Breast health

The mystery of breast pain — and how to solve it

by Dixie Mills, MD, FACS

Breast pain is a concern for women of all ages in Western industrial countries. Because we have been taught that pain means something is wrong, women often jump to the conclusion that breast pain must be cancer. However, breast cancer has few warning signs, and pain is rarely a symptom of the disease. Mastalgia, the medical term for breast pain, has not been that well studied, partly because even to this day most scientists are men and don’t have a problem with breast pain. The causes of breast pain are not well understood, and therefore the treatments are a bit unclear also. But there are therapies we use at Women to Women that may work for you.

Diagnosing breast pain

Although very few complaints of breast pain are actually breast cancer, it is every woman’s first fear and she should see her health provider to rule this out. A breast exam needs to be done to be sure there is no lump, and an ultrasound should be performed to be sure there is nothing hidden. It is so important that a woman not let fear prevent her from taking this initial step. When you feel something out of the ordinary, the majority of the time it will be benign, but it is always a signal from your body for attention.

For many women, it’s very useful to track their breast pain and any other symptoms of hormonal imbalance during their menstrual cycles. I’ve so often seen persistent breast pain three out of four weeks of the month to indicate hormonal imbalance, and for women in their 40’s, this is sometimes one of the first signs of perimenopause.

The place to begin to understand any mystery is to collect information about the problem, try out a few solutions, collect more data, sit with it, and then discover what works best for you. Most women were never taught much about the breast itself or to look at it as the miracle organ it is, with the power to transform water, protein and blood into milk. Breasts are made of a mixture of fat, fibers and glands. The glands or ducts and lobules are ready to make milk and prepare to do so each month during our menstrual cycle. The fibers, like strands of thread or rope support the breasts and hold up the glands. The fat cushions and stuffs up the breast. Different women have differing amounts of these three components, which are determined by our genes. Our breasts change throughout our life, from puberty through childbearing and nursing years to old age. They also change monthly with our menstrual cycles.

Causes of breast pain — cyclical mastalgia

The most common type of breast pain is related to our hormones during a monthly cycle. Stimulated by the estrogen and progesterone during the second half of the cycle, the breasts swell and become more lumpy and tender. Then with a period, while the uterus sloughs off its lining, the breasts reabsorb the extra fluid instead of discharging it. At different times, often in the years before menopause, the hormones are a bit off balance and the breasts suffer more tenderness. Many women can identify when they ovulate by the sensations in their breast or nipples. For some women this may mean too little or too much estrogen, for others too little progesterone. This type of cyclic breast pain occurs in both breasts, sometimes more one-sided than another. It is often felt more in the lateral aspect where there is more breast tissue. It may differ from month to month but always gets worse before a period and then lets up with menstruation.

Cyclic breast pain can be made worse by some foods we eat or drink and some medications we take. An obvious one is caffeine, which contains a chemical called methylxanthine that causes blood vessels to dilate. This microscopic swelling can cause distention in the breasts and add to the pain. Again it doesn’t cause or lead to cancer, so a woman may want to balance her desire for coffee with the discomfort it causes in her breasts. Decaf coffee and teas have less caffeine and most sodas and chocolates do too. Excedrin has as much caffeine in one pill as a cup of coffee. Diets high in salt increase swelling by causing fluid retention, and this also puts a strain on the breast tissue.

There is some recent evidence that fatty foods — mostly animal fats — contribute to breast pain. The reason here is less clear but may have to do with the animals’ own hormones, what they have been given to eat, or the way the fat is broken down by our bodies. For some women, dairy products are the culprit. Again the exact reason is unclear. These women may have an underlying allergy to the dairy products or may be reacting again to the hormones that were fed to the cows. The standard American diet in general is proinflammatory — see our articles on omega-3 fatty acids for suggestions on how you can address this imbalance naturally.

Additional causes of breast pain

The most common medications that cause breast pain are pills with hormones in them — either birth control pills or hormone replacement therapy (HRT). The amounts of either estrogen or progesterone (or both) may just not be right for a particular woman, or she may react to the additives in the pill or the synthetic compounds. Some psychiatric medications or antidepressants may increase breast pain. Even some cholesterol-lowering and heart medications can cause breast changes.

The other big contributor to exacerbating breast pain is stress. Again the exact mechanism is unclear. Scientists are only beginning to understand the links between the immune system, our emotions, and our hormones. Everyone has different stress levels and stressors, but it is a truism that too much stress is not good. And likewise, we could all benefit from learning how to relax and take time for ourselves. It was more natural and expected for our ancestors to take time out monthly during the “bleeding” than now. With Tampax and Midol we can go on as if nothing is different. I’ve come to think that breast pain may be a reminder for us to step back and look around.

