbing and lasts from a few moments, up to days at a time. Nodularity is found less commonly than in women with cyclical breast pain. It may also be hormonally related, or associated with abnormalities of the fatty acids, it may be caused by other, more specific, benign breast changes. For example, abnormalities of the major milk ducts, within and just beneath the nipple, which is called duct ectasia can cause breast pain and may also result in nipple discharge.
Previous operation may produce a painful scar and trauma can also produce changes called fat necrosis which can be painful.
A benign (non-cancerous) condition called sclerosing adenosis can cause breast pain. It consists of changes in the lining of the milk glands and ducts which distorts the normal pattern and produces thickening of the breast tissue.
Pain felt in the region of the breasts, but not arising from the breast itself is the third category under which mastalgia is normally classified. Conditions that might cause this type of pain include angina, gall-stones, arthritis of the spine, hiatus hernia, nerve entrapment syndromes like carpal tunnel or cervical rib, pleurisy or chest infections.
Causes from the chest wall under the breast may arise from the muscles (myalgia) or the intercortal nerves (neuralgia) or from an unusual condition known as Tietz's syndrome. This causes swelling of the junction between the bony ribs and cartilages of the sternum (breast bone) and is felt in the inner part of the breast.
In these types of breast pain simple painkillers like Aspirin or Paracetamol may be helpful. In more severe cases pain drugs like Diclofenac (Voltarol) or Ibuprofen (Brufen) can produce good pain relief. Local injections of steroids in the Tietz's syndrome may also work well.
Breast Care leaflet given to patients in the nurse led breast pain clinic
BREAST PAIN
More than half of all women will experience significant breast pain or discomfort at some time during their reproductive life. Normally this is a feature of benign breast changes and hardly ever associated with breast cancer. The precise cause is not known but it appears to be related to effects of normal female hormones on the milk glands and milk ducts of the breast. These are often firmer or harder than the surrounding softer fatty tissue in the breasts and it is this which makes them feel lumpy. After a full examination and special tests where appropriate we are normally able to confirm its benign nature. Having been reassured there is no cancer present most women are able to cope with the discomfort. Helpful simple measures to ease the situation include wearing a good supporting or even a sports bra, including at night if necessary, and using pain killers such as Aspirin or Paracetamol when the pain is a little more severe. If the symptoms are really troublesome there are medications which have been shown to bring relief to some, but not to all, women and these can be tried in turn. I usually start with the one least likely to cause side effects which is Evening Primrose Oil. It can be bought from a chemist or supermarket without prescription.
There are many different preparations of Evening Primrose Oil containing varying amounts of the active ingredient Gamolenic Acid. The chemist can advise about the dose contained in these, aiming to take approximately 120 - 160mg of Gamolenic Acid twice daily. Often EPO does not give instant relief and it needs to be taken for up to four months before you can decide if it is helpful or not. If it has not helped by the time four months is reached then it is not going to be effective.
The following can only be obtained on prescription - Danazol 100mg once daily or Bromocriptine 2.5mg twice daily. Although usually well tolerated in the doses suggested they may cause side effects which include fluid retention and weight gain. (Your chemist can tell you about the full range of side effects for the drugs they prescribe.)
I am sometimes asked about antibiotics and diuretics (water tablets) but there is no evidence that they help at all in this condition. The pill has an unpredictable effect on breast pain. Some women find it helps and others do not. Some women only experience breast pain after starting the pill but this is unusual. Hormone replacement therapy (HRT) causes breast pain in about one in ten women and a change to a lower dose or a different HRT may help. Diet seems to have little proven effect on breast pain, but it may be worth trying to reduce fatty foods and coffee intake. If all this fails there are some other drugs which can be useful but these are available on a "named patient" basis and only available through the Breast Clinic.
We run a Breast Pain Clinic led by a nurse specialist and you may ring for an appointment on 01622 225743
If you get desperate ask your doctor to refer you back.
Breast Care leaflet given to patients in the Breast Pain Clinic
HOW COMMON IS BREAST PAIN?
Breast pain is very common. Two out of three women suffer from breast pain- at some time in their lives. Breast pain can be worrying for women, but most breast pain can be treated and is rarely a sign of breast cancer on its own.
THERE ARE TWO TYPES OF BREAST PAIN
Pain related to the menstrual cycle (cyclical breast pain)
Pain related to your cycle (non-cyclical breast pain)
WHY DOES BREAST PAIN HAPPEN?
