概述

乳房疼痛(又称“乳腺痛”)在女性之中很常见,其症状包括乳房触痛、剧烈的灼热感或乳腺组织紧绷。这种疼痛可能持续存在,也可能只是偶尔发生。

乳房疼痛的程度包括轻度到剧烈疼痛。可能发生的情况:

  • 每个月只有几天出现疼痛,在月经之前两到三天出现。这种正常的轻度至重度的疼痛会影响两侧乳房。
  • 每月持续一周或更长时间的疼痛,从月经前开始,有时候会一直持续到月经周期结束。疼痛为中度或重度,会影响两侧乳房。
  • 整月持续疼痛,与月经周期无关。

绝经后的女性有时候也会出现乳房疼痛,但乳房胀疼在未绝经的年轻女性中更为常见。

大部分时候,乳房疼痛是非癌性(良性)乳房疾病的信号,极少表明患有乳腺癌。然而,如果不明原因的乳房疼痛在一至两个月经周期之后仍未消退或在绝经后持续存在,则需要联系您的医生接受诊断。

症状

大多数乳房疼痛可分为周期性或非周期性。每种类型的乳房疼痛都有明显的特征。

乳房疼痛特征
周期性乳房疼痛 非周期性乳房疼痛
明显与月经周期有关 与月经周期无关
描述为迟钝、沉重或疼痛 描述为紧绷、灼热或疼痛
常伴有乳房肿胀或肿块 持续或间歇
通常会影响两侧乳房,尤其是上部、外部,并会蔓延到腋下 通常影响一侧乳房的局部区域,但可能扩散到整个乳房
在经期开始前两周内加剧,然后缓解 最容易影响绝经期后的女性
更容易影响到绝经前的 20 多岁和 30 多岁的女性,以及正在过渡到绝经期的 40 多岁女性  

乳房外乳房疼痛

“乳房外”这个术语的意思是“乳房外部”。乳房外乳房疼痛感觉像是从乳房组织开始的,但其实源头在其他地方。举个例子,拉伸胸部肌肉会导致胸壁或肋廓疼痛,并扩散(辐射)到您的胸部。

何时就诊

如果乳房疼痛,请与医生约诊:

  • 每天连续疼痛,持续数周
  • 发生在乳房的特定区域
  • 似乎随着时间推移越来越糟
  • 干扰日常活动

虽然以乳房疼痛为主要症状的女性患乳腺癌的风险较低,但如果您的医生建议进行评估,则务必完成评估。

Extramammary breast pain

The term "extramammary" means "outside the breast." Extramammary breast pain feels like it starts in the breast tissue, but its source is actually outside the breast area. Pulling a muscle in the chest, for example, can cause pain in the chest wall or rib cage that spreads (radiates) to the breast. Arthritis that involves the cartilage in the chest, also known as costochondritis, can also cause pain.

When to see a doctor

Make an appointment with your doctor if breast pain:

  • Continues daily for more than a couple of weeks
  • Occurs in one specific area of your breast
  • Seems to be getting worse over time
  • Interferes with daily activities
  • Awakens you from sleep

Breast cancer risk is very low in people whose main symptom is breast pain, but if your doctor recommends an evaluation, it's important to follow through.

病因

有时,无法确定乳房疼痛的确切原因。诱发因素可能包括以下一项或多项:

  • 生殖激素。周期性乳房疼痛看似与激素和月经周期密切相关。周期性乳房疼痛通常会因怀孕或绝经而减轻或消失。
  • 乳房结构。非周期性乳房疼痛往往是由乳管或乳腺中的病变所致。这可能导致乳腺囊肿的发生。乳房外伤、先前的乳房手术或其他局限于乳房的因素都可能引起乳房疼痛。另外,乳房疼痛也可能始于乳房外部(例如胸壁、肌肉、关节或心脏),然后辐射到乳房。
  • 脂肪酸失衡。细胞内脂肪酸的不平衡可能会影响乳腺组织对循环激素的敏感性。
  • 药物使用。某些激素药物(包括某些治疗不孕症的药物和口服避孕药)可能与乳房疼痛有关。另外,乳房压痛也可能是绝经后使用雌激素和黄体酮激素疗法所产生的副作用。乳房疼痛可能与某些抗抑郁药有关,如选择性血清素再摄取抑制剂(SSRI)抗抑郁药。
  • 乳房大小。乳房大的女性可能会出现与乳房大小有关的非周期性乳房疼痛。颈部、肩部和背痛可能会伴有乳房大引起的乳房疼痛。
  • 乳房手术。因乳房手术和形成疤痕引起的乳房疼痛有时会在切口愈合后继续存在。

