Welcome to the world of nipple vasospasm and/or Raynaud's of the nipple.
I am writing this as a public service, because I thought I was being a whimp about nipple pain and losing my mind, and I think there are more women out there like me than the medical community realizes.
Note: It appears that the anti-hypertensive drug Labetolol can cause extreme nipple pain as a side-effect. A lot of women experiencing hypertension during pregnancy are put on this drug. See my comment below dated 11/01/2016 for NIH and journal articles.
When we are pregnant and nursing (breastfeeding), women are told to expect a certain amount of breast-related discomfort. When we complain about extreme pain, we are sometimes diagnosed with mastitis. If treatment for mastitis fails, then we're told it's probably a fungal infection, like thrush. If treatment for fungal infection doesn't relieve the pain, mothers are told to grin and bear it, or give up breastfeeding. Thousands of women choose to suffer through agony because they know that breastfeeding is what is best for their children. Thousands more give up on breastfeeding entirely, feeling inadequate as mothers and unsupported by their physicians. I recently learned that nipple vasospasm, and particularly Raynaud's of the nipple, are leading causes of breastfeeding failure -- and no one knows about it.
Really. I first started experiencing it at about 5 months in to my pregnancy, when I started taking Labetalol for hypertension. I finally spoke of the throbbing, burning pain, I was told some women experienced that as their milk came in, and that it would fade. I knew that this level of intense pain just couldn't be 'normal', so I started researching online. It took me several hours of digging to turn up the information on Raynaud's/vasospasm of the nipple. My OB had never heard of it. She talked to another OB and that doctor told her she'd had a few patiednts with it over the years, but it was rare. I was referred to a lactation consultant who said my symptoms were characteristic of Raynaud's and recommended a medication(nifedipine) that I can't take while I'm pregnant. I have to wait until I'm breastfeeding. Meanwhile, I suffer.
What are the symptoms of Raynaud's or vasospasm of the nipple?
1-Extreme burning pain, the kind of nipple-on-fire pain that has you crying hysterically, wakes you up at night, doesn't respond to Tylenol, and makes you wish you could take drugs, drink alcohol, or knock your head against a wall until you find oblivion.
2-Extremely hard, puckered nipples and areolae, as if you'd been exposed to intense cold.
3-A blanching (whitening) of the tips of the nipples.
4-The areolae turn a very dark reddish, purplish, or bluish hue.
5-The edges of the aureolae sometimes turn a bright, angry red.
6-The pain lasts anywhere from just minutes, to over an hour.
If these symptoms are triggered by exposure to cold, it is called Raynaud's, otherwise, it is called nipple vasospasm. Whatever they call it, it is maddeningly painful.
I've tried Tylenol, sunburn gels, nipple ointments and numbing sprays, my hairdryer, warm washcloths, etc. The only thing that helps is a long, hot shower. The problem is, being pregnant, my tolerance for long, hot showers is pretty low. The other night I got out of the shower after 20 minutes, still with pain but bearable, and crawled into bed. 90 minutes later I was awake again. It took 30 minutes in a hot shower, with me feeling lightheaded and my knees about to buckle, before the horrid fucking pain abated.
I've experienced this for 5 nights running. I'm exhausted. I'm cranky. I'm dreading breastfeeding. As I emptied my dishwasher this morning, I was actually tempted by steak knives: I contemplated sawing off my nipples.
Several causes and treatments of nipple vasospasm are hypothesized. Causes could be too much caffeine, not enough B6 vitamins, exposure to cold, etc etc. Treatments recommended are heat, avoidance of vasocontrictors like caffeine and nicotine, ingesting vasodilators like nitrates, alcoholic beverages, niacin, and certain herbs. Based on the feedback I've been getting from other women, hypertensive meds, particularly Labetalol, may be causing this.
Ibuprofen helps some women, and Nifedipine usually works within days, and requires no more than 6 weeks at a low dosage to prevent recurrance. So the literature says.
I'm not sure what I'm going to do, especially on those nights when the pain outlasts my endurance of hot showers. Perhaps a bit of alcohol. This late in my pregnancy I'm not turning to ibuprofen and I'm not very tolerant of NSAIDs anyway. I might hit my doc up for prescription-strength topical lidocaine or procaine. Or maybe I'll get lucky and it will just disappear. I just know that I can't take another 23 days of this.
I hope that my research helps other women out there who are going crazy with nipple pain.
I was at my doctor's office for a routine fetal monitoring when this hit again. I sat in the chair and cried silently until the RN came in to check the tape and saw me. My pain tolerance is legendary so she was shocked. She asked what was going on. I showed her my breasts. Dark purplish aureolae and nipples, with the tips a shocking grayish white. She went and grabbed my OB. She examined me, gave me lidocaine cream and hot towels but they didn't make much difference. She asked me if anything helped. I defiantly told her about 1/2 ounce of scotch or Bailey's Irish Cream worked within a few minutes and I figured such a small amount wasn't going to affect the baby. She said I was right. She said that the stress hormones I was pumping out due to that level of pain was much worse for the baby than a small amount of alcohol. So now I've got doctor's orders to drink next time I have one of these vasospasms. Whee!