Brief overview
- Causes: A distinction is made between cycle-dependent and cycle-independent causes (premenstrual syndrome, pregnancy, menopause, cysts, inflammation of the mammary glands, etc.).
- Symptoms: Unilateral or bilateral pain in the breast, feelings of tension and swelling, painful nipples
- When to see a doctor? E.g. when breast pain occurs for the first time, when the symptoms do not disappear with the onset of menstruation.
- Diagnosis: Medical history, gynecological examination, palpation of the breast, X-ray, blood test, etc.
- Treatment: depending on the cause, e.g. puncturing of cysts, hormone preparations
What is breast pain?
Breasts are considered a symbol of femininity. They are an erogenous zone and belong to the secondary sexual characteristics. In addition, the breasts serve for breastfeeding in women. When breast pain occurs, every touch is unpleasant, the breast possibly feels nodular, this frightens many women.
Actually, breast pain or pain in the nipples is very common and does not necessarily mean anything bad. Nevertheless, many women immediately think of breast cancer when they experience these symptoms.
The breast pain may change over time. This is related to the inner workings of the female breast, which consists mainly of fatty and connective tissue. Embedded in this is the glandular tissue, which produces milk when needed.
Over the course of life, the ratio of fatty to connective and glandular tissue changes. In older women, the proportion of fat in the breast predominates. Then there are hardly any nodular changes in the breast tissue during the menstrual cycle.
Sometimes, however, there are growths in the breast tissue that cause pain and tightness in the breast (mastalgia) regardless of the cycle – a phenomenon that also affects men.
Breast pain: causes
There are many possible causes of breast pain. For example, physicians distinguish between cycle-dependent and cycle-independent causes of breast pain.
Mastodynia: cycle-dependent causes
In addition, the breasts are better supplied with blood. Overall, they become larger and heavier as a result, and nodular changes may also be palpable.
Other hormonal causes of breast pain
Premenstrual dysphoric disorder (PMDS): In addition to breast pain, symptoms include fatigue, abdominal pain, back pain or headaches. They typically start in the days before menstrual bleeding. Often they are so severe that they have a significant impact on everyday life. Since 2013, this has been recognized as a disorder in its own right (depressive disorder) that needs to be treated. It affects up to eight percent of women of childbearing age.
Fibrocystic mastopathy: Hormones are probably responsible. If there is too much estrogen and too little progesterone locally, individual components of the breast tissue grow excessively. As a result, swelling the size of a cherry stone, displaceable nodes or cysts usually form in both breasts. They are often noticeable through pressure discomfort. Rarely, fluid also leaks from the nipple.
Pregnancy: A certain feeling of tension, breast pain or aching nipples are considered one of the first signs of pregnancy. This is because shortly after implantation of the egg, the breast begins to prepare for its future breastfeeding task. The glandular tissue changes, the breast becomes larger and more sensitive to touch.
Engorged breast milk: If the baby is latched on incorrectly for breastfeeding, or too much time passes between feedings, breast milk may engorge the breast. A first indication of such a milk stagnation is when the breast or developing swellings hurt. Now is the time to take countermeasures, because otherwise the breast may become inflamed!
Menopause: Naturally, menopausal women are less likely to experience cycle-related breast pain. Unless they specifically take hormones to counteract the symptoms of menopause. Then breast pain is a possible side effect.
Mastalgia: Causes independent of the cycle
Cysts: A cyst is a fluid-filled blister. In breast tissue, such cysts may cause chest pain when they reach a certain size and push the surrounding tissue to the side. Most of the time, cysts are benign. It is not known more precisely why they develop. They often appear between the ages of 30 and 50 or with the onset of menopause.
Benign soft tissue tumors: These are soft, bulging lumps just under the skin. They cause pain especially when they develop near nerves. Doctors distinguish between changes in fatty tissue (lipomas), connective tissue (fibromas) and the glandular sac (atheromas) – where dead skin cells and sebum collect near a sebaceous gland.
Inflammation of the mammary glands outside the breastfeeding period (nonpuerperal mastitis): In this form, bacteria also penetrate the breast tissue and trigger inflammation there. Patients younger than 30 years of age are particularly affected.
