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Breast Pain (Mastalgia) 

Most women (up to 7 in 10 women) develop breast pain at some stage in life develop breast pain at some stage in their life.

What are the Types of Breast Pain?

In about 2 in 3 women the pain develops in the days just before a period - cyclical breast pain.

In the remainder the pain is not related to periods - non-cyclical.

If you are not sure which type of breast pain you have, it may be worth keeping a pain diary for 2 to 3 months. Record the days when you have breast pain, and highlight the days when the pain is severe enough to affect your lifestyle. You can then see if there is a pattern.

The pain is often mild but in some women it is more severe and can affect quality of life. Treatment, over and above simple reassurance, may be necessary for these women.


Cyclical Breast Pain

Cyclical breast pain is common. It can occur at any age after periods start, but most commonly occurs between the ages of 30 and 50. It does not occur in women past the menopause when the periods have stopped.

What are the symptoms of cyclical breast pain?

In many women the symptoms are mild. Indeed, it can be considered normal to have some breast discomfort for a few days before a period. However, in some women the pain can be severe and/or last longer - up to 1-2 weeks before a period. The 3-5 days prior to a period are usually the worst. The pain usually eases soon after a period starts. The severity can vary from month to month.Typically, the pain affects both breasts. It is usually worst in the upper and outer part of the breast, and may travel down the arms. If you have cyclical breast pain your breasts may also become larger, tender and slightly lumpy in the week or so before a period.

What causes cyclical breast pain?

It is thought that women with cyclical breast pain have breast tissue which is more sensitive than usual to the normal hormone changes that occur each month. It is not due to any hormone disease, or to any problem in the breast itself. It is not serious, but it can be a real nuisance.

What are the treatment options for cyclical breast pain?

No treatment may be needed if the symptoms are mild. Many women are reassured by knowing that cyclical breast pain is not a symptom of cancer or serious breast disease. The pain quite often settles by itself within 3-6 months, but can come back from time to time.

If the pain is more severe, or for the times when it may flare up worse than usual, treatment options include the following:

  • Support the breasts. Wear a well supporting bra when you have pain. Some women find that wearing a supporting bra 24 hours a day for the week before a period is helpful. It is best to avoid underwired bras. Wear a sports bra when you exercise.
  • Painkillers such as paracetamol or ibuprofen. Take regularly on the days when the breasts are painful.
  • Topical ('rub-on') anti-inflammatory cream. For example, topical diclofenac or topical ibuprofen. Side-effects from these creams are very rare.
  • Cutting out caffeine. Caffeine is said by some women to make things worse. This has not been proven in research studies. However, in the week or so before a period it may be worth trying to cut out tea, coffee and cola which contain caffeine to see if this helps.
  • Consider your medication. The contraceptive pill or hormone replacement therapy (HRT) may make cyclical breast pain worse. If appropriate, it may be worth discussing with your doctor stopping or changing the preparation to see if this helps.
  • Diet. Fatty acids may have a role in causing breast pain, so adjusting your diet by reducing animal fats (such as butter, cream and fatty meat) and increasing your intake of fresh fruit and vegetables can be helpful.
  • Evening primrose oil is often recommended as a treatment for breast pain. A dose of 1-2gms of Evening Primrose oil each day for a period of 6 weeks is required before benefit can be assessed. Improvement in severity of cyclical and non-cyclical mastalgia is 58% and 38% respectively. If symptoms improve you should continue these tablets.
  • Drugs to block hormones. Medication such as danazol or tamoxifen can ease pain in most cases. These medicines work by reducing the level, or blocking the effect of, female hormones such as oestrogen. You need to take them regularly (not just when the pain occurs). However, significant side-effects are common with these drugs. So, they are not usually tried unless you have severe pain which occurs during most months and does not ease with other treatments.

Non-cyclical Breast Pain

Breast pain can be present all the time, or 'come and go' in a random way. This type of breast pain is not related to periods and is most common in women over 40. The pain may be in just one breast, and may be localised to one area in a breast. Sometimes the pain is felt all over one or both breasts. There are various causes. For example:

  • Pain coming from the breast tissue itself in the absence of any lumps, tumours, or other abnormality being detected. The reason why this type of pain occurs is not known.
  • Pain coming or radiating from the chest wall under the breast rather than the breast itself. Muscular or bony problems of the chest wall account for some cases.
  • Infection is a cause in a small number of cases.
  • Breast cancer is a very uncommon cause of breast pain.

What is the treatment for non-cyclical breast pain?

In many cases the pain goes after a few months without any treatment. Anti-inflammatory painkillers such as ibuprofen may ease the pain. Topical anti-infammatory cream may also work. Other treatments may be appropriate, depending on whether a cause is found.


Breast Pain and Breast Cancer

Women with breast pain often worry that the pain is caused by breast cancer. But, the first symptom of breast cancer is usually a painless lump. If there is a cancer associated with pain it is likely that another symptom such as a breast lump, breast enlargement, distortion of the skin or redness of the skin will also be noticed. These changes should be easily spotted on assessment by a doctor or by a mammogram.

Page Last Updated: 17/02/2015 16:19 
Printed from Salisbury NHS Foundation Website http://www.salisbury.nhs.uk