I am a 67-year-old woman and have been suffering with breast pain for several years. At times it is excruciatingly painful, particularly at night. Tests have found no obvious cause.
Name and address supplied.
Dr Martin Scurr replies: Breast pain is always something to check with a doctor but given the length of time you have had this, it’s almost certainly due to a benign cause.
In your longer letter, you mention you’re on hormone replacement therapy (HRT) and I suspect this is the most likely reason for your pain. The oestrogen in HRT can stimulate the breast tissue so that it becomes engorged with blood, leaving it swollen and tender.
It always affects both breasts rather than just one and, as in your case, the pain is often worse at night when you’re lying down. This is simply because of the pooling of blood in the already sensitive tissue in this position.
Breast pain can also be triggered by fibrocystic changes in the tissue. Breasts are made up of three main types of tissue – glandular, fatty and connective or fibrous – which hold the other two types in situ.
This fibrous tissue can collect in small lumps, often in both at the same time – it’s not clear why, though it may be linked to changes as a result of pregnancy.
This is less common in post-menopausal women, so if fibrocystic changes were to blame for your pain, you probably had it prior to the menopause and the HRT has exacerbated it.
I think it’s also safe to rule out problems relating to the chest wall or rib cage, such as costochondritis – inflammation in the joints between the ribs and the sternum (this is usually as a result of strain or respiratory infection and would be felt more widely around the chest region than just the breasts).
My advice is to stop HRT for three months to see if your breast pain settles down – your GP should be able to suggest other, non-hormonal treatments or advice (such as pain medication or acupuncture, or other complementary therapy).
I have had Raynaud’s disease in my left hand for over a decade. It’s very painful and now the skin on my fingers is breaking up. Other than keeping it warm, is there anything I can do?
Anthony Hughes, Cardiff.
Dr Martin Scurr replies: Raynaud’s disease is where blood vessels in the toes and other extremities (e.g. the tip of the nose) spasm in response to cold – as a result, the fingers etc will turn white then blue, and on warming, the skin flushes red and the affected fingers can become very painful.
This is known as primary Raynaud’s – the fact that your skin is breaking up suggests you have secondary Raynaud’s phenomenon, where the symptoms are due to an underlying problem, typically an autoimmune condition affecting the connective tissue and impeding blood flow – this in turn can cause ulceration of the skin.
But if an autoimmune problem was the issue, this would have been evident earlier in your life.
It’s more likely you have atherosclerosis, a build-up of fatty deposits that obstructs blood flow in your arm.
You also mention that you were referred to a vascular surgeon but surgery to improve blood flow was ruled out as you are taking the blood-thinner warfarin and this can raise the risk of a life-threatening bleed during surgery.
But there are medications that may help – nifedipine, used for angina and high blood pressure, works by dilating the arteries. So, too, does glyceryl trinitrate ointment, which is massaged into the fingers.
But the ointment can only be used sparingly, twice daily as it can cause dizziness, facial flushing and nausea (as can nifedipine, which may also cause headaches).
And as you say, keeping your hands warm must be part of the solution.
In my view… Fat pill linked to ‘electric shock’
Like many GPs, I’m now taking care of an increasing number of patients who’ve bought weight-loss jabs online.
Mostly they’re looking for me to reassure them about side-effects – many have heard about the rare but worrying risk of acute pancreatitis and there are other scare stories.
So far, I’ve seen nothing untoward other than nausea and diarrhoea – and hair loss with significant weight loss.
For the past year, I’ve been prescribing Ozempic, which contains semaglutide, for patients with type 2 diabetes.
Some of my weight-loss and type 2 diabetes patients are reluctant to self-administer injections. So I’ve suggested the oral version of semaglutide which, while less effective, also suppresses appetite and helps with weight reduction.
But I now learn from recent studies that 5 per cent of those taking this suffer dysesthesia, an unpleasant burning electric shock sensation affecting the skin. It’s not clear if this also occurs with the jabs, but it demonstrates, once again, the need to carefully balance the benefits of new treatments against the (emerging) risks.
