Breast pain (called mastalgia) is quite common—about 70 percent of
women will experience breast pain at some point in their lives—and it
is one of the most frustrating clinical problems for doctor and
patient alike.
To start with, it is important to gain as much information as possible about the pain. When you go to your doctor, it would be helpful if you can explain whether the pain is cyclical, and therefore more likely to be related to hormonal changes or water retention at certain times in your menstrual cycle, or noncyclical, and therefore more likely to be due to direct pressure on a nerve in the neck or chest wall.
Other factors that may contribute to breast pain in some women include birth control pills, hormone replacement therapy, weight gain, and bras that do not fit properly. Women who experience breast pain beyond the first few days of breastfeeding should speak with their doctor or lactation consultant.
Some women experience pain that is due to water retention but does not seem to correlate with the menstrual cycle. This observation has led researchers to look for environmental or nutritional causes for the pain, but as of yet, there are no clear answers. In the future, we may find that there are women who have certain vitamin deficiencies associated with breast pain. Currently, there is no evidence that certain vitamins can help control breast pain. Even so, some women say they have found some relief by taking vitamin B6, vitamin B1, and vitamin E.
A second hypothesis, called the "methylxanthine hypothesis," promotes the idea that caffeine, the methylxanthine found in coffee, tea, chocolate, and cola, could be associated with water retention, proliferation of cells, and, in turn, breast pain. (Methylxanthine is also present in some asthma medications.) Although this is a plausible mechanism, controlled trials in which women are randomly given caffeine tablets or a placebo and then asked about their breast pain have not found caffeine to be associated with breast pain.
Some women have found that wearing a good, supportive bra, like a sports bra, even at night, can help reduce breast pain. Others have tried reducing sodium intake, maintaining a low-fat diet, going on the birth control pill, and losing weight (if they are overweight).
A clinic in Cardiff, Wales, tested evening primrose oil, a natural form of gamolenic acid, and found that it relieved the breast pain in 44–58 percent of the women with moderate to severe pain who tried it. Evening primrose oil can be purchased at health food stores as capsules containing 500mg of gamolenic acid. Six capsules should be taken twice a day. Because it can take awhile for the evening primrose oil to have an effect, it is recommended that the initial trial period last four months. If after four months the pain has decreased, the evening primrose oil should be continued for another one to two months and then discontinued. This treatment should not be tried if you are pregnant or trying to get pregnant as it can cause miscarriage.
Another option is over-the-counter pain medication. Most likely, though, you will need to speak with your doctor about prescription medications that are more effective but are also associated with more side effects. The two most commonly used drugs to treat breast pain are bromocriptine (brand name Parlodel) and danazol (brand name Danocrine).
Parlodel lowers prolactin levels and has been found to be effective for cyclical breast pain in double-blind placebo-controlled randomized trials. Its side effects may include dizziness, upset stomach, headache, fatigue, vomiting, and constipation. You can decrease the chance that you will experience these side effects by starting on a low dose, going up in dosage incrementally, and using the lowest dose that is effective for you. Parlodel should not be used if you are on the birth control pill.
The steroid pain medication Danocrine has also been shown to be effective in controlled trials in reducing severe cyclical breast pain. It can be effective at very low doses, such as 100mg every other day. The side effects, which are seen primarily in women who take higher doses (600–800mg/day), may include a decrease in breast size; a deepening of the voice, hoarseness, or sore throat; weight gain; water retention and bloating; sweating; vaginal dryness, burning, itching, or bleeding; depression; irritability; and changes in the menstrual cycle. Also, Danocrine cannot be taken if you are on the birth control pill, pregnant, or breastfeeding. The drug tamoxifen, which is a hormonal treatment for breast cancer, also has been shown to be effective in reducing breast pain. The recommended dose is 10mg/day. It is usually given as a three-month trial, which is repeated if the pain recurs after the tamoxifen is stopped.
If no underlying cause can be found for breast pain that is noncyclical, and if the pain is in a specific area of the breast, trigger point injections with local anesthetic and, if necessary, steroids may be effective.
It is difficult to conduct research on breast pain because oftentimes the pain will just resolve on its own. It is not rare for a woman to have one episode of severe pain during her lifetime. It often lasts for a few months and then begins to decrease and ultimately go away.
That’s why doctors will want to know how long you have had symptoms and will typically not prescribe medication until you have been experiencing the pain for three months or longer and have found the other methods of relieving pain not to be effective.
