Breast Pain - Breast Tenderness Before Period

Breast pain (also known as breast tenderness, mastodynia, mammalgia, and mastalgia from the Greek μαστός mastos, "breast" and ἄλγος algos, "pain") is a medical symptom. 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.

Types

It can be classified into two main clinical patterns:

• Cyclical when the pain intensity is changing during the menstrual cycle.
• Non-cyclical when the pain remains essentially unchanged during the menstrual cycle. This type is less frequent.

Causes

Cyclical breast pain (cyclical mastalgia) is very often associated with fibrocystic breast changes or duct ectasia and believed to be caused by aberrations in dynamic hormonal changes mainly involving prolactin response to thyrotropin. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS).

Noncyclical breast pain has various causes and is harder to diagnose. Noncyclical pain has frequently its root cause outside the breast. Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause and during pregnancy. After pregnancy, breast pain can be caused by breastfeeding. Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis and medications such as digitalis, methyldopa (an antihypertensive), spironolactone, certain diuretics, oxymetholone (an anabolic steroid), and chlorpromazine (a typical antipsychotic). Also, shingles can cause a painful blistering rash on the skin of the breasts.

Treatment

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.

Iodine supplementation is used for the treatment of fibrocystic breast disease but there is only weak evidence it helps relieve pain.

Breast cancer

The great majority of breast cancer cases do not present with symptoms of pain.