What should I do?
If you think you have this condition, you may not need to see a doctor.
How is it diagnosed?
Cyclical mastalgia is diagnosed based on your symptoms and physical examination findings.
What is the treatment?
You might be advised to wear a supportive bra during the day, at night and while exercising to help reduce the pain.
Non-prescription pain relief in the form of tablets or gels can be used to treat mild pain.
If the pain is not controlled with these measures, you can be prescribed medication which controls your hormone levels.
When to worry?
If you have any of the following symptoms, please see a doctor within 48 hours:
- lump in the breast
- discharge from the nipple
- severe pain or pain NOT around the time of your period
- hot, red, painful skin on the breast.
Cyclical breast pain, also known as cyclical mastalgia, is pain in the breasts linked to the menstrual cycle.
Commonly, the pain affects the upper, outer area of both breasts and can sometimes be felt in the arms.
The pain can vary from a dull ache to a burning or stabbing sensation. In most cases it starts one to three days before your period begins, and improves at the end of your period.
Breast pain is not a symptom of breast cancer and cyclical breast pain does not increase your risk of developing breast cancer.
Read more about the symptoms of cyclical breast pain.
Why does cyclical breast pain happen?
Although the exact cause of cyclical breast pain is not known, it is related to the menstrual cycle, affecting women who are still having periods (before the menopause).
It is thought that the changes in hormone levels before periods begin are linked to cyclical breast pain. The menstrual cycle is controlled by your body releasing hormones, such as oestrogen. Hormones are powerful chemicals that have a wide range of effects on the body.
Cyclical breast pain is not associated with any other breast-related conditions.
How is cyclical breast pain treated?
Almost a third of women who get cyclical breast pain find that their condition gets better without treatment in around three menstrual cycles. However, for many, cyclical breast pain will return in the future.
Many women find they can live with their breast pain once they feel reassured that it is not caused by breast cancer.
The pain can usually be dealt with by over-the-counter painkillers and gels, such as paracetamol or ibuprofen. Speak to your pharmacist for advice.
If you have breast pain that is affecting your quality of life and painkillers have not helped, your doctor may request that you make a record of your daily pain for a period of time and refer you to a breast specialist for further treatment.
In most cases, the symptoms of cyclical breast pain are relatively mild, although some women experience moderate or severe pain.
The pain may be felt as a heaviness or soreness, but it has also been described as a stabbing or burning pain.
It is usually felt in the upper, outer area of your breasts and it may extend from your breasts to your armpits, and sometimes down your arms.
Your breasts may also be tender, with some swelling and general lumpiness – but not a single, hard lump.
The pain occurs at about the same point of your menstrual cycle every month, usually one to three days before the start of your period, and improves at the end of your period. The intensity of the pain will not always be the same.
As cyclical breast pain is related to the menstrual cycle, it usually affects women before the menopause. However, women can sometimes experience symptoms after the menopause if they undergo hormone replacement therapy (HRT).
When to see your doctor
Visit your doctor if you notice changes to your breasts, such as:
- a lump or area of thickened tissue in either breast
- discharge from either of your nipples (which may be streaked with blood)
- a lump or swelling in either of your armpits
- a change in the size or shape of one or both of your breasts
- dimpling on the skin of your breasts
- a rash on or around your nipple
- a change in the appearance of your nipple – for example, it becomes sunken into your breast
- pain in either of your breasts or armpits that is not related to your period
See your doctor if, as well as cyclical breast pain, you also have:
- any symptoms of an infection in your breast, such as swelling, redness or warmth in your breast, or a high temperature (fever)
- any symptoms of pregnancy, such as a missed period
If you have breast pain along with other symptoms, or the pain continues throughout your menstrual cycle (not only around your period), it may not be cyclical breast pain. Your doctor will be able to advise you further about what the cause may be.
Cyclical breast pain can usually be diagnosed after a consultation with a doctor.
Your doctor will be able to diagnose cyclical breast pain by asking you about your symptoms and your general health. For example, your doctor may ask:
- whether the pain affects both breasts
- where in your breasts you feel the pain
- whether you are taking any medication, such as the combined contraceptive pill
- whether you could be pregnant
- whether you have any other symptoms, such as a lump or discharge from your nipples
- whether you smoke
- how much caffeine there is in your diet (found in tea, coffee and cola)
The answers to these questions will help your doctor to rule out any other possible causes of your breast pain.
Your doctor may also decide to examine your breasts if they feel lumpy when you experience breast pain.
Recording breast pain
If you have moderate to severe breast pain, your doctor may ask you to complete a breast pain chart. The chart can be used to confirm your diagnosis and to plan appropriate treatment.
You can use a breast pain chart to record whether your breast pain on a particular day is mild, moderate or severe.
