BREAST PAIN

Mastalgia literally means breast pain. It is a common breast symptom, affecting 7 out of 10 women at some point during their lives.

There are 3 types of breast pain.

Breast pain related to the monthly menstrual cycle is referred to as 'cyclical'. Cyclical breast pain is most common in women in their 20s and 30s. It results from monthly fluctuations of the hormones oestrogen and progesterone. Oestrogen increases before a period, causing milk ducts and glands to swell and trap fluid in the breasts. The pain generally builds up from the middle of the menstrual cycle, peaks in the 3 to 7 days before each period and then improves when the period begins. The pain is often felt in the upper outer parts of both breasts and described as heavy, dragging or aching. Cyclical breast pain may worsen during perimenopause (when hormones surge erratically) and continue into menopause (especially in women taking hormone replacement therapy).

Breast pain that does not vary with the menstrual cycle is referred to as 'non-cyclical'. Non-cyclical breast pain is more common in women in their 40s or older. The pain can be constant or intermittent. The pain is usually restricted to a small area of one breast (typically in the inner part of the breast or under the nipple) and described as burning, stabbing or throbbing. Non-cyclical breast pain can be due to benign breast conditions (e.g. cysts, fibroadenomas), medications (e.g. antidepressants, antipsychotics, diuretics, digoxin) or trauma. Often no specific cause is found.

Pain that is felt in the breast can also arise from conditions outside the breast, including

• Pectoralis muscle strain from activities such as raking, shovelling and lifting.

• Costochondritis: inflammation of the cartilage that joins the ribs to the breastbone.

• Referred pain from heart disease, gastro-oesophageal reflux disease or gallstones.

Breast pain alone is an uncommon symptom of breast cancer. Around 10% of women with breast cancer present with breast pain alone. However, any breast pain that is new or persistent, or associated with a lump, skin or nipple changes always requires investigation with the triple test.

Breast pain can be reduced by wearing a well-fitting supportive bra. Have a bra specially fitted by trained staff. Here are 3 quick checks

• Centre Gore: Make sure the panel connecting the 2 cups is flush to the chest. It should lie flat against your breastbone with no gaps or spaces.

• Band: The band should be parallel to the ground - not riding up your back or seesawing when you bend over.

• Cups: Your breasts are fully contained within your bra.

There is no strong evidence to support specific dietary changes. However, some women find limiting salt and caffeine intake and eating a low fat diet to be helpful.

Evening primrose oil may effective for some women. The usual dose is 1000 mg 3 times a day with food. It needs to be taken regularly for 2 to 3 months for best results. Evening primrose oil is safe for short term use, but do not take it if you have a bleeding disorder, epilepsy, schizophrenia or trying to fall pregnant.

Pain Medication

Paracetamol or anti-inflammatory medication may lessen the severity of breast pain.

Low dose oral contraceptive pill may improve cyclical breast pain, though some women find it worsens their symptoms. You may wish to discuss a trial or change of the pill with your general practitioner. 

Breast cysts can be aspirated and fibroadenomas can be excised if associated with breast pain.