Breast pain

Diagnosis

Tests to evaluate your condition may include:

• Clinical breast exam. Your doctor checks for changes in your breasts, examining your breasts and the lymph nodes in your lower neck and underarm. Your doctor will likely listen to your heart and lungs and check your chest and abdomen to determine whether the pain could be related to another condition. If your medical history and the breast and physical exam reveal nothing unusual, you may not need additional tests.
• Mammogram. If your doctor feels a breast lump or unusual thickening, or detects a focused area of pain in your breast tissue, you'll need an X-ray exam of your breast that evaluates the area of concern found during the breast exam (diagnostic mammogram).
• Ultrasound. An ultrasound exam uses sound waves to produce images of your breasts, and it's often done along with a mammogram. You might need an ultrasound to evaluate a focused area of pain even if the mammogram appears normal.
• Breast biopsy. Suspicious breast lumps, areas of thickening or unusual areas seen during imaging exams may require a biopsy before your doctor can make a diagnosis. During a biopsy, your doctor obtains a small sample of breast tissue from the area in question and sends it for lab analysis.

Treatment

For many people, breast pain resolves on its own over time. You may not need any treatment.

If you do need help managing your pain or if you need treatment, your doctor might recommend that you:

• Eliminate an underlying cause or aggravating factor. This may involve a simple adjustment, such as wearing a bra with extra support.
• Use a topical nonsteroidal anti-inflammatory (NSAID) medication. You may need to use NSAIDs when your pain is intense. Your doctor may recommend that you apply an NSAID cream directly to the area where you feel pain.
• Adjust birth control pills. If you take birth control pills, skipping the pill-free week or switching birth control methods may help breast pain symptoms. But don't try this without your doctor's advice.
• Reduce the dose of menopausal hormone therapy. You might consider lowering the dose of menopausal hormone therapy or stopping it entirely.
• Take a prescription medication. Danazol is the only prescription medication approved by the Food and Drug Administration for treating fibrocystic breasts. However, danazol carries the risk of potentially severe side effects, such as heart and liver problems, as well as weight gain and voice changes. Tamoxifen, a prescription medication for breast cancer treatment and prevention, may help, but this drug also carries the potential for side effects that may be more bothersome than the breast pain itself.

Alternative medicine

Vitamins and dietary supplements may lessen breast pain symptoms and severity for some people. Ask your doctor if one of these might help you — and ask about doses and any possible side effects:

• Evening primrose oil. This supplement may change the balance of fatty acids in your cells, which may reduce breast pain.

• Vitamin E. Early studies showed a possible beneficial effect of vitamin E on breast pain in premenstrual women who experience breast pain that fluctuates during the menstrual cycle. In one study, 200 international units (IU) of vitamin E taken twice daily for two months improved symptoms in women with cyclic breast pain. There was no additional benefit after four months.

  For adults older than 18 years, pregnant people and breastfeeding women, the maximum dose of vitamin E is 1,000 milligrams daily (or 1,500 IU).

If you try a supplement for breast pain, stop taking it if you don't notice any improvement in your breast pain after a few months. Try just one supplement at a time so that you can clearly determine which one helps alleviate the pain — or not.

Preparing for your appointment

If you have breast pain that is new, that persistently affects just a particular part of your breast or that affects your quality of life, see your doctor for an evaluation. In some cases, when you call to set up an appointment, you may be referred immediately to a breast health specialist.

Preparing for an appointment

The initial evaluation of your breast pain focuses on your medical history. Your doctor will ask about the location of your breast pain, its relation to your menstrual cycle and other relevant aspects of your medical history that might explain the cause of your pain. To prepare for this discussion:

• Keep a journal, noting when you experience breast pain and other symptoms, to determine whether your pain is cyclic or noncyclic.
• Take note of all your symptoms, even if they seem unrelated to your breast pain.
• Rate your pain on a scale of 1 to 10, with 1 being no pain and 10 being the worst pain imaginable.
• Review key personal information, including major stresses or recent life changes.
• List all the medications, vitamins and supplements that you regularly take.
• List questions to ask your doctor, from most important to least important.

For breast pain, basic questions to ask your doctor include:

• What is the most likely cause of my symptoms?
• What kinds of tests might I need?
• What treatment approach do you recommend for my condition?
• Are there any home remedies I might try?

What to expect from your doctor

Your doctor may ask you questions such as:

• Where in your breast do you feel pain?
• How long have you had breast pain?
• On a 10-point scale, how severe is your pain?
• Do you have pain in one or both breasts?
• Does the pain seem to occur in any sort of pattern?
• Have you ever had a mammogram? When was your last one?
• Do you have any other signs or symptoms, such as a breast lump, area of thickening or nipple discharge?
• Have you noticed any skin changes, such as redness or a rash?
• Have you recently had a baby? Or have you experienced a pregnancy loss or termination?
• How does the pain impact your quality of life, for instance sleep, sexual activity or work? Does your pain make you less able to perform daily activities?
• Have you been involved in any activities or had a recent injury to your chest that may contribute to your breast pain?

Your doctor may also assess your personal risk of breast cancer, based on factors such as your age, family medical history and prior history of precancerous breast lesions.