Breast pain, cyclical
Breast pain (mastalgia) is a common symptom that affects up to two-thirds of women in the UK, mostly between the ages of 30 and 50.
Breast pain may be felt as a heaviness or soreness, and has also been described as a stabbing or burning pain. It's usually felt in the upper, outer area of your breasts and may extend from your breasts to your armpits, and sometimes down your arms.
Many women worry that breast pain may be a sign of a serious condition. However, breast pain by itself is not a symptom of breast cancer, and breast pain does not increase your risk of developing breast cancer.
In most cases, breast pain is relatively mild, although some women experience moderate or severe pain. Severe or chronic breast pain can interfere with daily activities and lead to stress, anxiety or depression.
Types of breast pain
There are two types of breast pain:
cyclical breast pain – the most common type of breast pain, linked to the menstrual cycle
non-cyclical breast pain – pain in the breasts unrelated to the menstrual cycle
Causes of breast pain
Cyclical breast pain
Although the exact cause of cyclical breast pain is unknown, it's thought to be linked to the changes in hormone levels before periods begin.
The menstrual cycle is controlled by your body releasing hormones such as oestrogen. Hormones are powerful chemicals that have a wide range of effects on the body.
The pain occurs around the same time every month, usually one to three days before the start of your period, and improves at the end of your period. The intensity of the pain will not always be the same.
Although cyclical breast pain mainly affects women who are still having periods (before the menopause), some women can experience symptoms after the menopause if they undergo hormone replacement therapy (HRT).
Cyclical breast pain is not associated with any other breast-related conditions.
Non-cyclical breast pain
In many cases, the cause of non-cyclical breast pain can't be identified. However, breast pain is sometimes caused by other conditions, including:
mastitis – a condition that can be related to breastfeeding and causes the breast tissue to become painful and swollen
breast lumps – there are many non-cancerous (benign) causes of breast lumps, some of which may be painful
breast abscess – a painful collection of pus that forms in the breast
Non-cyclical breast pain may also be the result of an injury elsewhere in the body, such as pulling a muscle in the chest, which is felt in the breast.
In rare cases, non-cyclical breast pain may be caused by other medications and treatments – such as some types of antifungal medicines, antidepressants or antipsychotics – that are used to treat mental health conditions.
When to see your GP
Visit your GP if you notice changes to your breasts, such as:
a lump or area of thickened tissue in either breast
discharge from either of your nipples (which may be streaked with blood)
a lump or swelling in either of your armpits
a change in the size or shape of one or both of your breasts
dimpling on the skin of your breasts
a rash on or around your nipple
a change in the appearance of your nipple – for example, it becomes sunken into your breast
pain in either of your breasts or armpits that is not related to your period
any symptoms of an infection in your breast, such as swelling, redness or warmth in your breast, or a high temperature (fever)
You should also see your GP if you have any symptoms of pregnancy, such as a missed period.
If you have breast pain alongside other symptoms, or the pain continues throughout your menstrual cycle (not only around your period), it may not be cyclical breast pain. Your GP can advise you on what the cause may be.
Your GP will be able to diagnose cyclical breast pain by asking about your symptoms and your general health. They may also examine your breasts if they feel lumpy when you experience breast pain.
Recording breast pain
You may be asked to record your breast pain, if it's severe. Completing a breast pain chart may help to diagnose whether it's cyclical breast pain and to plan appropriate treatment.
The chart will usually have a series of small boxes, with the month and date next to each one. You fill in the box for each day of the month to indicate your level of pain. This is usually done for at least two months.
How is breast pain treated?
Most cases of breast pain get better without treatment. Almost a third of women with cyclical breast pain find their condition gets better in around three menstrual cycles. However, for many, cyclical breast pain will return in the future.
Many women find they can live with their breast pain once they feel reassured that it's not caused by breast cancer.
The pain can usually be dealt with by over-the-counter painkillers and gels, such as paracetamol or ibuprofen. Speak to your pharmacist for advice.
