WHY DO BREASTS HURT? CAUSES AND TREATMENTS - MEDICINE - 2025

The breast pain, also known as mastalgia, breast pain or breast pain is all that pain that occurs in the mammary gland without any trauma, injury or prior conditioning of any kind. This is a fairly common condition.

Rather than a disease in and of itself, breast pain is a symptom that can appear in the context of multiple medical conditions. Almost inexorably when there is breast pain, the person is very distressed and their greatest concern is that they may suffer from breast cancer.

Mammography

However, even though it is possible that breast cancer presents with mastalgia, it is not the most frequent, there are many other benign conditions that can cause breast pain, most of these treatable.

Causes

The causes of breast pain are multiple and range from functional conditions to organic diseases, all of them with a common denominator: breast pain.

Among the functional causes, the most common is premenstrual tension syndrome, while among the organic causes the fibrocystic condition of the breast and mastitis are counted as the most common causes of breast pain.

Premenstrual tension syndrome

Premenstrual tension syndrome is a set of diverse signs and symptoms that some women present in the days before and during ovulation. These symptoms include pain in the lower abdomen, changes in mood and, in some cases, breast pain or breast pain.

It is believed that the symptoms of premenstrual tension syndrome are due to changes in hormonal peaks throughout the cycle that can generate negative sensations both psychically and physically, especially in women sensitive to this or in those cases where levels of hormone have a very wide variation.

Although mastalgia is not the cardinal symptom of this symptom complex, it certainly can occur to a greater or lesser extent, varying in severity from breast tenderness to severe mastalgia.

Fibrocystic breast condition

It is an anatomical condition where the glandular tissue of the breast tends to form small fibroids and cysts in response to the hormonal changes that occur throughout the menstrual cycle.

Its main difference from premenstrual tension syndrome is that there are demonstrable physical changes. Furthermore, the fibrocystic condition of the breast is limited to the mammary glands; that is, there are no symptoms in other parts of the body.

The severity of pain from fibrocystic breast conditions ranges from very mild to intolerable, although pain is almost inexorably associated with ovulation, when hormonal peaks tend to be higher.

Cysts and fibroids

In general, cysts and small fibroids tend to disappear spontaneously without the need for any treatment. However, as old cysts and fibroids disappear, new ones are forming somewhere in the mammary gland.

This continuous cycle of formation / disappearance of cysts is what gives its cyclical condition to breast pain due to fibrocystic mammary condition, usually accompanying the woman until the beginning of menopause.

At the time of menopause, the hormonal influx ceases and, therefore, the stimulus for cyst formation also ceases, which ultimately leads to the resolution of this situation.

Mastitis

Mastitis is the inflammation of the mammary gland. It is characterized by increased tumescence of the gland, pain and redness (phlogosis) accompanied by an increase in temperature.

The most common cause of mastitis is the accumulation of fluid within the mammary gland, which cannot be evacuated through the milk ducts.

Puerperal mastitis

If it is milk, it is usually referred to as puerperal mastitis, since it usually appears during the first days postpartum, when the baby still does not suck with great force, causing part of the milk to remain in the mammary gland. This causes inflammation and, therefore, mastitis.

The same thing happens when a woman cannot breastfeed for some reason; in these cases, the milk accumulated within the mammary gland produces dilation of the milk ducts and the rest of the structures, causing inflammation and pain.

When the fluid is not milk but a product of the normal secretions of the non-lactating gland, as in the case of ductal ectasia, the same situation occurs: accumulation of fluids that eventually dilate the ductal system and cause pain and inflammation.

In both cases, mastitis can become secondarily infected and can eventually generate a breast abscess, a very painful condition that always requires medical attention.

Other types of mastitis

In addition to the mastitis described so far, there is a special group of mastitis that are not associated with the accumulation of fluid in the mammary gland. On the contrary, the problem begins in the skin as cellulite that later spreads to the deep tissues.

In this case the symptoms are identical to those of the other mastitis, being possible to establish the difference only when complementary clinical studies are carried out.

Breast cancer

Although breast cancer can cause pain, it does not do so until it is very advanced, so if properly screened no woman should reach the point where breast cancer causes pain, since breast cancer diagnosis should have been made a long time before that happened.

However, if the diagnosis is not made and the breast cancer continues to grow uncontrollably, it can eventually cause breast pain due to compression on the tissues, compression of the lymphatic capillaries and, eventually, ulceration of the tumor.

When this occurs, the pain is very intense, and quite aggressive treatments are needed to reduce it and improve the quality of life of the patient.

Diagnosis

The diagnosis of the etiology of breast pain is based 90% on the information provided by the patient during the medical history and the findings of the physical examination.

However, in order to confirm suspicions (as in the case of fibrocystic mammary condition), establish a differential diagnosis (as in mastitis) and exclude the presence of organic pathology (as in the case of certain tumors), it is possible to resort to complementary tests, such as:

- Hematology, in order to determine if there is an active infection or not.

- Globular Sedimentation Rate or ESR, in order to exclude the presence of abscess.

- Breast ultrasound, to evaluate the morphological characteristics of the gland.

Mammography is rarely indicated as it provides little additional information and is very painful in a patient with increased breast sensitivity.

Treatments

Treatment of breast pain can be divided into two parts: general control of symptoms and prevention of recurrence.

Oral non-steroidal anti-inflammatory drugs (NSAIDs) are generally effective in controlling pain and reducing inflammation; however, in lactating women with mastitis these are usually avoided, so paracetamol (at high doses of up to 750 mg three or four times a day) and local cold are indicated to control inflammation.

Once the initial symptoms are controlled, it is necessary to identify the cause in order to establish a specific treatment, such as antibiotics in the case of mastitis.

Once this is done, it only remains to prevent recurrences. Depending on the cause, a specific therapeutic strategy is used.

For example, in cases of fibrocystic breast condition, there has been some success with treatments that include vitamin E, while in premenstrual tension syndrome, various medications are usually effective, including tricyclic antidepressants.

More invasive treatments

In some cases it may even be necessary to perform surgeries (severe fibrocystic breast condition, advanced breast cancer) or salvage radiation therapy (advanced breast cancer) to control the situation.

In any case, considering that breast pain can be of different origins and that only properly trained health professionals can establish the differential diagnosis, it is best to always consult a doctor in case of presenting any type of pain or discomfort at the level of the mammary gland.

References

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