风险因素

Breast pain is more common among people who haven't completed menopause, although it may occur after menopause. Breast pain can also occur in men who have gynecomastia, and in transgender people who are undergoing gender reassignment.

Other factors that may increase the risk of breast pain include:

  • Breast size. People who have large breasts may experience noncyclic breast pain related to the size of their breasts. Neck, shoulder and back pain may accompany breast pain that's caused by large breasts.
  • Breast surgery. Breast pain associated with breast surgery and scar formation can sometimes linger after incisions have healed.
  • Fatty acid imbalance. An imbalance of fatty acids within the cells may affect the sensitivity of breast tissue to circulating hormones.
  • Medication use. Certain hormonal medications, including some infertility treatments and oral birth control pills, may be associated with breast pain. Breast tenderness is a possible side effect of estrogen and progesterone hormone therapies that are used after menopause. Breast pain may be associated with certain antidepressants, including selective serotonin reuptake inhibitor (SSRI) antidepressants. Other medicines that can cause breast pain include those used to treat high blood pressure and some antibiotics.
  • Excessive caffeine use. Although more research is needed, some people notice an improvement in breast pain when they reduce or eliminate caffeine.

预防

The following steps may help prevent the causes of breast pain, although more research is needed to determine their effectiveness.

  • Avoid hormone therapy if possible.
  • Avoid medications that are known to cause breast pain or make it worse.
  • Wear a properly fitted bra, and wear a sports bra during exercise.
  • Try relaxation therapy, which can help control the high levels of anxiety associated with severe breast pain.
  • Limit or eliminate caffeine, a dietary change some people find helpful, although studies of caffeine's effect on breast pain and other premenstrual symptoms have been inconclusive.
  • Avoid excessive or prolonged lifting activities.
  • Follow a low-fat diet and eat more complex carbohydrates.
  • Consider using an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) — but ask your doctor how much to take, as long-term use may increase your risk of liver problems and other side effects.

Jan. 16, 2021
  1. Golshan M, et al. Breast pain. https://www.uptodate.com/contents/search. Accessed Jan. 22, 2019.
  2. Mastalgia (Breast pain). Merck Manual Professional Version. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/breast-disorders/. Accessed Dec. 13, 2020.
  3. Sivarajah R, et al. A review of breast pain: Causes, imaging recommendations, and treatment. Journal of Breast Imaging. 2020; doi:10.1093/jbi/wbz082.
  4. Bland KI, et al., eds. Etiology and management of benign breast disease. In: The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Dec. 13, 2020.
  5. Ferri FF. Gynecomastia. In: Ferri's Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 13, 2020.
  6. AskMayoExpert. Breast pain. Mayo Clinic; 2020.
  7. Holbrook AI, et al. ACR appropriateness criteria breast pain. Journal of the American College of Radiology. 2018; doi:10.1016/j.jacr.2018.09.014. https://acsearch.acr.org/docs/3091546/Narrative/. Accessed Dec. 8, 2020.
  8. Niell BL, et al. ACR appropriateness criteria evaluation of the symptomatic male breast. Journal of the American College of Radiology. 2018; doi:10.1016/j.jacr.2018.09.017.
  9. Vitamin E fact sheet for consumers. National Institutes of Health. https://ods.od.nih.gov/factsheets/VitaminE-Consumer/. Accessed Dec. 8, 2020.
  10. Pruthi S (expert opinion). Mayo Clinic. Dec. 13, 2020.