Breast pain, cyclical

Page last reviewed: 13/07/2011

Cyclical breast pain, also known as cyclical mastalgia, is pain in the upper, outer area of the breast, which can extend to the armpits.

Cyclical breast pain is connected to the menstrual cycle and therefore only affects pre-menopausal women (women who are still having periods). The menstrual cycle starts on the first day of a woman's period and ends on the day before her next period.

Cyclical breast pain usually starts one to three days before your period begins, and improves at the end of your period.

How common is cyclical breast pain?

Cyclical breast pain affects up to two-thirds of women, with around 1 in 10 women experiencing moderate to severe pain.

Outlook

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 women, cyclical breast pain will return in future menstrual cycles. 

Keeping a chart of when you experience pain and how severe it is may help with your diagnosis. You can also use over-the-counter painkillers, such as paracetamol, and record the effect that they have on your pain. See Cyclical breast pain - Treatment for more information.

If you have breast pain that is affecting your quality of life and painkillers have not helped, your GP may refer you to a breast specialist for further treatment.

Breast pain is not a symptom of breast cancer and cyclical breast pain does not increase your risk of developing breast cancer. However, visit your GP if you are concerned about your breast pain. They will be able to reassure you that it is not caused by a more serious underlying condition. Many women find they can live with their breast pain once they have been assured that it is not caused by breast cancer.

Other breast-related conditions

Cyclical breast pain is a condition itself rather than a symptom of something else. It is not related to breast cancer.

There are several other breast-related conditions and causes of breast pain that are not covered in this article. These include:

Page last reviewed: 13/07/2011

Cyclical breast pain usually affects both breasts. Symptoms include:

  • pain in the upper, outer area of your breasts
  • pain that extends from your breasts to your armpits, and sometimes down your arms 
  • tender breasts, with some swelling and lumpiness but not a hard lump

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

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. Your menstrual cycle starts on the first day of your period and ends on the day before your next period.

When to see you 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. In these circumstances, your GP will be able to advise you further about what the cause may be.

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Page last reviewed: 13/07/2011

The exact cause of cyclical breast pain is currently unknown, but it is related to the menstrual cycle. The menstrual cycle starts on the first day of a woman's period and ends on the day before her next period.

Hormones

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 may be associated with the changing levels of hormones in your body.

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

Other possible causes

Breast pain can be also be caused by some types of medication. However, if this happens, the pain may not come and go with your menstrual cycle but may be constant. Medicines that can cause breast pain include:

  • medicines that contain hormones, such as hormone replacement therapy (HRT) or the combined contraceptive pill
  • some antidepressants that are used to treat depression
  • some antipsychotics that are used to treat some mental health conditions, such as schizophrenia 
  • some anxiolytics that are used to treat anxiety
  • some blood pressure and heart medications 
  • some antimicrobials that are used to kill micro-organisms, such as bacteria, viruses or fungi

Smoking and caffeine (found in tea, coffee and cola) are thought to be risk factors for breast pain. It is also thought that the herbal remedy, ginseng, may be associated with breast pain.

Page last reviewed: 13/07/2011

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 your breasts 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.

Breast pain chart

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.

For example:

  • Filling in the whole box might indicate severe pain.
  • Filling in half the box might indicate mild pain.
  • Putting a dot in the middle of the box might indicate that you do not have any pain at all.

However, breast pain charts can differ slightly, so your GP will explain what you need to do when they give you the chart.

See Cyclical breast pain - Treatment for more information about recording breast pain.

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Page last reviewed: 13/07/2011

In some cases, cyclical breast pain improves without treatment. Many women find comfort in the reassurance that their breast pain is not due to a more serious condition.

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
  • taking over-the-counter painkillers, such as paracetamol or ibuprofen, when you experience breast pain

If you are taking over-the-counter painkillers, make sure that you are taking the correct dose and that the medicine is suitable for you. For example, ibuprofen should be used with caution in people with: 

  • asthma - when the airways of the lungs become inflamed (swollen) 
  • kidney problems 
  • liver problems

Your GP may also recommend a topical non-steroidal anti-inflammatory drug (NSAID) such as a cream or gel that can be rubbed directly on to the painful areas. Possible topical NSAIDs that may be prescribed include:

  • a gel containing diclofenac, such as Voltarol Emulgel 
  • a gel containing ibuprofen, such as Ibugel Forte

Again, 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, such as on a scratch on your breast. 

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.

Alternative therapies

Some women may 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.

Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body. See the Health A-Z topic about Acupuncture for more information on this alternative therapy.

Reflexology is a type of a therapy where certain areas of the body, such as the soles of the feet, are massaged to help improve general health.

Evening primrose oil

This is made from the seeds of the evening primrose flower and usually comes as a capsule. These are not available with a prescription but can be bought from some pharmacies and health food shops. Your GP will be able to recommend a suitable product and tell you how much you should take.

There is no evidence that evening primrose oil is any better for cyclical breast pain than a placebo (sham treatment), but the placebo effect of evening primrose oil is significant. The placebo effect is when people get better even though they have only taken a fake treatment. As evening primrose oil is unlikely to cause any side effects, your GP may suggest it as a treatment.

In some cases, evening primrose oil may not be advised - for example, if you are trying to get pregnant or if you have epilepsy (a condition that causes seizures). For this reason, always speak to your GP before trying a new treatment such as evening primrose oil.

Further treatment

If you have cyclical breast pain that is severe enough to affect your quality of life and the treatments above do not help, or if the above treatments have not worked after six months, your GP may suggest other treatment options.

Pain chart

If you have not already used a breast pain chart to record your breast pain, your GP may ask you to complete one. You will usually be asked to make a daily record of your pain for at least two months so that your GP can analyse whether there is a pattern to your pain.

After you have recorded your breast pain over a two-month period, your GP will be able to determine:

  • the severity of your breast pain
  • when your breast pain is most severe
  • how well you have responded to treatment

Referral

If your GP is unable to treat your breast pain, they may refer you to a breast specialist for further treatment, either at a hospital or a specialist breast clinic.

Medication

If you need further specialist treatment, you may be prescribed one of the following medications: 

  • danazol
  • bromocriptine
  • tamoxifen
  • goserelin
  • toremifene

Some of these medications are unlicensed for the treatment of breast pain (see below). This means that the medication's manufacturers have not applied for a licence for it 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.

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.

The medicines mentioned above all affect the levels of hormones (powerful chemicals) in your body, and some 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. Most women will not need to take these medicines and the side effects that are associated with them often put women off.

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

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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