Breast Discomfort

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Breast Discomfort

Ease Pain, Tenderness and Distress

Check out the crowd the next time you go to the beach, and you'll see that women's breasts come in all shapes and sizes. Breast problems are equally diverse. Some women's breasts ache just before or during menstruation. Others develop worrisome lumps. Some women have no problems--until they show up for their annual mammograms and wince at the pressure of the x-ray machine.

Easing the Ouch of Mammograms Doctors say that a mammogram (low-dose x-ray of the breasts) is the single best way to detect breast cancer early, in its most treatable stages. Yet women often skip their appointments or put them off. The reason: Mammograms hurt. To get a clear picture, the technician needs to compress your breasts between two plastic plates, explains Ellen Yankauskas, M.D., director of the Women's Center for Family Health in Atascadero, California. So if your breasts are at all tender (and even if they're not), the test may be uncomfortable. Dr. Yankauskas offers women this advice to minimize discomfort. * Schedule your test for about one week after the last day of your menstrual period, when breast swelling and tenderness is minimal. * A few weeks before your appointment cut down on your intake of caffeine and start taking 200 to 400 international units of vitamin E daily. * Immediately before your mammogram take a standard dose of ibuprofen or acetaminophen. * If pain persists despite these preventive measures, apply an ice compress and take an additional over-the-counter painkiller, if needed.

BLAME IT ON YOUR PERIOD

Breast care specialists say that for most women, breast discomfort waxes and wanes with the menstrual cycle. Right before and during menstruation, higher-than-usual levels of the female hormone estrogen may cause one or both breasts to swell and become tender. Discomfort ranges from mild tenderness in some women to excruciating pain in others. (Taking oral contraceptives produces similar effects.) For many women monthly bouts of breast discomfort disappear with menopause--unless they undergo estrogen replacement therapy.

Sometimes premenstrual changes foster the development of tender but harmless cysts in the breasts' milk-producing glands. Once labeled fibrocystic disease, these tiny fluid-filled sacs are actually quite normal. Fibrocystic changes are less likely in women over age 35, because with age, glandular tissue--where breast cysts tend to occur--is replaced with fat tissue.

SOMETHING OLD, SOMETHING NEW

Assuming that your doctor has assured you that you have nothing serious to worry about, here is what women physicians and other health professionals advise for breast pain or tenderness.

Warm gently. Holding a warm compress such as a heated towel or a heating pad against the breast for 10 to 15 minutes can give some relief from breast tenderness, says Ellen Yankauskas, M.D., director of the Women's Center for Family Health in Atascadero, California.

Cool down swelling. The uncomfortable swelling of breast tissues that often occurs before and during a menstrual cycle can be relieved with cold compresses, says Dr. Yankauskas. Wrap ice packs or bags of frozen vegetables in towels, mold them around your breasts and keep them there until the packs warm. Repeat as needed. (Never eat food that's been thawed and refrozen. Mark the packages before refreezing.)

Wear a supportive bra. The mere act of not wearing a bra can contribute to breast pain, says Michele A. Gadd, M.D., a participating surgeon at the Comprehensive Breast Health Center Division of Surgical Oncology at Massachusetts General Hospital in Boston. "The weight of the breasts themselves can contribute to discomfort." So many women find it helpful to wear supportive bras.

Be sure that you wear a bra that's constructed in a way that won't add to the irritation, suggests Dr. Yankauskas. Look inside the cups and make sure that there are no seams and nothing pushing up against you. If there is an underwire, make sure that it's very well-padded so that it doesn't add to the friction.

"This might not be the time of the month to wear your Wonderbra," she says. "Try a sports bra instead."

Serve up some soy. In societies where soybeans are a routine part of the diet, women have fewer breast problems, says Dr. Yankauskas. Soybeans, and foods made from soy, contain isoflavones--naturally occurring substances that are converted to hormonelike substances and may block certain unwanted effects of estrogen in the body, thus mitigating breast discomfort.

So the next time you order Chinese food, order an entrée with tofu instead of meat. Pour soy milk on your cereal. Or pick up some soy burgers for your next cookout. You can find soy milk, soy burgers and other soy products in health food stores.

Cut salt. "Salt is a water magnet," says Dr. Yankauskas. "So if breast discomfort is associated with fluid retention, then watching salt intake should help."

Cut caffeine. If you experience breast discomfort, abstain from caffeine in all forms, advises Tina Hieken, M.D., a surgical oncologist at the University of Illinois at Chicago Medical Center. This includes coffee, tea, caffeine-containing soft drinks, chocolate and painkilling medications (such as Excedrin) that contain caffeine. The culprit seems to be a compound called methylxanthine, contained in caffeine, that may stimulate breast tissue and cause pain.

You may feel an improvement if you cut back to just one or two cups of coffee a day, says Dr. Yankauskas. "But some women are very sensitive and really can't have any caffeine at all."

