Types of Breast Pain
Cyclic mastalgia is the most common type — pain that varies with the menstrual cycle, typically worse in the luteal (premenstrual) phase and relieved by menstruation. It is bilateral and diffuse, affecting the outer upper quadrants particularly. It results from cyclic hormonal influences on breast tissue. It is not associated with increased cancer risk. Non-cyclic mastalgia is unrelated to the menstrual cycle. It may be focal (at a specific location) or diffuse, may be constant or intermittent, and requires more thorough investigation to exclude an underlying cause.
Common Causes
Most breast pain has benign causes: fibrocystic changes (the most common finding in women with mastalgia), hormonal fluctuation, large or unsupported breast weight (musculoskeletal pain from the chest wall rather than the breast itself), post-surgical healing, and medication effects (particularly combined oral contraceptives and HRT). Occasionally pain is referred from outside the breast — costochondritis, cervical spine disease, or cardiac conditions can present as apparent breast pain.
When to Seek Evaluation
Breast pain that is new, focal, associated with a lump or skin change, or not clearly cyclic warrants medical evaluation to exclude an underlying pathology. Pain in a specific quadrant that is progressively worsening is more concerning than diffuse premenstrual tenderness. The vast majority of patients investigated for breast pain have benign findings, but evaluation is important to exclude the small proportion with significant pathology.
Management
For cyclic mastalgia: well-fitted supportive bra (particularly for exercise), evening primrose oil has modest evidence in some studies, reducing caffeine and dietary fat has been suggested but evidence is limited. For moderate to severe cyclic mastalgia: danazol and tamoxifen have the strongest evidence base for symptom reduction but have significant side effect profiles limiting their use. Non-cyclic pain: managed by identifying and treating the underlying cause.
