Breast pain — known medically as mastalgia — affects up to 70% of women at some point. It is rarely a sign of cancer, but it is one of the most distressing breast symptoms because it lives close to fears about cancer. Understanding the type of pain you have is the first step to relief and reassurance.
Cyclical mastalgia
Pain that builds in the second half of the menstrual cycle, peaks just before the period, and settles when the period starts. It is usually:
- •Bilateral (both breasts)
- •Heavy, achy, dull
- •Worse in the upper-outer part of the breast
- •Linked to lumpiness that comes and goes
Cause: normal hormonal fluctuation (oestrogen and progesterone). Worse if you are on certain HRT, the combined pill, or fertility treatment.
Non-cyclical mastalgia
Pain that has no relationship to the menstrual cycle. Usually:
- •One breast only
- •Sharp, burning, localised
- •May radiate to the armpit or arm
- •Often actually originates in the chest wall (costochondritis), rib, or muscle — not the breast itself
Other causes: large breasts and poor bra support, recent trauma, breast cyst, mastitis, post-surgical scar pain, shingles before the rash appears.
Pain you should not ignore
See a surgeon if your breast pain is associated with:
- •A new lump
- •Skin dimpling, redness or thickening
- •Nipple discharge (especially blood-stained)
- •Persistent pain in one spot for over 4 weeks
- •Fever and a hot, swollen area (suggests abscess)
- •Recent breast surgery or implants
What helps cyclical mastalgia
- •A professionally fitted, supportive bra (worn day and during exercise)
- •Reducing caffeine, nicotine and high-fat foods
- •Evening primrose oil 1000 mg twice daily for 3–6 months
- •Topical NSAID gel for flare-ups
- •Reviewing the contraceptive pill or HRT with your doctor
- •Stress reduction and adequate sleep
What investigations may be needed
For most women under 40 with cyclical pain and no lump: clinical examination only. For women over 40, or any age with focal/persistent pain: ultrasound ± mammogram. Blood tests are rarely useful unless infection is suspected.
When to see Dr Vanesha
Book an outpatient appointment at Medcare Al Safa if your breast pain is interfering with sleep, exercise or quality of life — or if any of the red-flag symptoms above are present. A female chaperone is always provided.