Breast pain (mastalgia) is common. It can be:
- Cyclical – occurring at specific times of the menstrual cycle
- Non-cyclical – unrelated to the menstrual cycle
Pain is not typically considered a symptom of breast cancer. After a proper assessment and without other features of breast cancer (e.g., a lump or skin changes), patients with mastalgia can generally be reassured.
Cyclical Breast Pain
Cyclical breast pain is more common and is related to hormonal fluctuations during the menstrual cycle. The pain typically occurs during the two weeks before menstruation (the luteal phase) and settles during the menstrual period. There may be other symptoms of premenstrual syndrome, such as low mood, bloating, fatigue or headaches.
Symptoms are typically:
- Bilateral and generalised
- Heaviness
- Aching
Non-Cyclical Breast Pain
Non-cyclical breast pain is more common in women aged 40 – 50 years. It is more likely to be localised than cyclical breast pain. Often no cause is found. However, it may be caused by:
- Medications (e.g., hormonal contraceptive medications)
- Infection (e.g., mastitis)
- Pregnancy
The pain may not originate in the breast but instead come from:
- The chest wall (e.g., costochondritis)
- The skin (e.g., shingles or post-herpetic neuralgia)
Diagnosis
A breast pain diary can help diagnose cyclical breast pain.
The three main things to exclude when someone presents with breast pain are:
- Cancer (perform a thorough history and examination)
- Infection (mastitis)
- Pregnancy (perform a pregnancy test)
Management
Options to manage cyclical breast pain include:
- Wearing a supportive bra
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (oral or topical)
- Avoiding caffeine is commonly recommended
- Applying heat to the area
- Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance
Last updated June 2021
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