To start with, it is important to gain as much information as possible about the pain. When you go to your doctor, it would be helpful if you can explain whether the pain is cyclical, and therefore more likely to be related to hormonal changes or water retention at certain times in your menstrual cycle, or noncyclical, and therefore more likely to be due to direct pressure on a nerve in the neck or chest wall.
Other factors that may contribute to breast pain in some women include birth control pills, hormone replacement therapy, weight gain, and bras that do not fit properly. Women who experience breast pain beyond the first few days of breastfeeding should speak with their doctor or lactation consultant.
Some women experience pain that is due to water retention but does not seem to correlate with the menstrual cycle. This observation has led researchers to look for environmental or nutritional causes for the pain, but as of yet, there are no clear answers. In the future, we may find that there are women who have certain vitamin deficiencies associated with breast pain. Currently, there is no evidence that certain vitamins can help control breast pain. Even so, some women say they have found some relief by taking vitamin B6, vitamin B1, and vitamin E.
A second hypothesis, called the "methylxanthine hypothesis," promotes the idea that caffeine, the methylxanthine found in coffee, tea, chocolate, and cola, could be associated with water retention, proliferation of cells, and, in turn, breast pain. (Methylxanthine is also present in some asthma medications.) Although this is a plausible mechanism, controlled trials in which women are randomly given caffeine tablets or a placebo and then asked about their breast pain have not found caffeine to be associated with breast pain.
Some women have found that wearing a good, supportive bra, like a sports bra, even at night, can help reduce breast pain. Others have tried reducing sodium intake, maintaining a low-fat diet, going on the birth control pill, and losing weight (if they are overweight).
A clinic in Cardiff, Wales, tested evening primrose oil, a natural form of gamolenic acid, and found that it relieved the breast pain in 44–58 percent of the women with moderate to severe pain who tried it. Evening primrose oil can be purchased at health food stores as capsules containing 500mg of gamolenic acid. Six capsules should be taken twice a day. Because it can take awhile for the evening primrose oil to have an effect, it is recommended that the initial trial period last four months. If after four months the pain has decreased, the evening primrose oil should be continued for another one to two months and then discontinued. This treatment should not be tried if you are pregnant or trying to get pregnant as it can cause miscarriage.
Another option is over-the-counter pain medication. Most likely, though, you will need to speak with your doctor about prescription medications that are more effective but are also associated with more side effects. The two most commonly used drugs to treat breast pain are bromocriptine (brand name Parlodel) and danazol (brand name Danocrine).
Parlodel lowers prolactin levels and has been found to be effective for cyclical breast pain in double-blind placebo-controlled randomized trials. Its side effects may include dizziness, upset stomach, headache, fatigue, vomiting, and constipation. You can decrease the chance that you will experience these side effects by starting on a low dose, going up in dosage incrementally, and using the lowest dose that is effective for you. Parlodel should not be used if you are on the birth control pill.
The steroid pain medication Danocrine has also been shown to be effective in controlled trials in reducing severe cyclical breast pain. It can be effective at very low doses, such as 100mg every other day. The side effects, which are seen primarily in women who take higher doses (600–800mg/day), may include a decrease in breast size; a deepening of the voice, hoarseness, or sore throat; weight gain; water retention and bloating; sweating; vaginal dryness, burning, itching, or bleeding; depression; irritability; and changes in the menstrual cycle. Also, Danocrine cannot be taken if you are on the birth control pill, pregnant, or breastfeeding. The drug tamoxifen, which is a hormonal treatment for breast cancer, also has been shown to be effective in reducing breast pain. The recommended dose is 10mg/day. It is usually given as a three-month trial, which is repeated if the pain recurs after the tamoxifen is stopped.
If no underlying cause can be found for breast pain that is noncyclical, and if the pain is in a specific area of the breast, trigger point injections with local anesthetic and, if necessary, steroids may be effective.
It is difficult to conduct research on breast pain because oftentimes the pain will just resolve on its own. It is not rare for a woman to have one episode of severe pain during her lifetime. It often lasts for a few months and then begins to decrease and ultimately go away.
That’s why doctors will want to know how long you have had symptoms and will typically not prescribe medication until you have been experiencing the pain for three months or longer and have found the other methods of relieving pain not to be effective.
No comments:
Post a Comment