The question always arises, “Do bras help the pain or make it worse?” Again the answer depends on who you are. Bras are not medically necessary; however, most people in Western societies expect women to wear them, and bras do make some clothes fit better. Many women feel better when wearing a bra for support or uplift. Other women prefer not to wear them. If you prefer to wear a bra, it is important to wear one that fits well and is comfortable. Some underwire bras, or too-tight bras, can pinch or cause constant rubbing which irritates skin and breast tissue and leads to pain. It was an old theory that this kind of tissue trauma led to breast cancer, but that has fallen out of favor. A study that concluded bras cause cancer has not been replicated.

If the pain persists for several months and does not appear to be cyclic, then a few standard medical tests, a chest x-ray, thyroid tests, and a dental exam should be done to rule out some rare diseases. Again, it’s important not to let fear override the signals our bodies send us, prompting or reminding us to take care of ourselves.

Natural treatments for mastalgia

Treatments for breast pain vary widely, again partially depending on your cultural setting. Women in England tend to use evening primrose oil or teas; in Italy they take vitamin E. The French use a cream to rub on their breasts, and in the United States we are told to grin and bear it. In Russia, I’m told, women put cabbage leaves on their breasts, then wrap themselves with warm cotton linen and go to bed for the night! All of the above may work for some women. Women in America are also offered birth control pills or a stronger male hormone, Danazol, to control the pain.

At Women to Women our basic remedy for breast pain is to help your body balance its hormones naturally. So we start with dietary changes, dietary supplements (including omega-3’s, vitamin E, and the B’s), gentle endocrine support, and stress reduction, including exercise. (These are the basic components of our Personal Program.) We also recommend you try steps to reduce the estrogen in your body, which includes the xenoestrogens you absorb from the environment.

While this approach is very effective, many women need additional pain relief. In such cases, I usually suggest the following:

• Topical (meaning used on the skin, not taken by mouth) iodine can be bought over the counter in the grocery or drugstore, usually for less than a dollar. Apply it in a quarter-sized area once a night on the breast until the brown spot persists overnight, or for one month. I will admit I cannot explain exactly how this works, but the iodine seems to adjust the hormones just enough to keep the swelling down, or perhaps it is treating some subclinical virus or bacteria. Most of our diets today do not have the same amount of iodine in them that our ancestors’ did. This use of iodine does not seem to impair thyroid function.


• Bioidentical progesterone support may also be helpful. Consult your healthcare practitioner for guidance.


• If you can find a therapist trained in lymphatic massage, he or she can be very helpful in treating some types of breast pain. You do not have to have lymphedema or arm swelling for lymphatic massage to help lymph flow and treat the pain. I have found it very effective in treating upper outer quadrant pain in particular. You can try some breast massage techniques on yourself first, if you want.


• A minor breakthrough may be NSAID (nonsteroidal anti-inflammatory drugs such as Motrin or Advil) creams. They have been used in at least two randomized, blinded, placebo–controlled studies and found to be effective and safe for breast pain. Unfortunately these creams at this time are difficult to find and are available only by prescription or from a compounding pharmacy. But they do work. Hopefully some marketing company will realize there is a need out there and make doctors and health providers aware! Or better yet, sell them over the counter!


• Castor oil packs help loosen up the breast tissue — and also require a woman to take at least 20 minutes off and lie down!


• Remember that emotional factors can create pain. It’s important to try and identify the source or cause of your pain and deal with it specifically. Sometimes reassurance that it isn’t something bad is enough. Given some time and support, I’ve found that women can find their unique, personal answers and let go of the pain.

The as-of-yet unsolved epidemic of breast cancer has put fear and terror into most women’s hearts. This increased awareness may bring increased funding and research, but it has unfortunately alienated most of us from an important part of our body. We have forgotten that our breasts are a natural part of us that serve a very healthy function of nurturing our offspring. They also can give us much pleasure. Breasts are much more than simple sex symbols; they are symbols of our nurturing strength and life force, and evidence of our own intuitive powers.

While some causes of breast pain may still remain a mystery, no woman should remain in a prolonged state of anxiety about it. First off, get it checked out — to ease your mind and validate your concerns. Find someone who will listen to you and offer some reassuring solutions, not just tell you to grin and bear it, or make you feel it is all in your head. It isn’t!

 

Original Publication Date: 01/25/1999
Last Modified: 02/16/2010
Principal Author: Dixie Mills, MD