Breast pain can cause a lot of anxiety. Many women worry that they may have breast cancer. You may find it reassuring to know that breast pain alone is usually not a sign of breast cancer and does not increase your risk of breast cancer.

Breast pain is very common in women across all ages. Approximately two out of three pre-menopausal women (women who have not been through menopause) will experience breast pain at some point in their lives.

There are two main categories of breast pain

• Breast pain that is part of a women's normal menstrual cycle is known as 'cyclical breast pain'. Women may experience it as discomfort and lumpiness in their breast a week or so before their period. The breast becomes tender and sore to the touch. The pain can also vary from mild to severe. It often goes away once the period starts.
• Some women have lasting pain in the breast that is not related to their menstrual cycle. The pain may be coming from elsewhere in the body. This is known as 'non-cyclical breast pain'.
  

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Cyclical breast pain
Cyclical breast pain is linked to changing hormone levels during the menstrual cycle, which mainly affects pre-menopausal women. These hormonal changes cause the breast tissues to be more sensitive, which can in turn, cause pain.

You may experience heaviness, tenderness, burning, prickling or stabbing pain, or feel tightness in the area. The pain can affect one or both breasts and can spread to the armpit, down the arm and to the shoulder blade. This type of pain usually stops when the ovaries become inactive after menopause. However, women on hormone replacement therapy (HRT) after their menopause can also experience breast pain. This is because the HRT maintains some hormones at a pre-menopausal level.

Non-cyclical breast pain
There are two types of non-cyclical breast pain.

• True non-cyclical breast pain comes from the breast but is not linked to the menstrual cycle.
• Extra mammary or chest wall pain (known as musculoskeletal pain) is felt in the area of the breast but actually comes from elsewhere, such as the muscles, bones and joints.

Both types of non-cyclical breast pain can result in continuous pain or pain that comes from time to time and can affect women before and after menopause. The pain can be in one or both breasts and can affect the whole breast or a specific area. It may feel like a burning, prickling or stabbing pain, or tightness in the area. The pain may last from a few minutes up to a few days.

Seek medical attention if the pain is persistent and/or associated with other breast symptoms such as a breast lump or skin changes etc.

Cyclical breast pain
Although cyclical breast pain is linked to the menstrual cycle, it can also be associated with taking contraceptive pills, certain anti-depressant drugs, or even stress.

Non-cyclical breast pain
It may be due to breast infection, previous breast surgery etc. However, in many cases, it is not entirely known what causes true non-cyclical breast pain that is not linked to the menstrual cycle.

Extra mammary or chest wall pain could be related to an underlying problem such as inflammation (swelling) of the chest wall, known as costochondritis which affects parts of the ribs. The pain could also be the result of underlying muscle injury, heart problem etc.

The diagnosis is reached after a detailed history and physical examination. Breast imaging may be required if there are other associated symptoms such as a breast lump etc.

If your breast pain is related to extra mammary or chest wall pain, the doctor will advise you on the treatment accordingly depending on its cause.

If there is an identifiable cause for the breast pain such as infection, appropriate treatment for the underlying cause will be given. If not, true non-cyclical breast pain with no attributable cause can be treated as for cyclical breast pain.

Treatment for cyclical breast pain
If you have cyclical breast pain, the pain that you are experiencing is part of your monthly cycle and is normal. The pain is usually self-limiting without need of further treatment. However, if the pain becomes unmanageable, some of the treatment options below may help:

• Changes in diet and lifestyle choices For a start, your doctor may suggest simple things that you can do to help reduce the pain. These include reducing your intake of caffeine, while increasing the amount of fresh fruits and vegetables you eat and engaging in regular exercise to help maintain a healthy weight. You may also be advised to wear a supportive and correctly fitted bra.
• Some women have found relaxation therapy, such as listening to soothing music, useful in reducing the symptoms of cyclical breast pain. Other complementary therapies that promote wellbeing, such as acupuncture and aromatherapy, may also be helpful.
• If your pain started when you began taking a contraceptive pill, changing to a lower dosage pill or a different brand may help. If the pain continues, you may want to try non-hormonal methods of contraception such as condoms etc.
• A simple painkiller such as Paracetamol or Ibuprofen (either as a cream, gel or tablet) can help with pain relief.