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.

Read more about treating cyclical breast pain.