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SURGICAL WEBSITES BREAST DISEASE LIVER ABSCESS Anatomy of liver SURGICAL WEBSITES KIDNEY SURGERY POSTGRADUATE SURGERY LINKS
BREAST DISEASE Breast cancer Breast lump Breast awareness Breast calcifications Breast cysts Breast pain Duct ectasia Fat necrosis Fibroadenoma Hyperplasia Intraductal papilloma Phyllodes tumour Sclerosing adenosis
LIVER ABSCESS Anatomy of liver Physiology of liver Method of examination of liver Haematology of liver disease. Amoebic liver abscess .Pyogenic liver abscess. Percutaneous needle aspiration of liver abscess. Case study. Result Result continued Discussion
CHOLECYSTECTOMY Introduction Historical Review Anatomy of Gallbladder Physiology of Gallbladder Physiologic effects of pneumoperitoneum Pathology of Gallbladder Investigations Pre- operative preparation of laparoscopic cholecystectomy Contraindications Treatment modalities for gallstones. Anaesthesia
INGUINAL HERNIA HOW SURGICAL OPERATION IS DONE THYROID EXAMINATION MANAGEMENT OF SEVERELY INJURED PATIENT SEPSIS AND MULTIPLE ORGAN FAILURE CHEST TRAUMA BRONCHOGENIC CARCINOMA TETANUS AND ANAEROBIC INFECTIONS
Breast pain Breast pain
This section is for women who have breast pain, which is also known as mastalgia. It talks about the types of pain you might have, how a diagnosis is made and how breast pain can be treated.
Breast pain can cause a lot of anxiety, and many women worry that they may have breast cancer. You may find it helpful to know that breast pain is not usually a sign of breast cancer. We hope the information will help you understand more about breast pain and reassure you.
Types of breast pain
Breast pain is very common, affecting approximately two out of three pre-menopausal women at sometime in their lives. There are two main types of breast pain.
Breast pain that is part of a woman's normal menstrual cycle is known as cyclical breast pain. Women may experience it as discomfort and lumpiness in their breasts a week or so before their period. It can vary from a mild ache to severe pain and often goes away once the period starts.
Other women can have lasting pain that is not related to their menstrual cycle. This is known as non-cyclical breast pain.
Both types of breast pain can be treated, so if you have breast pain that is severe or long lasting and affecting your daily life, you may want to talk to your GP.
Cyclical breast pain
Cyclical breast pain is linked to the menstrual cycle and affects women who haven't been through the menopause (change of life), usually those in their thirties and forties. Normal hormonal changes take place throughout the menstrual cycle. These make the breast tissue over sensitive, which in turn causes the breast pain.
You may experience a burning, prickling, stabbing or drawing-in pain. It can affect either one or both breasts and can spread to the armpit (axilla) and down the arm. This type of pain often stops after the menopause when the ovaries stop working. However, women who are taking hormone replacement therapy (HRT) after their menopause can also experience breast pain. This is because the HRT puts them into a pre-menopausal state.
What causes cyclical breast pain?
The exact cause of cyclical breast pain is not known. The latest research suggests that it may be a result of extremely low levels of an essential fatty acid called gamolenic acid (GLA). It can also be associated with starting to take the contraceptive pill, and with certain anti-depressant drugs and herbal remedies.
Diagnosis
Your GP will examine your breasts and take a detailed history of the type of pain you have and how often it occurs. To check that the pain is linked to your menstrual cycle your GP will generally ask you to fill in a simple pain chart.
Treatment
In many cases your GP will be able to reassure you that what you are experiencing is a perfectly normal part of your monthly cycle. In the first place, s/he may suggest simple things you can try, such as reducing your intake of caffeine, chocolate and red wine and increasing the amount of fresh fruit and vegetables you eat. You may also be advised to wear a well supporting bra day and night.
If your pain started when you began taking the contraceptive pill, changing to a low dose pill or a different brand may help. If the pain continues, you may want to try a non-hormonal method of contraception such as condoms or a diaphragm.
Evening primrose oil
Your GP may suggest a course of evening primrose oil, which contains the essential fatty acid GLA. It works by topping up low levels of GLA in the body. You can buy evening primrose oil at many chemists and health food shops. Different brands of evening primrose oil contain different strengths of GLA so check the product information carefully or ask your GP. To get the recommended daily dose of GLA (240 milligrams) you will probably need to take about 3 grams of evening primrose oil.
Many women won't experience any further pain after a course of evening primrose oil but it is important to know that your pain will not get better immediately. It can often take between two and four months for you to notice any improvement, and you will usually need to take evening primrose oil for about six months. If your pain improves during this time you may be able to halve the dose.
Evening primrose oil generally causes few side effects, but you may experience nausea, an upset stomach or headaches. It is not advisable to take it if you are pregnant, trying to get pregnant or if you have epilepsy.
Hormone drugs
If evening primrose oil isn't effective or the pain comes back, your GP may prescribe a hormone drug. The drugs used to treat breast pain are danazol and bromocriptine.
