Fibrocystic change: cyclical breast pain and lumpiness
Fibrocystic change is the commonest benign breast disorder, causing cyclical pain and lumpiness, usually in both breasts, that rise and fall with the menstrual cycle.
Remember
Pain and lumpiness, usually in both breasts, that build before a period and ease afterwards point to benign fibrocystic change rather than cancer. Once it is confirmed and no discrete (separate, standout) mass is present, treat with reassurance, a well-fitting bra and simple pain relief.
Fibrocystic change is a benign breast condition, most commonly seen in women aged 20 to 50. Hormone changes across the menstrual cycle act on the breast tissue, which develops patches of fibrosis (scarring), cysts (fluid-filled sacs) and some inflammation.
Because the tissue follows the hormone cycle, the symptoms are cyclical. Both breasts are usually involved, feeling heavy, tender and lumpy, most noticeably in the week before a period, and the discomfort eases when the period starts. The lumpiness is often in the upper outer part of the breasts. Different areas are affected to different degrees, which gives diffuse nodularity (a generally lumpy, bumpy feel) rather than one dominant lump.
Cancer behaves differently: a malignant lump is usually painless, and it does not rise and fall with the cycle. If the pattern is unclear, a symptom diary helps, and examination should ideally be performed in the middle of the cycle.
Once fibrocystic change is confirmed and a discrete (separate, standout) mass has been excluded, the woman needs reassurance that it is benign, plus symptom relief: a well-fitting bra and simple pain relief such as paracetamol or ibuprofen. She should return if a discrete lump appears or the pattern changes. If severe pain affecting sleep and quality of life fails to improve after about three months of this, referral to a specialist can be considered.
Key facts
- Pattern
- pain and lumpiness, usually in both breasts, that build in the week before a period and ease once bleeding starts
- Cause
- hormonal changes cause patches of fibrosis (scarring), cysts (fluid-filled sacs) and some inflammation
- Who it affects
- it occurs most commonly in women aged 20 to 50
- Cancer contrast
- a malignant lump is usually painless and does not rise and fall with the cycle
- If the pattern is unclear
- a symptom diary helps, and examination should ideally be done in the middle of the cycle
- First-line care
- reassurance, a well-fitting bra and simple pain relief such as paracetamol or ibuprofen, once the diagnosis is confirmed and a discrete (separate, standout) mass has been excluded
Exam traps
- Breast pain on one side that stays constant through the cycle is non-cyclical breast pain (mastalgia), not fibrocystic change, which causes pain and lumpiness, usually in both breasts, that fluctuate with menstruation.
- A smooth, very mobile lump that does not change with the cycle is the usual picture of a fibroadenoma (a single, smooth, mobile lump), not fibrocystic change, which causes diffuse lumpiness that fluctuates with the cycle.
- Thick green discharge from several ducts points to duct ectasia, a different benign condition in which a dilated, blocked duct causes nipple discharge, and it does not give the bilateral cyclical discomfort of fibrocystic change.
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