Cyclical mastalgia
Cyclical mastalgia (breast pain tied to the menstrual cycle) is pain, usually in both breasts, that builds before a period and settles when it ends.
Remember
Pain in both breasts that rises before a period and settles when it ends is cyclical mastalgia, a normal hormonal pattern, and breast pain on its own is rarely a sign of cancer.
Memory aid
Cyclical pain follows the calendar
If the pain keeps to the monthly calendar it is probably hormonal, and if it ignores the calendar, look for another cause.
Pain in the breast is called mastalgia. Most breast pain is cyclical mastalgia, which follows the hormonal changes of the menstrual cycle. In women who still have periods it is the most common breast pain.
The predictable timing is the key to recognising it. The pain typically begins up to two weeks before a period, gets worse, and goes away once the period ends. It is usually a dull, heavy or aching pain in both breasts, and it may spread to the armpit. The pain is usually diffuse (spread over a wide area instead of limited to one place), with no single sore spot.
The pain is put down to the normal monthly rise and fall of oestrogen and progesterone, the two main female sex hormones. In the luteal phase (the second half of the cycle, after ovulation) they stimulate the breast tissue to proliferate (increase in bulk), so the breasts feel full, heavy and tender. When the period starts, hormone levels fall and the pain eases.
Because this is a normal hormonal effect and not a disease of the breast, examination normally finds nothing abnormal: no lump, skin change or nipple discharge. Reassurance, simple painkillers and a well-fitting bra are usually enough, and a diary of symptoms set against the cycle helps to confirm the pattern.
Pain that is non-cyclical, meaning it does not follow the periods, and focal (confined to one area) may point to injury, a ruptured cyst or inflammation. Breast pain on its own is unlikely to be a symptom of cancer, but a hard lump that does not move, skin changes, a nipple turning inwards, or a red, hot, swollen breast with fever needs clinical assessment.
Key facts
- Timing
- typically begins up to two weeks before a period, gets worse, and then goes away when the period ends.
- Feel and spread
- a dull, heavy or aching pain, usually in both breasts, which may spread to the armpit.
- Cause
- put down to the normal monthly rise and fall of oestrogen and progesterone acting on the breast tissue.
- Examination
- normally no lump, skin change or nipple discharge.
- Management
- reassurance, simple painkillers and a well-fitting bra are usually enough.
- Cancer
- breast pain on its own is unlikely to be a symptom of cancer.
Exam traps
- Pain that peaks just after a period and settles before the next one reverses the usual timing of cyclical mastalgia, which builds before a period and eases when it ends, so a different timing should prompt a search for another cause.
- Luteinising hormone (the hormone that triggers ovulation) does not cause the breast changes that come before a period, which follow the rise and fall of oestrogen and progesterone in the luteal phase.
- Breast cancer usually presents as a painless lump or with skin or nipple changes, so pain that rises and falls with the cycle in both breasts, with no lump or skin change, points away from cancer.
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