Breast pain

Breast pain is very common in women of all ages. For example, approximately two out of three pre-menopausal women (women who haven’t been through the menopause) will experience it at some time in their lives. There are two main categories of breast pain, both of which can be treated.

• Cyclical breast pain
• Non-cyclical breast pain

What is cyclical breast pain?

Cyclical breast pain is linked to changing hormone levels during the menstrual cycle and therefore it mainly affects women before their menopause. These hormonal changes make the breast tissue more sensitive, which in turn can cause pain.

You may experience heaviness, tenderness, a burning, prickling or stabbing pain, or a feeling of tightness in the area. The pain can affect either one or both breasts and can also spread to the armpit, down the arm and to the shoulder blade. This type of pain usually stops when the ovaries are no longer active after the menopause.

Women taking hormone replacement therapy (HRT) after their menopause can also experience cyclical breast pain. This is because the HRT maintains some hormones at a pre-menopausal level.

What causes cyclical breast pain?

Although cyclical breast pain is linked to the menstrual cycle, its exact causes are unknown. Pain can also be associated with taking the contraceptive pill, certain anti-depressant drugs, some herbal remedies (for example, ginseng), or stress.

What is non-cyclical breast pain?

There are two types of non-cyclical breast pain:

• true non-cyclical breast pain that comes from the breast but is not linked to the menstrual cycle
• extra mammary or chest wall pain (known as musculoskeletal pain) is felt in the area of the breast but actually comes from elsewhere such as the muscles, bones and joints.

Both of these types can result in continuous pain or pain that comes and goes and can affect women before and after the menopause. The pain can be in one or both breasts and can affect the whole breast or a specific area. It may be a burning, prickling or stabbing pain, or a feeling of tightness in the area. It can last from a few minutes to a few days.

What causes non-cyclical breast pain?

It is often not known what causes breast pain that is not linked to the menstrual cycle. It may be related to certain non-cancerous (benign) breast conditions, previous breast surgery or underlying medical conditions not directly related to the breasts.

Diagnosis

Your GP will examine your breasts and take a detailed history of the type of pain you have and how often it occurs. To check if the pain is linked to your menstrual cycle, they may ask you to fill in a simple pain chart. To see an example of a breast pain chart, download our Breast pain booklet.

Your GP may refer you to a breast clinic where you’ll be seen by specialist doctors or nurses. For more information see our Referral to a breast clinic booklet.

Treatments for cyclical and non-cylical breast pain

If you have cyclical breast pain, your GP may reassure you that what you’re experiencing is a perfectly normal part of your monthly cycle.

The treatment options for cyclical and non-cyclical pain are often the same, however non-cyclical pain is not always as easy to treat.

Diet and lifestyle changes

Your GP may suggest simple things you can try which can help to reduce pain.

• Reducing your intake of caffeine, chocolate and red wine and taking regular exercise to help maintain a healthy weight.
• Some women have found relaxation therapy useful in reducing the symptoms of cyclical breast pain.
• Other complementary therapies that promote wellbeing, such as acupuncture and aromatherapy, may also be helpful.

If your pain started when you began taking a contraceptive pill, changing to a low-dose pill or a different brand may help. If the pain continues, you may want to try a non-hormonal method of contraception such as condoms or a diaphragm.

There is evidence that having low levels of an essential fatty acid called gamolenic acid (GLA) can contribute to cyclical breast pain. However, recent research has shown that taking additional GLA does not reduce pain levels. Despite this, your GP may suggest that you try evening primrose or starflower oil, which contain GLA, as some women have found it helps them to feel better generally. Your GP will advise you how much to take and for how long.

Evening primrose oil doesn’t usually cause any side effects, but you may experience nausea, an upset stomach or headaches. It’s not advisable to take it if you’re pregnant or trying to get pregnant. People with epilepsy are usually advised not to take evening primrose or starflower oil.

Anti-inflammatory medicines

Research has shown that non-steroidal anti-inflammatory pain relief, such as ibuprofen, can help breast pain, particularly non-cyclical pain. They are most effective in creams or gels applied directly to the affected area, but they can also be taken in tablet form. However, before using this type of pain relief in tablet form you should be assessed and advised by your GP on the correct dose, how long you should use it for and any possible side effects, especially if you have asthma or stomach ulcers.

Hormone drugs

If your pain is severe, prolonged and hasn’t improved with any of the suggestions already mentioned, your GP or specialist may want to consider giving you a hormone suppressing drug. The drugs used to treat breast pain are danazol, tamoxifen, goserelin, and bromocriptine. These drugs all have side effects, so they are only suitable for use following a thorough discussion of the benefits and the potential risks.

If you are prescribed one of these drugs, your specialist will advise you on what dose to take and for how long. Recent evidence suggests younger women may benefit from a short course of treatment, which can be repeated as necessary, whereas older women who are near to (or going through) the menopause may benefit from a longer course of treatment.

Only danazol is currently licensed to treat breast pain. Bromocriptine was licensed to treat breast pain but is now rarely used due to its side effects. Recent research has shown that tamoxifen and goserelin are effective in treating breast pain and have fewer side effects. Therefore it is not uncommon for these to be used.

For more information on this type of treatment, download or order our free Breast pain publication.

Surgery

Generally surgery is not recommended as a treatment for breast pain. However, if your breast pain hasn’t improved with other treatments and continues to be severe and disrupts your everyday life, surgery may be considered. Surgery is only used in extreme circumstances to improve your quality of life, and your breast surgeon needs to discuss all the implications (for example, continued pain after surgery and scarring) with you before making a decision.

Treatment for pain from elsewhere

Pain from elsewhere usually comes from the chest wall (musculoskeletal) area. It can be associated with an underlying problem such as inflammation (swelling) of the chest wall. This is called costochondritis (Tietze’s syndrome), which affects parts of the ribs (called costal cartilages), or lateral chest wall pain, which affects the side of the chest wall.

Your GP or specialist may be able to tell that the costal cartilages are painful if pressure is put on them. Sometimes this inflammation can feel similar to heart pain. You may feel tightness in the chest and a severe, sharp pain. The pain may also spread down the arm and can be worse when you move.

You may find it helpful to rest and avoid sudden movements that increase the pain. Pain relief such as paracetamol or ibuprofen (either as a cream, gel or tablet) may help. Your GP or specialist may also suggest injecting the painful area with a local anaesthetic and steroid.

It is thought that smoking makes the inflammation worse, so if you smoke you may find that your pain improves if you cut down or stop altogether.

Occasionally, pain from other conditions can be felt in the breast – for example, angina (tightness across the chest) or gallstones. This is known as referred pain. If this happens, your GP or specialist will advise you on the most appropriate treatment.

What this means for you

Breast pain can be very distressing and many women are anxious that they may have breast cancer. In most cases breast pain will be the result of normal changes that occur in the breasts. Even though you may feel reassured that your breast pain is normal and you don’t have breast cancer, the pain often persists. This can be upsetting, especially if your specialist can’t tell you the exact cause of your breast pain.

Women affected by breast pain may feel many different emotions. Fear, frustration or helplessness are all normal reactions. Although understanding more about your breast pain will not cure it, it may help you to get back some control over your life.

Having breast pain does not increase your risk of breast cancer. However, it is still important to be breast aware and go back to your GP if you notice any other changes in your breasts.

You can find out more about being breast aware in our Your breasts, your health: throughout your life booklet.