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What's causing my breast pain?

Q: Lately, I've been having a great deal of pain in my breasts. It's not time for my period and I know I'm not pregnant. Those are the only times I've ever had pain like this before. I went for my well-woman checkup about 8 months ago and got a mammogram and ultrasound, which revealed many fibrous cysts and a calcified lymph node in my armpit. Is this a normal thing leading up to menopause? Could my pain be the cysts "flaring up"? What's your advice?

A; Breast pain, also called mastalgia, is a common symptom with several different causes.

Important details about the timing and location of the pain will help determine the cause. Breast pain may come and go in a pattern timed to the menstrual cycle, it may be continuous, or occur randomly. Pain may affect both breasts or be isolated to a specific location in one breast.

Breast pain can be caused by the hormone changes of the menstrual cycle and by those leading to menopause. Hormone-related pain tends to be most severe just prior to menses and involve both breasts. As a woman approaches menopause, the timing of menstrual related events, including breast pain, may become less predictable.

Pain that is more local to one spot or isolated to a single breast may be caused by a cyst, growth, or infection. Breast cysts are fluid-filled sacs often surrounded by dense fibrous tissue. They tend to come and go and can be drained if symptoms are severe.

Pain is not a typical symptom of cancer. And infection is usually accompanied by other symptoms such as redness, fever, or discharge.

Any breast pain that continues, is severe or is located on one spot of the breast should be evaluated by your doctor. If a specific cause is found and treated, the pain will go away.

General measures to relieve breast pain include:

--Mild analgesics (ibuprofen or acetaminophen)

--Warm compresses

--Wearing a good supporting bra, especially for exercise

Treating cyclic breast pain may also include the use of oral contraceptives or other hormones.

(Joan Bengtson, M.D., is an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and Brigham and Women's Hospital, Boston, Mass. Dr. Bengtson is a Senior Medical Editor at Harvard Health Publications.)

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