How to take care of your breasts?

The mammary glands are the largest human skin glands. They are made not only of adipose tissue, but also glandular and connective tissue. The glandular tissue is arranged in so-called lobes, which are divided into smaller lobules. These are the harder, large structures that you can feel under your fingers in healthy breasts. The hormones that act on our breasts are mainly estrogens, progestogens and prolactin, and to some extent it depends on them whether our breasts hurt or not.

In Polish medicine, this is a somewhat "under-groomed" organ. Palpation should be performed by a gynecologist (at least during the first visit - later you can do it yourself regularly), but even if a gynecologist feels something, he will not treat the breasts. In most cases (because there are individual gynecological departments that also deal with breast diseases), breast changes are dealt with by an oncological surgeon. And who to go to for an ultrasound? And here it is different: some gynecologists deal with it, surgeons, radiologists, oncologists. It is important to find someone in your area who does it simply well. And how do we know whether we should have a mammogram or an ultrasound? The general rule is that if you have not breastfed, an ultrasound is recommended, and after breastfeeding - a mammogram. This is related to the reconstruction of the mammary gland. We must remember that this is a general rule, sometimes it is advisable to have both tests, and sometimes, for example, due to the multitude of changes, an MRI scan is recommended. Due to the complexity of this diagnostics, it is a good idea to consult your gynecologist in advance - he will certainly give you good advice.

According to the guidelines for breast cancer prevention in Poland, every woman between 50 and 69 years of age should have a mammogram every two years. There are no such recommendations from the National Health Fund for young women (these are population programs, so they are only performed in groups of increased population risk), so hypothetically, the test is only recommended if you have a family history of breast cancer. There are many guidelines that depend on many factors, so it is best to discuss when and how you should examine your breasts with your gynecologist. I can add that in my opinion every woman should have a breast ultrasound at least once to be sure that she is performing a self-examination on healthy breasts, because according to various sources, changes in the breasts are detected by palpation only when they are 1-2 cm in size. When introducing contraception (which in many cases slightly increases the risk of even benign changes), I recommend this test to patients so that we know what the situation is at the beginning of the contraceptive adventure. If you want to learn more about contraception, read our article "All contraceptive methods – which to choose? "

And what does a breast self-examination look like? Below is a link with short instructions . It is important that you do it regularly, preferably every month on the same day of your menstrual cycle (ideally right after your period), because no one will know your breasts like you do. Most changes in the breasts are felt during this examination, and we often underestimate its importance.

This is just a short introduction to cancer prevention, but in this post I wanted to address a problem that affects more women, namely breast pain (mastalgia) and breast pain combined with engorgement (mastodynia). According to various studies, breast pain affects 50-80% of women before menopause, so we can consider it a fairly significant problem. Unfortunately, it is also very often trivialized. What can you do for yourself? First, if you experience breast pain, consider whether it is not the fault of uncomfortable underwear. Women who wear bras that are too small complain about breast pain 3 times more often. Therefore, another point to take care of yourself: wear comfortable, well-fitting underwear. A bra that is too tight causes pressure, while one that is too large does not hold the breasts, which are adversely affected by gravity.

You can read more about (not) wearing a bra in the text " Is going without a bra healthy? ".

Mastalgia is divided into 3 groups: cyclical, non-cyclical and chest pain. In cyclical mastalgia, pain is associated with our menstrual cycle, intensifies mainly in its second phase, the luteal phase, and usually lasts about 5 days. This pain involves both breasts, characterized as mild. What is its cause? Hormonal fluctuations in our body, which, in addition to PMS , also cause breast pain. Non-cyclical mastalgia has an unknown etiology. It occurs most often in the perimenopausal period, i.e. in older women than cyclical mastalgia. Acute pain very often affects one breast and it is localized (the patient shows exactly where it hurts). We cannot forget that the cause of chest pain may also be diseases of the musculoskeletal system (sternocostal, sternoclavicular joints), cardiovascular or nervous system (e.g. shingles), which is why differential diagnosis of these ailments is important. When talking about breasts, we cannot forget about mastodynia, which occurs when breast pain is accompanied by swelling.

Where do these pain symptoms come from? The etiology is not 100% known. We know that hormones have a very large impact on the occurrence of pain symptoms, and not only in terms of hormonal changes in the menstrual cycle, but also, for example, taking hormonal contraception . Stress, physical exertion, alcohol abuse or depression also have an impact on our symptoms. Obesity also predisposes to a more frequent occurrence of mastalgia. And mastalgia itself often coexists with irritable bowel syndrome or pelvic pain syndrome. Interestingly, according to one study, pain symptoms subside in 70% of women who, as a result of tests, make sure that they are healthy, which is why the psychological aspect of this disease is very important. And it is not about telling the patient "you're making it up", but understanding the psychological basis of the disease.

Okay, so how do we treat it? We need to start by ruling out a neoplastic process. Very often, mastalgia is accompanied by tenderness of the nipples or thickening around the areola, which can also be an expression of an ongoing neoplastic process - that is why an ultrasound scan is recommended at the beginning of our journey.

First-line drugs are non-steroidal anti-inflammatory drugs, e.g. diclofenac, used both orally and locally, e.g. in the form of an ointment. Additionally, we can use flax seeds (containing phytoestrogens) or V. agnus extract (used in mastodynia and PMS). Second-line drugs are selective estrogen receptor modulators, bromocriptine or danazol, however, due to significant side effects, such therapies must be implemented in consultation with a doctor and are reserved only for patients with severe symptoms that do not subside after using other methods of treatment.

In summary. Your breasts hurt: what next? Answer a few questions.

1. First, analyze your underwear: is it properly fitted? Is it tight or too loose?
2. Is there no other cause for these symptoms?
3. Are the symptoms related to the menstrual cycle or not?
4. Apart from pain, are there any lumps or abnormal discharge from the nipple or other disturbing symptoms?
5. After excluding pathology (ultrasound, mammography), the next step may be the local application of diclofenac and preparations containing chasteberry extract.
6. If, despite taking these steps, the pain does not subside, we must return to the doctor for further treatment.

As in every post, here too I ask you to take care of yourself and your body, observe your body and trust your doctors. It is essential to have an honest conversation about your symptoms and concerns. Most often, it is easy to get rid of pain and it does not mean anything bad. Which does not change the fact that we have to take care of ourselves and realize how important our lifestyle is.

Breast self-examination [LINK]
Grzechocińska, B. (2018). Breast pain related and unrelated to the menstrual cycle". Gynecology after diploma , 6. [LINK]
Phelan, ST (2018). Diagnosis and treatment of benign breast disease. Postgraduate Gynecology, 3.
Colak, T., Ipek, T., Kanik, A., Ogetman, Z., & Aydin, S. (2003). Efficacy of topical nonsteroidal antiinflammatory drugs in mastalgia treatment. Journal of the American College of Surgeons, 196(4), 525–530.
Karowicz-Bilińska, A., Kędzia, W., Kotarski, J., Nowak-Markwitz, E., Oszukowski, P., Poręba, R., Spaczyński, M., Radowicki, S. (2013). Position of the Expert Team of the Polish Gynecological Society on the use of Mastodynon® in gynecology. Ginekologia Polska, 2(84), pp. 157-159.