Breast Pain

What are the types of breast pain?

Breast pain (mastalgia) is usually classed as either:

• Cyclical breast pain - where the pain is related to periods. Typically, it occurs in the second half of the monthly cycle, getting worse in the days just before a period, OR
• Non-cyclical breast pain - where the pain is not related to periods.

Up to 7 in 10 women develop breast pain at some stage in their life. About 2 in 3 cases are cyclical breast pain, and about 1 in 3 are non-cyclical. If you are not sure which type of breast pain you have, it may be worth keeping a pain diary for 2-3 months. Record the days when you have breast pain, and highlight the days when the pain is severe enough to affect your lifestyle. See what pattern emerges.

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 to the inner part of the upper arm. If you have cyclical breast pain your breasts may also become larger, tender and slightly lumpy in the week or so before a period.

Quality of life for some women can be significantly affected. Physical activity such as jogging can make the pain worse. Such things as hugging children and sexual activity can be painful.

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 problem may settle by itself within 3-6 months. Studies have shown that cyclical breast pain goes away within three months of onset in about 3 in 10 cases. However, in up to 6 in 10 women where the pain has gone, it tends to develop again sometime within two years. So, in other words, the problem may 'come and go' over the years.

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') non-steroidal anti-inflammatory drugs (NSAIDs). For example, topical diclofenac or topical ibuprofen. You can buy various topical NSAIDs or get them on prescription. Topical NSAIDs have been shown to help relieve the pain of cyclical breast pain. In particular, one research study clearly showed that topical diclofenac helped to relieve the pain in many cases. None of the participants in this study reported any side-effects.
• 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 stopping or changing the preparation to see if this helps. Discuss this with your doctor.
• Drugs to block hormones. Medication such as danazol, bromocriptine, tamoxifen and goserelin injections 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.

Note: gamolenic acid (efamast) used to be a popular remedy. Gamolenic acid is also in Evening Primrose Oil. However, research studies have shown that this has little effect. So, you can no longer get this on prescription. Also, diuretics ('water tablets') used to be popular. However, they do not work as the pain is not caused by fluid retention.

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.
• Shingles may cause pain before a rash develops.
• Breast tumours, cancer and lumps are an uncommon cause of breast pain.
• The cause is often not clear.

As there are various causes it is best to see a doctor for assessment.

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 (NSAIDs) such as ibuprofen may ease the pain. Topical NSAIDs 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. Pain is not usually an early symptom. (Well advanced breast cancer can be painful though.) In about 1 in 20 cases of breast cancer the first symptom is pain.

Therefore, even though breast pain is not likely to be caused by cancer, see your doctor if you have any concerns about breast pain or any other breast symptoms. In particular, see a doctor promptly if you feel any lump in a breast.