Breast pain

Question 1

What types of breast pain are there?

Answer 1

Cyclical – occurring at specific times of the menstrual cycle
Non-cyclical – unrelated to the menstrual cycle

Question 2

What is cyclical breast pain?

Answer 2

Cyclical breast pain is more common and is related to hormonal fluctuations during the menstrual cycle. The pain typically occurs during the two weeks before menstruation (the luteal phase) and settles during the menstrual period. There may be other symptoms of premenstrual syndrome, such as low mood, bloating, fatigue or headaches.

Symptoms are typically:

Bilateral and generalised
Heaviness
Aching

Question 3

Non-cyclical breast pain

Answer 3

Non-cyclical breast pain is more common in women aged 40 – 50 years. It is more likely to be localised than cyclical breast pain. Often no cause is found. However, it may be caused by:

Medications (e.g., hormonal contraceptive medications)
Infection (e.g., mastitis)
Pregnancy

The pain may not originate in the breast but instead come from:

The chest wall (e.g., costochondritis)
The skin (e.g., shingles or post-herpetic neuralgia)

Question 4

How do we diagnose breast pain?

Answer 4

A breast pain diary can help diagnose cyclical breast pain.

The three main things to exclude when someone presents with breast pain are:

Cancer (perform a thorough history and examination)
Infection (mastitis)
Pregnancy (perform a pregnancy test)

Question 5

How do we manage breast pain?

Answer 5

Wearing a supportive bra
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (oral or topical)
Avoiding caffeine is commonly recommended
Applying heat to the area
Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance