mastalgia الم الثدي

Breast Pain (Mastalgia)
Most women develop breast pain at some stage in life. In most cases it is mild and occurs just before periods. In some cases it is more severe. Treatment options are discussed below. Breast pain is not usually an early symptom of breast cancer. However, see your doctor if you have any concerns.


What are the types of breast pain?

Breast pain (mastalgia) is usually classed as either:

cyclical breast pain - where the pain is worse before a period, or
non-cyclical breast pain - where the pain is not related to periods.
About 2 in 3 cases of breast pain are cyclical, 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, particularly between the ages of 30 and 50. In many women it is mild, but in some women it becomes more severe and can affect day-to-day life.

What are the symptoms of cyclical breast pain?
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. It tends to develop from about mid-cycle onwards, and is usually worse for 3-7 days before a period. The severity can vary from month to month. The pain usually eases soon after a period starts. If you have cyclical mastalgia 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 quite 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 which 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 that cyclical breast pain is not a symptom of cancer or serious breast disease. The problem often settles by itself within 3-6 months. If the pain is more severe, treatment options include the following.

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.

Caffeine is said by some women to make things worse. So, in the week or so before a period it may be worth trying cutting out tea, coffee and cola which contain caffeine.

Take painkillers such as paracetamol or ibuprofen regularly on the days when the breasts are painful.

A low fat / high carbohydrate diet has been shown to help reduce the pain in some women. It may be worth a try if you have particularly painful breasts each month. You need to eat this diet for several months before you notice any difference. (But, a low fat diet is generally good for health anyway.) Your practice nurse can give further advice on what foods are low in fat and high in carbohydrate.

The contraceptive pill or hormone replacement therapy (HRT) can make cyclical breast pain worse in some women. If appropriate, it may be worth stopping or changing the preparation to see if this helps. Discuss this with your doctor.

Medication such as danazol or bromocriptine eases pain in about 6 in 10 cases. These medicines work by reducing the level of certain female hormones such as oestrogen. You need to take them regularly (not just when the pain occurs). However, side-effects are common with these medicines. So, they are not usually tried unless you have severe pain which occurs on 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 more common in women over 40. The pain often stems from the chest wall under the breast rather than the breast itself. 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. The cause is often not clear. Muscular problems of the chest wall account for some cases. Infection is a cause in a small number of cases. 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 away after a few month without any treatment. Anti-inflammatory painkillers such as ibuprofen may ease the pain. Other treatments may be appropriate, depending if a cause is found.

Breast pain and breast cancer

Women with breast pain often worry that the pain is caused by breast cancer. But, breast cancer usually first develops as a painless lump. Pain is not usually an early symptom. (Well advanced breast cancer can be painful though.) However, in about 1 in 20 cases of breast cancer the first symptom is pain.

So, see your doctor if you have any concerns about breast pain or any other breast symptoms.