Most women develop breast pain at some stage in life. In most cases the
pain develops in the days just before a period. In some cases the pain
is not related to periods. The pain is often mild but in some women it
is more severe and can affect quality of life. Treatment options
include painkillers and topical (rub-on) anti-inflammatory drugs.
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.
References
-
Mansel RE; ABC of breast diseases. Breast pain. BMJ. 1994 Oct 1;309(6958):866-8.
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Breast Pain; Clinical Evidence BMJ 2005; Needs subscription
-
Colak T, Ipek T, Kanik A, et al;
Efficacy of topical nonsteroidal antiinflammatory drugs in mastalgia
treatment. J Am Coll Surg. 2003 Apr;196(4):525-30. [abstract]
-
Norlock FE;
Benign breast pain in women: a practical approach to evaluation and
treatment. J Am Med Womens Assoc. 2002 Spring;57(2):85-90. [abstract]
© EMIS and PiP 2008 Updated: 23 Jan 2008
