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Breast Pain (Mastalgia)

Mastalgia is the medical term for breast pain. It is very common, with some surveys finding half of women experiencing some episodes of breast pain. Reassuringly mastalgia on its own is very rarely a sign of breast cancer (just under 2%).

Mastalgia can be cyclical (related to natural hormone variations), non-cyclical, or referred pain. Common possible causes of referred pain include shoulder bursitis, nerve impingement in the neck, or rib pain.

Risk factors

The following lifestyle factors can contribute to experiencing mastalgia:

  • Nicotine
  • Methylxanthines / caffeine – found in coffee, tea, chocolate and cola
  • Alcohol
  • Ill-fitting bras
  • High dietary fat intake

Management

If not already done, a breast ultrasound +/- mammogram should be performed to make sure there is no breast abnormality related to the symptoms. Assuming they are normal, I would recommend abstaining/reducing intake of caffeine, alcohol and nicotine. Wearing a well fitted sports bra is also useful.

Evening Primrose Oil (EPO) is a natural source of linolic acid, that is often deficient in patients with mastalgia. Taking and EPO supplement (dose 2-3 grams daily) can decrease pain symptoms, particularly those with cyclical mastalgia. It can be purchased over the counter and generally has minimal side effects.

Keeping a pain diary is a method of tracking the pattern of the pain. It can determine if the pain is cyclical or not, and anticipate painful periods so it can be managed better. During painful episodes, simple analgesics can be used (e.g. paracetamol or ibuprofen with food). Topical non-steroidal anti-inflammatory gels (e.g. voltaren gel) used during painful periods can help manage the pain and reduce the risk of side effects e.g. stomach ulcers or kidney impairment.

Please download Dr Nathan’s Breast Pain diary to assist with your records.

Reassuringly mastalgia will often improve over time or resolve. My priority in managing mastalgia is to exclude cancer and then help manage the pain.