Danazol works by blocking certain hormones produced during the menstrual cycle. It is given as a tablet and you take 100-200mg daily. Like all drugs it can have side effects, including weight gain, acne, absence of periods (amenorrhoea), facial hair growth and changes to the voice. It is important to remember that you may not experience any of these.
Bromocriptine works by lowering the level of the hormone prolactin. It is also given as a tablet and you take 2.5mg daily. Its side effects can include nausea, vomiting, dizziness, headaches and constipation. These can be reduced by starting at a low dose of 1.25mg and gradually increasing to the full dose. Again, it is important to remember that you may not have any side effects.
As with evening primrose oil, both these drugs need to be taken for two to four months for effects to be seen. After this time it may be possible to gradually reduce the dose.
Both drugs make the contraceptive pill less reliable, so if you are on the pill you should use another method of contraception. You should not take these drugs if you are pregnant, as they are harmful to the unborn baby.
In the majority of women these treatments will be effective in settling breast pain, but a small number may continue to have pain. If this is the case you may be offered other drugs such as tamoxifen and Zoladex (goserelin). However, as these are not licensed for breast pain, you would need to be referred to a breast clinic where a specialist would make a special request for them. You can call our helpline if you would like more information about these drugs.
Surgery
If you continue to experience breast pain that is so severe and long lasting that it disrupts your everyday life, surgery may be an option. This would mean a removal of the breast (mastectomy). Surgery would only be considered in extreme circumstances to improve your quality of life, and you would need to discuss all the implications before making a decision.
Non-cyclical breast pain
There are two types of non-cyclical breast pain:
- true breast pain that comes from the breast but is not linked to the menstrual cycle
- pain that is felt in the area of the breast but is actually coming from elsewhere such as the muscles, bones and joints. This may be referred to as musculoskeletal pain.
Both of these can result in continuous pain and can affect women both before and after the menopause. The pain tends to be in a specific area and can be in both breasts at the same time. The pain that you have may be a burning, prickling, stabbing or drawing-in pain.
What causes non-cyclical breast pain?
The cause of breast pain that is not linked to the menstrual cycle is often unknown. It can sometimes be related to specific benign (non-cancerous) breast conditions or underlying conditions that are not directly related to the breasts.
Diagnosis
Your GP will examine your breasts and take a detailed history of the type of pain you have and how often it occurs. S/he may also ask you to fill in a pain chart. (There is a pain chart you can use at the back of this booklet). If your GP thinks you may have non-cyclical breast pain s/he may ask you to lean forward during the examination so that your breasts fall away from your chest. This can help her/him assess if the pain is within your breast or in the chest wall.
Your GP may decide to refer you to a breast clinic at any time for further investigations or treatment.
Treatment
True breast pain
True non-cyclical breast pain is not easy to treat. In the first place, your GP may suggest simple things you can try, such as reducing your intake of caffeine, chocolate and red wine and increasing the amount of fresh fruit and vegetables you eat. You may also be advised to wear a well supporting bra day and night.
Non-steroidal anti-inflammatory painkillers such as ibuprofen can help this type of pain. If it continues, your GP or specialist may advise you try evening primrose oil, which is also used to treat breast pain linked to the menstrual cycle.
It may take some time to find out what works best for you and there may be other practical things you can try that are relevant to your lifestyle. You may wish to talk to your GP or specialist, or ring Breast Cancer Care's helpline to find out more.
Pain from elsewhere
Pain coming from elsewhere can be associated with an underlying problem such as swelling (inflammation) of the chest wall. This is called costochondritis or Tietz's Syndrome. The pain comes from the supportive tissue covering the ribs called costal cartilages. Your GP or specialist may be able to feel that this costal cartilage is swollen and it may be more painful if pressure is put on it. Sometimes this inflammation can be like heart pain. You may feel tightness of the chest and a severe, sharp pain. The pain may also spread down the arm and can be worse when you move.
You may find it helpful to rest and avoid sudden movements that increase the pain. Painkillers such as paracetomol or ibuprofen may help. Your GP or specialist may also suggest injecting the painful area with a local anaesthetic and steroid.
It is thought that smoking makes the inflammation worse, so if you smoke you may find that your pain improves if you cut down or stop altogether.
Occasionally, pain from other conditions can be felt in the breast, for example angina (tightness across the chest) or gallstones. This is known as referred pain. In this instance your GP or specialist will advise you on the most appropriate treatment.
Breast pain can be very distressing, and many women are anxious that they may have breast cancer. In most cases breast pain will be the result of normal changes that occur in the breasts of all women during their reproductive years. Whilst you may feel relief at being told that it is normal and you do not have breast cancer, the pain often persists. This can be very upsetting, especially if you are unable to hug your partner or cuddle your children for several weeks each month or if your specialist is unable to tell you the cause of your breast pain. You may feel many different emotions, such as fear, frustration or helplessness, and these are all normal reactions. Understanding more about your breast pain will not cure it, but it may help you to alter the way you cope and get back some control over your life.
Having breast pain does not increase your risk of breast cancer, but it is still important to be breast aware and go back to your GP if you notice any other changes.
Washington, DC Registry
Last modified: Friday, 22-Jul-2005 08:22:32 EDT |