Breast pain is often caused by abnormal sensitivity of breast tissue to normal female hormones. Breast tissue is influenced by the hormones which control your periods. From the time of ovulation, generally half way between periods, the hormones build up and then fall rapidly once the period starts. For some women breast tissue is more sensitive even though their hormone levels are normal and therefore in the few days leading up to the period many women feel discomfort in their breasts. Sometimes this can be bad enough to interfere with daily activities and is often accompanied by considerable lumpiness. This combination of pain and lumpiness is known medically as fibrocystic change (fibrocystic areas within the breast which are common and due to normal changes within the breast tissue) and is not related in any way to breast cancer
This increase in sensitivity is often linked to the pattern of fatty acids in the blood stream. Fatty acids are substances present in all fats and oils which can affect the way the body responds to its own hormones. Women with breast pain often have low levels of a fatty acid called Gamolenic Acid (GLA). Low levels of GLA are not caused by dietary deficiencies but by an inefficient conversion process in the body.
Pain on its own is rarely a symptom of breast cancer, but your G.P. may want to refer you to a specialist to ensure that there are no underlying causes of the pain. For example, cysts (non-cancerous fluid filled sacs) can often cause pain which may disappear when the cyst is drained and some breast pain is due to inflammation of the rib cage or muscular/skeletal problems.
WHAT CAN BE DONE FOR BREAST PAIN?
Having been reassured that there is no cancer is often all a woman needs to cope with her breast pain. There are some simple measures that can be taken to help.
YOUR BRA
Many women do not wear the correct size of bra which can make breast pain worse. Underwired bras can also worsen the pain. You need to make sure that your bra fits properly and is supportive. The breast care nurse specialist can advise you about this or you can visit a specialist fitter. Most large department stores now have a lingerie department with fitters available.
PAINKILLERS
Simple Pain killers such as paracetamol or aspirin can help ease the discomfort of pain.
DIET
There is evidence that increased breast sensitivity can be related to the balance between saturated and unsaturated fats, so adjusting your diet, reducing animal fats and increasing your intake of fresh fruit and vegetables may help. Reducing your intake of caffeine may also help. If these simple measures fail to make a difference then there are other options.
GAMOLEMC ACID (GLA)
Is the recommended treatment for breast pain. It is well tolerated with few side effects (main side effects: nausea, loose motions, slow response to treatment). 60% of patients respond to this treatment. It is found in evening primrose oil (EPO) or star flower oil (SFO). It is important to take the correct dose. Different products of EPO and SFO contain different amounts of GLA. The amount of Gamolenic Acid in these preparations should be stated on the bottle and the chemist or health food store assistants should be able to advise you. You need 320mg of GLA per day. A more recent preparation is Efamast 80, the dose of which is 2 tablets twice daily. The relief of breast pain is not always immediate with GLA. It can take up to four months before you feel any benefit. If there is no reduction in your pain by this time then it is not going to work for you.
PRESCRIPTION ONLY DRUGS
It is important to be reviewed in the nurse-led Breast Pain Clinic to see if the GLA has worked. You will be given a follow up appointment when you leave. There are other drugs that can be given, mainly Danazol and Bromocrlptine.
DANAZOL
This drug works by counteracting your own hormones and is effective in 70% of patients. However, it has a higher side effect profile such as weight gain, nausea, grey skin and lowering of the voice (in 5% of patients). The once daily dose of l00mg can be adjusted to reduce symptoms. Danazol should not be combined with the pill and it is important to avoid pregnancy during treatment.
BROMOCRIPTlNE
This drug works by reducing prolactin levels (prolactin milk producing hormone) and is effective as GLA but has a higher incidence of side effects such as nausea and dizziness. The usual dose in this condition is Bromocriptine 2.5mg.
Treatment with hormones is generally continued for six months and many women will need no further treatment.
Women often ask about antibiotics and diuretics (water tablets), but there is no evidence that they help as treatment for breast pain. The pill has an unpredictable effect on breast pain with some women finding it helps reduce pain and others not 'HRT causes breast pain for about one in ten women and a change to a different HRT or a lower dose may help.
If you have any concerns about breast pain in the meantime you Can telephone:
Fiona Anderson, Breast Care Nurse 01622 225743
