Types of breast pain
Cyclical mastalgia is the most common type. The pain is linked to the menstrual cycle, typically worst in the week or two before a period and improving once the period starts. It often affects both breasts and may be described as heaviness, tenderness, or aching. It is caused by hormonal changes affecting the breast tissue.
Non-cyclical mastalgia has no relationship to the menstrual cycle. It may be constant or intermittent and is more likely to be localised to one area of one breast. Causes include injury, cysts, infections, medication side effects, musculoskeletal pain (chest wall), and, rarely, an underlying breast lump.
Common causes
- Hormonal fluctuations during the menstrual cycle
- Pregnancy and breast-feeding
- Starting or changing hormonal contraceptives or hormone replacement therapy
- Breast cysts
- Trauma or injury to the breast
- Mastitis (breast infection)
- Musculoskeletal chest wall pain (costochondritis, muscle strain)
- Certain medications including some antidepressants and diuretics
Breast cancer rarely presents with pain as the only symptom. However, persistent localised pain, especially with any associated lump, skin change, or nipple change, should be assessed promptly.
When to see a doctor
- Pain that is persistent, does not resolve after a few menstrual cycles, or is getting worse
- Pain that keeps you awake at night or prevents normal daily activities
- Pain localised to one specific area of the breast that is consistent between cycles
- Pain accompanied by a new lump, skin changes, or nipple discharge
- Pain in a post-menopausal woman (breast pain is less common after menopause and warrants assessment)
Treatment options
Reassurance and lifestyle measures: For cyclical mastalgia, reassurance that the pain is benign is often sufficient. A well-fitting supportive bra, reduction in caffeine, and evening primrose oil are sometimes helpful. Most cases of cyclical mastalgia resolve spontaneously or with simple measures.
Medical management: For persistent or severe mastalgia, medications including topical diclofenac gel, danazol, or tamoxifen (in selected cases) can significantly reduce pain. These are prescribed based on the severity and type of mastalgia.
Treating the underlying cause: If a cyst, infection, or other structural cause is identified, treating that specific problem usually resolves the pain. Dr. Shruthi orders targeted investigations to find and address the cause.
Breast pain alone, without any lump, skin change, or nipple change, is very rarely a sign of cancer. But getting it assessed gives you certainty. Knowing the cause is almost always more reassuring than wondering.