Breast cancer: This is a malignant tissue growth (tumor) in the breast tissue. It usually originates from the milk ducts and less frequently from the glandular lobules. Breast pain may also occur, but not in the early stages. Breast cancer is the most common cancer in women.
Irritated nipples: Especially painful nipples are sometimes also triggered by the wrong clothing. For example, when rough textiles, too tight clothing or constant friction during sports irritate the sensitive skin.
Causes of breast pain in men
Men are also sometimes affected by breast pain – often in connection with an enlarged mammary gland on one or both sides (gynecomastia).
Gynecomastia occurs naturally due to hormonal imbalances (as neonatal, pubertal, or geriatric gynecomastia). For example, it is possible for men to suffer from breast pain during puberty.
Other causes of chest pain
Chest pain may also occur with a number of other conditions (for example, reflux disease, heart attack, pneumonia, pulmonary embolism, rib fracture, et cetera). Read more about these and other causes of chest pain in the article Chest pain.
How does chest pain manifest itself?
Breast pain (mastodynia) occurs both unilaterally in the right or left breast and bilaterally and may be accompanied by feelings of tension and swelling. Those affected may also complain of painful nipples.
The cycle-dependent increase in volume may cause some stretching pain. In addition, the breast reacts more sensitively to touch. Normally, the complaints disappear again when the estrogen level drops, menstruation occurs and the fluid is expelled from the tissue.
In the case of enlarged mammary glands, for example, men also report feelings of tension and a certain sensitivity to touch in the breast. In addition, the nipples may hurt.
What to do about breast pain?
The treatment of breast pain depends on the cause. For example, if cysts are responsible for the pain, it is possible to have them “lanced” (punctured) by a doctor to drain the fluid they contain. This reduces the pressure on the surrounding tissue, whereupon the chest pain usually disappears.
If hormonal imbalances are the cause of the pain, the doctor prescribes hormone preparations for mastodynia therapy if necessary. If the doctor diagnoses breast cancer, he or she immediately initiates an individually tailored cancer therapy (surgery, chemotherapy, radiation therapy, et cetera).
If the pain is severe, the doctor also prescribes painkillers, for example with the active ingredient paracetamol.
Home remedies for breast pain
For cycle-dependent breast pain in the context of PMS, herbal preparations (such as with monk’s pepper), meditation and relaxation exercises are said to be helpful. As part of a naturopathic therapy, diet is also said to be able to influence mastodynia. For example, it is recommended to avoid coffee and alcohol. Another approach is to reduce the total fat intake and to exercise regularly.
Consult your gynecologist for advice on this. Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
Breast pain: When to see a doctor?
In principle, it is advisable to have chest pain that occurs for the first time clarified by a doctor. This also applies if other complaints and abnormalities occur, such as lumps that were not there before or an oozing nipple.
If the complaints are dependent on the menstrual cycle, they usually disappear again with the onset of menstruation. If this does not happen, it is also advisable to consult a doctor.
With any kind of change that seems strange to you, it is advisable to see a doctor. If in doubt, it is better to go to the doctor once too often. Breast cancer in particular can be treated well and is even curable if detected at an early stage.
Breast pain: examinations
In the case of female breast pain, the right contact person is the gynecologist. He will first question you in detail to obtain your medical history (anamnesis). He may also be interested in whether the breast pain occurs before or after the period, whether it is sideways or in the middle, and whether you notice it when you touch it.
The doctor may also ask you if the chest pain occurs on inhalation or exhalation, or if it is movement-related. This is an indication that the discomfort may be musculoskeletal in origin, that is, originating in the muscles or skeleton.
An X-ray examination of the breast (mammography) helps to rule out breast cancer as the cause of the breast pain. If there are suspicious tissue changes on the X-ray, the doctor may take a tissue sample (biopsy) to have it examined more closely in the laboratory.
The doctor also takes blood samples. As part of the blood test, he or she measures levels of sex hormones to possibly provide clues to a hormonal cause of the chest pain.
In men with chest pain, the doctor performs the same tests for clarification. The right contact here is an andrologist or a clinic that specializes in breast diseases.
