Breast Pain (Mastalgia)

Introduction

Breast pain is very common in women of all ages. It is not associated with an increased risk of diagnosing breast cancer. Breast pain does not require specialist input and can be safely managed by women at home, in the same way that they might need to manage period pain. There is no need for breast imaging, if there are no other concerning symptoms, so women with breast pain do not need to come to breast clinic.

Having painful, sore or tender breasts can cause a lot of anxiety, and many women do still worry that they may have breast cancer. There are many reasons breasts can be painful, however breast pain by itself does not increase the risk of finding a cancer in the breast when we compare with women who do not have breast pain. Studies show that breast pain often settles with 3-6 months. It is common for breast pain to recur in the future and when this happens, the symptoms again, usually settle within a few months.

If you develop any of these symptoms, please see your General Practitioner.

Symptoms

Pain can occur in one or both breasts, it can also spread to the armpit. Sometimes women can experience pain that spreads down the arm and to the shoulder blade but this is more likely to be a musculoskeletal problem than to come from the breast. Breast pain can be a dull, continuous, ache. Or, it can be a sharp, shooting pain. The pain may come and go each month. Or, it may last for several weeks or even months and can range from mild to severe. It is not unusual for breast pain to only affect one breast.

Types of breast pain

Cyclical – many women experience breast pain as part of their normal menstrual cycle (periods). This is called cyclical breast pain. Cyclical breast pain is linked to changing hormone levels during the menstrual cycle. The pain often goes away once a period starts. This type of pain usually stops after the menopause, though women taking hormone replacement therapy (HRT) can also have breast pain.

Non-cyclical – pain in the breast that doesn‘t follow a pattern relating to the menstrual cycle, is known as non-cyclical breast pain. Non-cyclical breast pain may be continuous or it may come and go. It can affect women before and after the menopause.

With both cyclical and non-cyclical pain, it is common for the breasts to feel tender to touch. Hormone levels in the body fluctuate in healthy women. There is no benefit in testing isolated hormone levels where the only symptom is breast pain.

Musculoskeletal pain

Chest wall (musculoskeletal) pain – Pain in the breast can be caused by a problem somewhere else, such as an area of inflammation within the chest wall, or from a pulled muscle or irritated nerve in the chest. Sometimes pain can radiate along a nerve and the origin of this pain may be in the back or shoulder area.

Chest wall pain is very common. The diagnosis is made by a combination of listening to a patient’s description of the symptoms, and by the examination findings. There is rarely any need for scans or tests. This type of breast pain can last for many months and may spread into the back, shoulder or arm. Pain may be worse after movement or in certain positions. It may be eased by a combination of physiotherapy exercises and regular pain relief medicines.

Self-management for breast pain

For almost all women, breast pain will settle without any intervention. It can be distressing and may impact on your quality of life, but it will usually get better without any need for treatment.

There are a number of self-management options that can be used to help reduce breast pain, sometimes with good results. They are:

• Wearing a well-fitting bra: This can support painful breasts and keep them from being pulled uncomfortably. Some women find a sports type bra is useful. Some women find wearing no bra is more comfortable. It is worth exploring different options to find what is most comfortable for you.
• Paracetamol and/or Ibuprofen, or a topical non-steroidal anti-inflammatory preparation: Research has shown that non-steroidal anti-inflammatory pain relief, such as Ibuprofen, can help breast pain. This type of pain relief can be applied directly to the affected area as a topical gel (e.g. ibuprofen gel) or it can be taken as a tablet.
• Vitamin E supplements: Studies have shown that Vitamin E can also help to reduce breast pain symptoms if taken regularly for a few months.
• Evening Primrose Oil: Some women have found that Evening Primrose Oil helps them to feel better generally and studies have shown some benefit in managing breast pain. This can be bought in most supermarkets and chemists. 3000mg (3g) can be taken daily. We recommend taking this for at least six weeks as the reported benefits are not immediate. This should not be taken if you are pregnant or trying to conceive.
• Practicing stress relief: Stress affects hormone levels in the body. This can impact on how pain is experienced and exacerbate symptoms that might otherwise be more easily managed.
• Exercising: Physical activity decreases oestrogen but it’s difficult to tell from studies if it really decreases breast pain. Wearing a sports bra during exercise is recommended. Regular exercise has many general health benefits and reduces the risk of breast cancer by helping to maintain a healthy weight. It may also have a benefit in managing stress and helping you feel better.
• Keeping a breast pain diary: This can be a helpful tool especially if you’re trying to see a pattern in your symptoms, which is the best way to determine the kind of breast pain you have.
• Reducing caffeine and eating a low-fat diet: Studies are mixed on how well this works, but it may help some women. Poor sleep is associated with breast pain, especially non-cyclical pain. There are simple steps that you can take to improve your sleep, which may help your breast pain to get better. Have a look at:

• Consider an alternative to the oral contraceptive pill or hormone replacement therapy: For some women, stopping these medications, or where possible, changing to a lower dose, can help to reduce breast pain.

Specialist breast pain clinic

Some women have breast pain that does not settle and they may wish to be seen in a specialist breast pain clinic. The doctor or nurse will ask questions about the breast symptoms and about general health, examine both breasts and armpit areas and examine the chest wall and back. It is rarely necessary to arrange a mammogram or scan when the only symptom is pain.

Women seen in these clinics will be advised on techniques they may not have tried to aim to manage the symptoms. For a small group of women, there can be a role for hormone-blocking medications, such as Danazol or Tamoxifen. These medications have side effects and risks that mean they are rarely used to manage breast pain but if symptoms are severe, a short course of treatment is often effective and can be prescribed.

Coping with breast pain

Breast pain can be very distressing. Even though you may feel reassured that your breast pain is normal and you don’t have breast cancer, the pain often remains. Women affected by breast pain may feel many different emotions, including fear, frustration or helplessness. Although understanding more about your breast pain won’t cure it, it may help you to get back some control over your life.

Having severe, long-lasting breast pain can sometimes affect a woman’s daily activities which may cause anxiety and, for some, depression. However, this isn’t the case for most women and their pain can be helped or managed. Having breast pain doesn’t increase your risk of breast cancer however, it’s still important to be breast aware and go back to your GP if the pain increases or changes, or you notice any other changes in your breasts.