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Mastalgia

Cyclical breast pain – NHS Choices

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Cyclical breast pain 

Introduction 

Non-cyclical breast pain

Breast pain that is not linked to the menstrual cycle is sometimes called non-cyclical. Many cases of non-cyclical pain are idiopathic, meaning that there is no identifiable cause.

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 benign (non-cancerous) causes of breast lumps, some of which may be painful
  • breast abscess – a painful collection of pus that forms in the breast

Although it is rare, non-cyclical breast pain can also be caused by other medications and treatments, such as:

Smoking and caffeine are also thought sometimes to cause non-cyclical breast pain.

If you have breast pain that doesn’t seem to be associated with your menstrual cycle and you are concerned, see your GP.

Cyclical breast pain, also known as cyclical mastalgia, is pain in the breasts linked to the menstrual cycle.

Commonly, the pain affects the upper, outer area of both breasts and can sometimes be felt in the arms.

The pain can vary from a dull ache to a burning or stabbing sensation. In most cases it starts one to three days before your period begins, and improves at the end of your period.

Breast pain is not a symptom of breast cancer and cyclical breast pain does not increase your risk of developing breast cancer.

Read more about the symptoms of cyclical breast pain

In the UK, cyclical breast pain affects up to two-thirds of women, mostly between the ages of 30 and 50. In one in 10 women the pain can be severe.

Why does cyclical breast pain happen?

Although the exact cause of cyclical breast pain is not known, it is related to the menstrual cycle, affecting women who are still having periods (before the menopause). 

It is thought that the changes in hormone levels before periods begin are linked to cyclical breast pain. 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.

Cyclical breast pain is not associated with any other breast-related conditions.

How is cyclical breast pain treated?

Almost a third of women who get cyclical breast pain find that their condition gets better without treatment 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 is 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 you have breast pain that is affecting your quality of life and painkillers have not helped, your GP may request that you make a record of your daily pain for a period of time and refer you to a breast specialist for further treatment.

Read more about diagnosing cyclical breast pain and treating cyclical breast pain.

Page last reviewed: 13/09/2012

Next review due: 13/09/2014

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Menstrual cycle

Find out about the menstrual cycle, periods, what’s normal, PMS and fertility


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NHS Choices Syndication

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Breast pain, cyclical

Diagnosing cyclical breast pain

Cyclical breast pain can usually be diagnosed after a consultation with a GP.

Your GP will be able to diagnose cyclical breast pain by asking you about your symptoms and your general health. For example, your GP may ask:

  • whether the pain affects both breasts 
  • where in your breasts you feel the pain
  • whether you are taking any medication, such as the combined contraceptive pill
  • whether you could be pregnant
  • whether you have any other symptoms, such as a lump or discharge from your nipples  
  • whether you smoke 
  • how much caffeine there is in your diet (found in tea, coffee and cola)

The answers to these questions will help your GP to rule out any other possible causes of your breast pain.

Your GP may also decide to examine your breasts if they feel lumpy when you experience breast pain.

Recording breast pain

If you have moderate to severe breast pain, your GP may ask you to complete a breast pain chart. The chart can be used to confirm your diagnosis and to plan appropriate treatment.

You can use a breast pain chart to record whether your breast pain on a particular day is mild, moderate or severe.

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 the level of pain that you have. This is usually done for at least two months.

Published Date
2014-07-25 10:29:18Z
Last Review Date
2012-09-12 00:00:00Z
Next Review Date
2014-09-12 00:00:00Z
Classification
Breast pain


NHS Choices Syndication

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Breast pain, cyclical

Introduction

Cyclical breast pain, also known as cyclical mastalgia, is pain in the breasts linked to the menstrual cycle.

Commonly, the pain affects the upper, outer area of both breasts and can sometimes be felt in the arms.

The pain can vary from a dull ache to a burning or stabbing sensation. In most cases it starts one to three days before your period begins, and improves at the end of your period.

Breast pain is not a symptom of breast cancer and cyclical breast pain does not increase your risk of developing breast cancer.

Read more about the symptoms of cyclical breast pain

In the UK, cyclical breast pain affects up to two-thirds of women, mostly between the ages of 30 and 50. In one in 10 women the pain can be severe.

Why does cyclical breast pain happen?

Although the exact cause of cyclical breast pain is not known, it is related to the menstrual cycle, affecting women who are still having periods (before the menopause). 

It is thought that the changes in hormone levels before periods begin are linked to cyclical breast pain. 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.

Cyclical breast pain is not associated with any other breast-related conditions.

How is cyclical breast pain treated?

Almost a third of women who get cyclical breast pain find that their condition gets better without treatment 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 is 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 you have breast pain that is affecting your quality of life and painkillers have not helped, your GP may request that you make a record of your daily pain for a period of time and refer you to a breast specialist for further treatment.