If you cut down, be patient, says Dr. Hieken. It may take a few weeks or even months to notice a difference.

Make yourself a cup of herbal tea. Corn silk, buchu, and uva ursi--herbal teas found at health food stores--act as mild diuretics that can flush out some of the fluid that contributes to breast discomfort, says Dr. Yankauskas.

Ease pain with evening primrose oil. "Though there is no scientific explanation for it, taking evening primrose oil relieves breast pain in about 30 percent of the women I see," says Dr. Gadd. Health food stores sell evening primrose oil in tablet form. Take three tablets nightly before bed when you experience breast discomfort, says Dr. Gadd.

Try some vitamin E. "Some studies have shown that taking slightly larger amounts than the Daily Value of vitamin E is very effective in relieving breast tenderness and discomfort from fibrocycstic breasts," says Dr. Yankauskas. Either start with the Daily Value of 30 international units (IU) and increase it when you experience breast problems or take 200 to 400 IU of vitamin E a day. "That should be safe. But don't take more," she says. Vitamin E is stored in your body fat, so too much could be toxic.

Eat less fat. Women in cultures that customarily consume a low-fat diet have fewer breast complaints than those where women eat high-fat diets, says Dr. Yankauskas. So she advises women who complain of breast problems to eat a diet consisting of less than 30 percent fat. (On a 1,800 calorie-per-day diet, that's no more than 60 grams of fat.)

Lose weight. Women store estrogen in body fat, says Dr. Yankauskas. Losing excess weight can therefore help minimize the hormone's contribution to breast discomfort.

When To See A Doctor If you have breast pain every month, without respite, consult your doctor, even if it seems to be related to your menstrual cycle, says Michele A. Gadd, M.D., a participating surgeon at the Comprehensive Breast Health Center Division of Surgical Oncology at Massachusetts General Hospital in Boston. You should also consult your doctor if you notice: * Breast pain that comes on suddenly, especially when you haven't been experiencing monthly pain * Breast pain that occurs after starting new medication or hormone replacement therapy * Bloody or milky discharge from one or both nipples * Any breast lump or thickening, whether or not it is painful If you have had breast lumps in the past that your doctor diagnosed as noncancerous, you might choose to wait until your menstrual period passes to see if the lump or thickening disappears, says Dr. Yankauskas. If you have no symptoms but are worried about your breasts for any reason, go ahead and see a physician, says Frances Marcus Lewis, R.N., Ph.D., professor of family and child nursing at the University of Washington in Seattle. "A woman's feelings about what is happening are as important as what's actually happening." Also, women over the age of 30 should be sure to see a physician for a breast exam every year. Ask your doctor or nurse to teach you how to do a monthly self-exam. Become familiar with your normal breast anatomy in order to detect any subtle changes, says Dr. Lewis.

Walk away breast pain. "Women who exercise two or three times a week have fewer breast problems," says Dr. Yankauskas. Exercise helps by reducing body fat and increasing circulating levels of endorphins--natural feel-good chemicals released by the brain. Avoid exer cises such as running or aerobic dance that create bounce and tug at your ligaments; that can contribute to breast pain. "A good brisk walk is just as good as any type of running or aerobic dance classes and probably easier on the breast tissue," she says. Be sure to wear a supportive athletic bra with nonelastic straps.

Swimming is also a good exercise choice for that sensitive time of the month.

Don't worry. Fear of breast cancer may make breast pain more noticeable. So if you're worried, get a checkup, advises Dr. Gadd. "In my practice, once most women know that they don't have cancer, the pain seems to be not so much of an issue. At first the pain seems to affect everything--from their jobs to their ability to carry on day-to-day functions--but once we've determined that they don't have cancer, they're not even that interested in taking any pain medication."

LUMPS THAT AREN'T

As it happens, worrisome (but harmless) lumps and thickenings in the breast are pretty common, especially among premenopausal women. Rest assured, though, doctors say that most breast lumps are not cancer, especially in women under the age of 40. Nevertheless, it is important that you become familiar with the normal terrain of your breasts in order to detect any changes in existing lumps or new lumps that warrant medical attention.

Here's what women doctors advise.

Check once a day only. "Many times, a woman finds a lump in her breast and keeps touching it and checking it, and guess what she's doing? She's making it hurt more," says Dr. Yankauskas. If you discover a lump at an "obvious" point in your menstrual cycle--either right before your period or mid-cycle, wait a few days to see if it disappears after your period.

"Go ahead and recheck the lump," says Dr. Yankauskas. "But once a day is enough."

Unplug your milk duct. If you're breastfeeding and find a lump, don't panic: What you feel could simply be a backed-up milk duct, says Dr. Yankauskas. To release the blockage, soften the affected breast with a warm washcloth, express the excess milk and feed your baby.