Understanding and managing cyclical breast pain

Written in association with: Professor Kefah Mokbel
Published:
Edited by: Conor Dunworth

In his latest online article, renowned consultant oncoplastic breast surgeon Professor Kefah Mokbel delves into cyclical breast pain. He explains the causes of cyclical breast pain, lifestyle modification that can aid pain relief and the medications available.

 

What is cyclical breast pain?

Cyclical breast pain, also known as mastalgia, is a common concern among women, affecting up to 70% of them at some point in their lives. This type of pain occurs in a pattern that corresponds to the menstrual cycle, typically worsening in the days leading up to menstruation and easing after its onset. It's characterized by tenderness, heaviness, or aching in one or both breasts. Interestingly, some women may also experience radiation of pain towards the arms and armpits, adding to the discomfort. The pain typically lasts for 5–7 days.

 

What causes cyclical breast pain?

While the exact cause of cyclical breast pain remains unclear, hormonal fluctuations during the menstrual cycle are believed to play a significant role. Changes in oestrogen and progesterone levels can lead to breast tissue swelling and inflammation, contributing to discomfort. Additionally, factors such as nutrition, psychological stress, and fluctuations in body weight may exacerbate symptoms.

Cyclical breast pain is not usually a symptom of breast cancer and the patient does not require any specific investigations. However, an ultrasound scan is sometimes requested to confirm in the case of women under the age of 40. In older women, mammography is recommended as a screening strategy.

 

Are there any lifestyle modifications I can make to help relieve pain?

Lifestyle modifications, such as wearing a well-fitted bra for proper support, engaging in regular exercise to reduce inflammation and improve overall well-being, maintaining a low-fat diet, optimising body weight, and practising stress-reduction techniques like meditation, may provide relief.

Recent research has shed light on potential management strategies for cyclical breast pain. Herbal remedies like nigella sativa, chamomile, flaxseed, evening primrose oil, vitex-agnus-castus, and red clover have shown promise in alleviating symptoms, thanks to their anti-inflammatory and hormonal-balancing properties. Supplements include vitamin D3, vitamin E and omega-3.

 

What medications are available?

Pharmaceutical options for managing breast pain are limited. Topical diclofenac gel is effective in improving symptoms. Danazol is the only drug formally approved for this purpose, but its use is often limited due to adverse effects such as weight gain, acne, and mood changes. Low-dose tamoxifen and cabergoline have shown efficacy in reducing breast pain, but they are not formally approved for this indication. However, most patients do not require any pharmaceutical drugs since symptoms tend to improve or resolve following reassurance.

By understanding the nature of cyclical breast pain and exploring various management strategies, women can take proactive steps to alleviate their symptoms and improve their quality of life.

 

 

 

Professor Kefah Mokbel is a renowned consultant oncoplastic breast surgeon based in London. If you would like to book a consultation with Professor Mokbel, you can do so today via his Top Doctors profile.

By Professor Kefah Mokbel
Surgery

Professor Kefah Mokbel is an internationally renowned breast cancer surgeon and researcher who specialises in the multidisciplinary care of patients with breast cancer. He is the lead oncoplastic breast surgeon, chair of breast cancer surgery and chair of the multidisciplinary breast cancer program at the London Breast Institute & The Princess Grace Hospital (part of HCA Healthcare). His areas of expertise include breast cancer detection, oncoplastic breast surgery, breast screening, DCIS, LCIS, inflammatory breast cancer, fibroadenoma, phyllodes tumours, breast cancer genetics & genomics, breast pain, breast cysts and lumps and breast implants. In addition, he is an honorary professor of breast cancer surgery at Brunel University London and the founder and president of a UK cancer charity; Breast Cancer Hope.

Following the completion of his undergraduate medical education at the London Hospital Medical College in 1990, Professor Mokbel pursued surgical training at the Royal Marsden, Charing Cross, Chelsea and Westminster, Saint Mary’s and St Bartholomew’s hospitals and completed his higher surgical training as an oncoplastic breast surgeon in 2000. Professer Mokbel has won various prestigious prizes, awards and honours during his education, training and postgraduate career.

He qualified as a Fellow of the Royal College of Surgeons in 1994 and was then granted the Master of Surgery degree in 2000 by The Imperial College of Science, Technology and Medicine for his research in the field of molecular biology of breast cancer.

Professor Mokbel's research interest lies in the field of molecular biology and the clinical management of breast cancer and aesthetic breast surgery. This includes breast reconstruction following mastectomy and augmentation mammoplasty using implants and fat transfer. In addition, he has authored or coauthored more than 400 scientific papers, editorials, commentaries and textbook chapters (Google Scholar H-index = 59 and I10-index = 209) and has authored 14 textbooks aimed at medical students and postgraduate doctors. His current academic interest is focused on how to apply the advances from clinical trials to daily surgical practice. He is also currently a member of the editorial board of various global medical journals and has peer-reviewed for renowned journals such as The Lancet.

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