Read more about diagnosing cyclical breast pain and treating cyclical breast pain.

Published Date
2014-07-25 10:28:49Z
Last Review Date
2012-09-12 00:00:00Z
Next Review Date
2014-09-12 00:00:00Z
Classification
Breast,Breast pain


NHS Choices Syndication

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Breast pain, cyclical

Medicines information

Learn about the medicines used to treat or manage this condition: preparations, benefits and side-effects are all covered.

The information is provided through a collaboration between NHS Choices, the medicines information provider Datapharm and other health organisations. It’s based on the best available clinical evidence and is continually updated.

To take advantage of this unique resource, go to:

Published Date
2011-09-11 15:29:01Z
Last Review Date
2008-11-06 00:00:00Z
Next Review Date
2010-11-06 00:00:00Z
Classification
Breast pain


NHS Choices Syndication

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Breast pain, cyclical

Symptoms of cyclical breast pain

In most cases, the symptoms of cyclical breast pain are relatively mild, although some women experience moderate or severe pain.

The pain may be felt as a heaviness or soreness, but it has also been described as a stabbing or burning pain.

It is usually felt in the upper, outer area of your breasts and it may extend from your breasts to your armpits, and sometimes down your arms.

Your breasts may also be tender, with some swelling and general lumpiness – but not a single, hard lump.

The pain occurs at about the same point of your menstrual cycle 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.

As cyclical breast pain is related to the menstrual cycle, it usually affects women before the menopause. However, women can sometimes experience symptoms after the menopause if they undergo hormone replacement therapy (HRT).

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

See your GP if, as well as cyclical breast pain, you also have:

  • any symptoms of an infection in your breast, such as swelling, redness or warmth in your breast, or a high temperature (fever)
  • any symptoms of pregnancy, such as a missed period

If you have breast pain along with other symptoms, or the pain continues throughout your menstrual cycle (not only around your period), it may not be cyclical breast pain. Your GP will be able to advise you further about what the cause may be.

Published Date
2014-07-25 10:28:55Z
Last Review Date
2012-09-12 00:00:00Z
Next Review Date
2014-09-12 00:00:00Z
Classification
Breast pain


NHS Choices Syndication

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Breast pain, cyclical

Treating cyclical breast pain

You can improve your symptoms of cyclical breast pain by wearing well-fitted bras and taking painkillers. Some cases don’t need treatment at all.

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 feel reassured by the fact that their breast pain is not due to a more serious condition and find it easier to live with.

Self-help

If your breast pain requires treatment, there are several self-help measures that 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 that the medicine is suitable for you. For example, topical NSAIDs should not be used where the skin is broken. 

Other options

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.

Alternative therapies

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.

Further treatment 

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 or refer you to a breast specialist, either at a hospital or a specialist breast clinic.

Medication

In rare cases, you may be prescribed one of the following medications if you need further specialist treatment:

  • danazol
  • bromocriptine
  • tamoxifen
  • goserelin
  • toremifene

These medicines affect the levels of hormones in your body and evidence suggests that they may help to reduce cyclical breast pain. However, they can also all 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 that 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.

Sometimes, doctors will use an unlicensed medication if they think that 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 inform you that it is unlicensed and discuss the possible risks and benefits with you.

Danazol

Danazol is licensed to treat severe pain that is 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)
  • dizziness 
  • a rash 
  • weight gain 
  • heavy periods (menorrhagia)
  • a deepening voice – this may be permanent
  • spots (acne)
  • hirsutism – excessive hair growth, for example on the face

Bromocriptine

Bromocriptine is licensed to treat some conditions that affect the breasts, such as galactorrhoea (the over-production of breast milk). Side effects include:

  • nausea (feeling sick)
  • low blood pressure (hypotension), which can cause dizziness
  • headaches
  • constipation (an inability to empty your bowels)

Tamoxifen

Tamoxifen is a medicine that is used to treat breast cancer. It is also used as an unlicensed medicine to treat breast pain. Side effects include:

  • vaginal bleeding or discharge 
  • hot flushes 
  • 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

Goserelin is a medicine that is used to treat breast cancer. It may also be used as an unlicensed medicine to treat breast pain. Side effects include:

  • vaginal dryness
  • hot flushes
  • decreased libido (less interest in sex)
  • depression 

Toremifene

Toremifene is a medicine that is used to treat breast cancer. It may also be used as an unlicensed medicine to treat breast pain. Side effects include:

  • nausea (feeling sick)
  • depression
  • hot flushes
  • vaginal bleeding or discharge  
  • deep vein thrombosis (DVT) – a blood clot in one of the deep veins in the body
Published Date
2014-07-25 10:29:10Z
Last Review Date
2012-09-12 00:00:00Z
Next Review Date
2014-09-12 00:00:00Z
Classification
Breast pain

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