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
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
- 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 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
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!
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
Principal Author: Dixie Mills, MD