Breast pain

FIn another vein, I should add that most breast lumps (including cancerous ones in the early stages) are not painful; however, breast abscess lump (commoner in breastfeeding mothers) is a major cause of intense breast pain. To appreciate which is what, this requires meticulous sorting out clinically and applying appropriate expertise with ultrasound scan etc to arrive at the true diagnosis as to the cause of the non-cyclical breast pain.   

Cyclical breast pain
Cyclical breast pain is very common. It can first occur at any age after menses start, but most commonly first develops between the ages of 30 and 50 years. It does not occur in postmenopausal women when the monthly periods have stopped.
In many women the symptoms are mild. Indeed, it can be considered normal to have some breast discomfort for a few days before a period. However, in around one in ten women the pain can be severe and/or last longer - up to 1-2 weeks before a period. The 3-5 days prior to a period are usually the worst. The pain usually eases soon after a period starts. The severity usually varies from month to month. Typically, the pain affects both breasts. It is usually worst in the upper and outer part of the breast, and may travel to the inner part of the upper arm.

The breasts may also feel more swollen and lumpy than usual. This lumpiness is generalised so does not lead to a single definite lump forming. This swelling and lumpiness then improve soon after the period starts.
Noteworthy is the fact that physical activity such as jogging can make the pain worse as well as things as hugging children and sexual activity can be painful during this period of breast pain.
Generally, this mode of breast pain is not serious per se; it can be a nuisance sometimes disturbing the quality of life and social concentration.

Causes
The cause of cyclical breast pain in women is thought to be related to the fact that these affected women have breast tissue which is more sensitive than usual to the normal hormonal changes that occur each month. In other words, it is not coming up as a result of excess hormones-related disease or to any problem in the breast itself. 

Is treatment necessary?
Ordinarily, no treatment may be needed if the symptoms are mild. Most women would be reassured knowing that cyclical breast pain is not a symptom of breast cancer or any other serious breast disease for that matter. Usually the issue may get resolved in a short while on its own over a period of 3-6 months. However, in up to 6 in 10 women where the pain has gone, it develops again sometime within two years. So, in other words, cyclical breast pain may come and go over the years. Hence it’s best regarded as an off and on condition.
However, in cases where the pain comes more severe or unusually discomforting, the following approach/treatment options can come handy:

Support the breasts
The affected woman should wear a well supporting bra when the pain comes. It may worthwhile having a well fitted bra as many women actually wear the wrong size of bra. Some women find that wearing a supporting bra 24 hours a day for the week before a period is helpful. It is advised to avoid underwired bras. Similarly, it is best to wear a sports bra when exercising.

Pain relievers
Over the counters medications like paracetamol or ibuprofen can come handy with moderate pain when other physical measures do not help. These are taken regularly when the breasts become unbearably painful.

Topical rub-on painkillers
Rub on anti-pain ointments and gels like topical diclofenac or topical ibuprofen have been shown to help relieve the pain of cyclical breast pain

Consider pills replacement
Sometimes the problems get worse with routine medications being taken. Contraceptive pill or hormone replacement therapy (HRT) may make cyclical breast pain worse. Other drugs like some antidepressants and some blood pressure drugs may also worsen cyclical breast pain. It may then be appropriate to discuss with the doctor to see if it’s appropriate to stop or change the suspected medication and see if this helps.

Hormones blockers
Sometimes drugs like danazol, bromocriptine, tamoxifen and goserelin injections can ease pain in most cases. These drugs work by reducing the level, or blocking the effect of, female hormones such as oestrogen. These needed to be taken regularly and not just when the pain occurs. However, significant side-effects are common with these drugs. Hence, they are reserved as last measures.

Anyhow, if a breast pain becomes more painful than usual and more haphazard in presentation, it is best it’s examined by a doctor who will recommend the appropriate investigations and necessary lifestyle changes.

Commonly, the starting points after clinical examination are referrals for non-invasive ultrasound scan checks, mammography (where applicable in those in their 5th decades and above) and relevant blood hormonal assays.