Healthy Woman: Understanding Breast Pain

N E W   Y O R K -- Tender breasts are just one of the many uncomfortable and annoying symptoms millions of women experience prior to their periods.

While most women have just mild breast discomfort, others experience more severe pain each month. And some women have breast pain that is not associated with their menstrual cycle, which is known as noncyclic pain.

Sudden or severe breast pain is often a very alarming symptom for women. Breast pain is not usually a sign of breast cancer, but experts say it's important that women with breast pain, particularly severe pain associated with their menstrual cycle, or any kind of noncyclic pain, be evaluated for breast cancer.

"The reassurance is a big part of the evaluation of breast pain," says Dr. Sandhya Pruthi, the section head for the Breast Diagnostic and Cancer Clinics at Mayo Clinic in Rochester, Minn.

Below, Pruthi and other members of the team at Mayo's Breast Diagnostic and Cancer Clinics, Dr. Robin Smith, and Jennifer Hazelton, a clinical nurse specialist, talk about the most common causes of breast pain, as well as strategies for easing the pain.

What are the most common kinds of breast pain?Dr. Robin Smith: The breast pain that women experience has been broken down into three primary types. The first is called cyclic mastalgia, and this is pain that is associated with the menstrual cycle. Typically a woman's symptoms start within the two weeks prior to her menstrual cycle, worsening until the onset of her menstrual period, and then they tend to get better. Some women have pain throughout the entire month, but it improves and worsens according to the time in the cycle.

The second type of pain that women experience is called noncyclic mastalgia, which is pain that may be intermittent or constantly present, but does not appear to be associated with the menstrual cycle at all.

And the third type is breast pain that is actually pain from another source, such as the chest wall. Conditions such as costochondritis, caused by inflammation in the rib joints, can sometimes be perceived as breast pain, as can a number of other medical conditions in the same area.

How do women describe their symptoms?Smith: Women with cyclical breast pain tend to experience pain in both breasts. It is often described as heaviness, aching, or fullness. It seems as though the patients with noncyclic breast pain have pain that can involve both breasts, but it's more often one-sided, and it tends to be localized to one area in the breast. Sometimes patients will use terms such as "sharp" or "burning" to describe it.

There's a wide spectrum in terms of severity because we often pick up breast pain simply by asking patients about their breast symptoms, and most of these women are not very bothered by their pain. Other women actually do have pain severe enough to cause interference with school and work, their physical activities, leisure activities and sexual activity.

Why do hormonal fluctuations cause breast pain?Smith: I wish we had the answer to that. It seems obvious to all of us that there's a hormonal role in the cyclical type of breast pain, because it changes with the menstrual cycle and it tends to improve with changes in hormones, such as pregnancy or with menopause.