The chart will usually have a series of small boxes with the month and date next to each one. You fill in the box for each day of the month to indicate the level of pain that you have. This is usually done for at least two months.
You can improve your symptoms of cyclical breast pain by wearing well-fitted bras and taking painkillers. Some cases don't need treatment at all.
Some women find that cyclical breast pain improves on its own. In other cases it may disappear and return periodically over a number of years. Many women feel reassured by the fact that their breast pain is not due to a more serious condition and find it easier to live with.
If your breast pain requires treatment, there are several self-help measures that you can try. These include:
- wearing a better-fitting bra during the day
- wearing a soft support bra while you are sleeping
- wearing a sports bra while exercising
- taking over-the-counter painkillers, such as paracetamol or ibuprofen, when you experience breast pain
Your doctor may also recommend a topical non-steroidal anti-inflammatory drug (NSAID) that can be rubbed directly on to the painful areas, such as:
- a gel containing diclofenac
- a gel containing ibuprofen
Follow the manufacturer’s instructions and make sure that the medicine is suitable for you. For example, topical NSAIDs should not be used where the skin is broken.
Some experts have also suggested that breast pain may be improved by:
- reducing your intake of caffeine, which is found in tea, coffee and cola
- reducing your intake of saturated fat, which is found in butter, crisps and fried food
- not smoking (if you smoke)
However, the benefits of making these changes have not been scientifically proven and they are not usually recommended by doctors.
Some women use alternative therapies, such as acupuncture or reflexology, to relieve the symptoms of cyclical breast pain. However, the lack of evidence supporting their effectiveness means that more research is needed before they can be recommended by the NHS.
Evening primrose oil
Although there is no scientific evidence to suggest that capsules of evening primrose oil can treat cyclical breast pain, many women find it beneficial.
Evening primrose oil can be bought from some pharmacies and health food shops.
As evening primrose oil may not always be suitable – for example, if you are trying to get pregnant or if you have epilepsy – you should speak to a doctor before using it. Your doctor may also be able to recommend a suitable product and tell you how much you should take.
If you have cyclical breast pain that is severe enough to affect your quality of life and the above mentioned treatments do not help, your doctor may suggest other treatment options or refer you to a breast specialist, either at a hospital or a specialist breast clinic.
In rare cases, you may be prescribed one of the following medications if you need further specialist treatment:
These medicines affect the levels of hormones in your body and evidence suggests that they may help to reduce cyclical breast pain. However, they can also all cause some unpleasant side effects, such as excessive hair growth and a permanently deep voice.
Some of these medications are unlicensed for the treatment of breast pain. This means that the medication’s manufacturers have not applied for a licence for the drug to be used in treating breast pain. In other words, the medication has not undergone clinical trials (a type of research that tests one treatment against another) to determine whether it is an effective and safe treatment for breast pain.
Sometimes, doctors will use an unlicensed medication if they think that it is likely to be effective and that the benefits of treatment outweigh any associated risk.
If your specialist is considering prescribing an unlicensed medication, they should inform you that it is unlicensed and discuss the possible risks and benefits with you.
Danazol is licensed to treat severe pain that is caused by fibrocystic breast disease (fibroadenosis). This is a condition that causes benign (non-cancerous) growths to develop in the breast. Side effects include:
- nausea (feeling sick)
- a rash
- weight gain
- heavy periods (menorrhagia)
- a deepening voice – this may be permanent
- spots (acne)
- hirsutism – excessive hair growth, for example on the face
Bromocriptine is licensed to treat some conditions that affect the breasts, such as galactorrhoea (the over-production of breast milk). Side effects include:
- nausea (feeling sick)
- low blood pressure (hypotension), which can cause dizziness
- constipation (an inability to empty your bowels)
Tamoxifen is a medicine that is used to treat breast cancer. It is also used as an unlicensed medicine to treat breast pain. Side effects include:
- vaginal bleeding or discharge
- hot flushes
- an increased risk of womb cancer (endometrial cancer)
- an increased risk of thromboembolism – when a blood clot forms in your veins (thrombosis), which may cause a blockage
Goserelin is a medicine that is used to treat breast cancer. It may also be used as an unlicensed medicine to treat breast pain. Side effects include:
- vaginal dryness
- hot flushes
- decreased libido (less interest in sex)
Toremifene is a medicine that is used to treat breast cancer. It may also be used as an unlicensed medicine to treat breast pain. Side effects include:
- nausea (feeling sick)
- hot flushes
- vaginal bleeding or discharge
- deep vein thrombosis (DVT) – a blood clot in one of the deep veins in the body
Learn about the medicines used to treat or manage this condition: preparations, benefits and side-effects are all covered.
The information is provided through a collaboration between NHS Choices, the medicines information provider Datapharm and other health organisations. It's based on the best available clinical evidence and is continually updated.