If your breast pain is caused by another condition, such as a breast abscess, the pain should ease once the condition is treated.
If your breast pain is affecting your quality of life, your GP may request that you keep a record of your daily pain and may refer you to a breast specialist for further treatment.
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Treating breast pain
You can improve your symptoms of cyclical breast pain by wearing well-fitting bras and taking painkillers. Some cases don't need any treatment.
Some women find that cyclical breast pain improves on its own. In other cases, it may disappear and return periodically over a number of years.
Many women also feel reassured to know that their breast pain is not due to a more serious condition, and therefore find it easier to live with.
If your breast pain requires treatment, there are several self-help measures you can try. These include:
wearing a better-fitting bra during the day
wearing a soft support bra while you are sleeping
wearing a sports bra while exercising
taking over-the-counter painkillers, such as paracetamol or ibuprofen, when you experience breast pain
Your GP may also recommend a topical non-steroidal anti-inflammatory drug (NSAID) that can be rubbed directly on to the painful areas, such as:
a gel containing diclofenac
a gel containing ibuprofen
Follow the manufacturer’s instructions and make sure the medicine is suitable for you. For example, topical NSAIDs should not be used where the skin is broken.
Some experts have also suggested that breast pain may be improved by:
reducing your intake of caffeine – which is found in tea, coffee and cola
reducing your intake of saturated fat – which is found in butter, crisps and fried food
not smoking (if you smoke)
However, the benefits of making these changes have not been scientifically proven, and they are not usually recommended by doctors.
Some women use alternative therapies, such as acupuncture or reflexology, to relieve the symptoms of cyclical breast pain. However, the lack of evidence supporting their effectiveness means that more research is needed before they can be recommended by the NHS.
Evening primrose oil
Although there is no scientific evidence to suggest that capsules of evening primrose oil can treat cyclical breast pain, many women find it beneficial.
Evening primrose oil can be bought from some pharmacies and health food shops.
As evening primrose oil may not always be suitable – for example, if you are trying to get pregnant or if you have epilepsy – you should speak to a GP before using it. Your GP may also be able to recommend a suitable product and tell you how much you should take.
If you have cyclical breast pain that is severe enough to affect your quality of life and the above-mentioned treatments do not help, your GP may suggest other treatment options.
You may also be referred to a breast specialist, either at a hospital or a specialist breast clinic.
In rare cases, you may be prescribed one of the following medications if you need further specialist treatment:
These medicines affect the hormone levels in your body, and evidence suggests that they may help to reduce cyclical breast pain. However, they can also cause some unpleasant side effects, such as excessive hair growth and a permanently deep voice.
Some of these medications are unlicensed for the treatment of breast pain. This means the medication’s manufacturers have not applied for a licence for the drug to be used in treating breast pain. In other words, the medication has not undergone clinical trials (a type of research that tests one treatment against another) to determine whether it is an effective and safe treatment for breast pain.
Doctors will sometimes use an unlicensed medication if they think it is likely to be effective and that the benefits of treatment outweigh any associated risk.
If your specialist is considering prescribing an unlicensed medication, they should let you know it is unlicensed and discuss the possible risks and benefits with you.
Danazol is licensed to treat severe pain caused by fibrocystic breast disease (fibroadenosis). This is a condition that causes benign (non-cancerous) growths to develop in the breast. Side effects include:
nausea (feeling sick)
a deepening voice – this may be permanent
hirsutism (excessive hair growth) – for example, on the face
Tamoxifen is a medicine used to treat breast cancer. It is also used as an unlicensed medicine to treat breast pain. Side effects include:
vaginal bleeding or discharge
an increased risk of womb cancer (endometrial cancer)
an increased risk of thromboembolism – when a blood clot forms in your veins (thrombosis), which may cause a blockage
Goserelin is a medicine used to treat breast cancer. It may also be used as an unlicensed medicine to treat breast pain. Side effects include:
less interest in sex