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Breast Pain: Mastalgia
Breast Pain Is A Common Problem
Breast Pain is one of the most common complaints in women, especially those of reproductive age. In reproductive women, it is often cyclic, occuring in the pre-menstrual phase. In older women, menopause may mean an end to symptoms, but hormone replacement may also cause when there had never been symptoms before. Recent studies show that the rates of breast pain are much higher than had previosly been thought.
Causes Of Breast Pain: Don't Know, But It Isn't Cancer
There is a lack of scientific information about what causes mastalgia Many things have been implicated as causing it. But, few have been firmly proven.
Speculated causes include:
Vitamin defiencies
water retention
mental stress
caffeine or chocolate (containing substances called methylxanthines)
essential fatty acid deficit
Other popular notions have not panned out, in spite of considerable research to document them.
Disproven reasons include:
Estrogen Excess
Progesterone Deficits
Breast cancer is an extremely rare cause of breast pain. Many women discover breast cancer masses because they have pain and therefore check their breasts more carefully. But, the pain is rarely related to the cancer.
Nor do birth control pills contribute.
Reasons that are implicated as causes of breast pain are:
Hormone Replacement Therapy (clearly implicated)
Pre-menstrual phase (clearly implicated, but the exact reasons are unclear)
excess prolactin (some scientific evidence, but not yet solidly proven)
Pregnancy.
Things A Woman Can Do Herself For Breast Pain (Mastalgia)
Even though the evidence isn't clear, it can't hurt decrease caffeine intake. This may help the pain, but will not decrease any nodularity she might have with it.
If it is pre-menstrual and seems to be associated with water retention and PMS, then drink more water. The old adage of restricting salt and even restricting water intake backfires. It simply sets in to motion the body's reactions to retain more salt and fluid. Drinking clear liquids flushes out the system.
Many herbs and viatmins are suggested. Vitamins B and E have been looked at scientifically and have NOT been shown to work. Primrose oil has fairly strong evidence of effectiveness. Vitex agnus castus has some limited evidence.
One of the simpliest solutions is a more supportive bra. Underwire, that is properly fitting, for daytime. High impact, compression bras for sports.
Going To The Doctor For Breast Pain (Mastalgia)
A woman should go to the doctor if the breast pain is interferring with her normal activities. Signs of interference are avoiding body contact (hugs or sex), and avoiding impact activities (sports or running).
She should be ready to answer the following questions about her pain:
When was her last period?
Any chance of pregnancy?
When did it start
Where exactly is the pain?
One or both breasts?
Is it cyclic?
Is she on hormone replacement?
On a scale of 1-10 (10 is worst) how bad is the pain?
The doctor will also do a breast exam in the office. This is essentially the same as a self-breast exam. If a mass is detected, she will follow the procedures for evaluating a breast mass.
Otherwise, mammography will be done only women in the age range where routine mammography is done. This is between 40-50 depending on the standard her doctor uses. Mammography should NOT be done on younger women, when pain is the only symptom or sign.
Mammography should be scheduled during the least painful times, if the pain is cyclic. Pain medication can be given one hour before the test also. However, this usually means that someone else will have to drive or go with the woman to the test because she will be somewhat sedated.
What Doctors Can Do For Breast Pain (Mastalgia)
If there are no other breast diseases, and the women has tried the self-help methods, then the doctor can move on to pharmacology. For women on hormone replacement, the first thing to try is lowering the dose.
There are three drugs show to be effective in breast pain, but all have high risks. Bromocriptine is one. A woman cannot be one this one long-term due to the side effects. Danazol is another with the same limits. However, some doctors are expeimenting with using it only in the the pre-menstrual phase. This has been shown to lower its side effects. It has yet to be proven that the longer term, more silent risks are also decreased significantly. The last drug is Tamoxifen. While very effective for breast pain, Estronaut had doubts its risks are wothit for breast cancer prevention. So, its use for breast pain is discouraged.
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