Painful breasts, mastalgia

Breast pain is the most common breast symptom and reason to seek medical help. The real cause is not known, but it is often linked to the menstrual cycle in younger women, with both breasts becoming tender or painful just before the period.

This is a normal occurrence caused by fluid retention related to the woman’s cycle, which is due to related hormonal activity.

Breast pain can also occur in perimenopausal and postmenopausal women, and is commonly non-cyclical and one-sided. It is wise to have your painful breasts assessed by your doctor, who may be able to suggest ways to manage the discomfort.

Both the contraceptive pill and menopause hormone therapy, or MHT (formerly called hormone replacement therapy, or HRT), can cause breast discomfort in some women. Sometimes a change in the prescribed type of hormone may be necessary. Ask your doctor for more information.

How to relieve breast tenderness or pain

• A warm shower, bath or hot water bottle to the breast
• An ice pack over the breast may be more effective than warmth
• A comfortable, supportive bra, such as a sports bra
• Going without a bra may be more comfortable
• Reduce your intake of caffeine, including coffee, tea, cola and chocolate
• Reduce your intake of salt and fat
• There is some evidence that suggests the use of vitamin B6 (pyridoxine), vitamin B1 (thiamine) and/or evening primrose oil may help
• Relaxation.

If none of the above relieves your breast discomfort, seek advice from your doctor.

Breast lumps

The normal glandular tissue of the breast is nodular, which means it is lumpy. This lumpiness, or nodularity, is usually most pronounced in the upper outer area of the breast. Nodularity, particularly when it varies during the menstrual cycle, is normal and not an indication of a breast problem.

Breast lumps that feel different from normal breast nodularity should be assessed by your doctor.

Fibroadenomas (fibrous lump)

These are common, non-painful, benign breast lumps, made up of glands and fibrous tissue. This type of lump feels quite smooth and firm, and is mobile in the breast tissue (often called a breast mouse).

Fibroadenomas occur more often in women between the ages of 15 and 30. They may occur occasionally in older women. Up to one in six women may have one at some stage.

Most fibroadenomas are small, but they can grow as large as a golf ball. They can become tender in the days before the period.

All new lumps should be assessed by your doctor by examination, mammogram/ultrasound and possibly a biopsy. Some lumps may require surgical removal.

Breast cysts

A breast cyst is a fluid-filled sac in the breast tissue. Cysts can vary in size with the menstrual cycle and may disappear spontaneously. They are benign and harmless, but can be painful.

Breast cysts commonly occur between the ages of 35 and 50, but may occasionally occur in younger women.

Any new lumps should be assessed by your doctor. Ultrasound can be used to assess whether a lump is cystic (fluid) or solid. If the cyst is large and painful, your doctor may aspirate (remove using suction) the fluid from the cyst, using a syringe with a fine needle. The presence of fluid in the lump generally confirms the diagnosis, and following aspiration the cyst will usually disappear. However, sometimes cysts recur and surgical removal may be necessary.

Benign fibrocystic disease

Some women have a combination of cysts and thickened breast tissue referred to as benign fibrocystic disease. This breast condition is characterised by lumpy breasts and is associated with pain and tenderness that may fluctuate with the menstrual cycle.

The likelihood of this combination occurring increases with age, and is a common cause of non-cancerous lumps. These problems often disappear after menopause, but may persist if you take MHT.

Nipple discharge

Nipple discharge is considered to be any fluid leaking from your nipples, and is mostly caused by benign (non-cancerous) processes.

While you’re pregnant or breastfeeding, it is quite normal for discharge or milk to leak from your nipples; this will decrease and eventually stop after you have weaned your baby.

An unexpected nipple discharge may be milky, clear, yellow, green, brown or bloody, thick and sticky or thin and watery, depending on the cause.

Nipple discharge can have a number of benign causes, including intraductal papilloma, mammary duct ectasia, abscesses, breast infection, excessive breast stimulation, fibrocystic breasts, galactorrhea, hormonal imbalance, injury or trauma to the breast, some medications, or prolactinoma, but also breast cancer.

You should see your doctor if:

• you notice any type of discharge
• the discharge is watery or blood stained
• the discharge is accompanied by a lump
• there is any inversion (pulling in) of the nipple and this is not usual for you.

Inflammation of the breast (mastitis)

This condition causes redness, heat, lumpiness and pain in the affected breast tissue. Most commonly, this is caused by an infection during breastfeeding, but it can occur at other times due to blockage and inflammation of the breast duct with an infection.

Treatment may include:

• antibiotics for the bacterial infection
• anti-inflammatory medication to relieve inflammation and pain
• continuing to breastfeed or express milk, as draining the breast helps clear the blocked ducts.

Treatment with antibiotics needs to be started immediately to prevent an abscess forming. If an abscess forms, a small surgical procedure is required to drain it.

Nipple & breast itchiness

Itchy nipples or breasts are common, uncomfortable and embarrassing problems that happen to many women. Itchiness is often due to contact dermatitis, related to the fabric type of your underwear, especially if the underwear is tight and you are in a humid environment. Itchiness can also be associated with hormonal changes, together with breast tenderness, during premenstrual days. Other causes include skin infection (fungal or bacterial) and some other skin disorders, such as seborrheic dermatitis or psoriasis. There is usually a visible rash with these conditions. Talk to your doctor about the best treatment for these problems.

Persistent itchiness and itchy breasts that are accompanied by nipple discharge or a breast lump or lumps should be taken seriously and assessed by your doctor.

When to see your doctor

If you have any of the breast problems discussed above, a visit to your doctor is recommended.

You should see your doctor about:

• new lumps
• new lumpiness
• changes in the shape of your breast
• changes in the colour of your breast
• changes in the nipple
• discharge from your nipple
• puckering or dimpling of breast skin
• any persistent breast pain
• any persistent nipple or breast itching or rash.