Cyclical and Noncyclical Breast Pain

Breast Pain That Is or Is Not Related to Your Period

Breast pain can be experienced in many different ways, and it may be related to your menstrual cycle (cyclic) or unrelated (noncyclical). You may have a vague feeling of tenderness or a dull ache or instead suffer from constant throbbing pain or sharp stabbing pain. Episodes of breast pain may come on a regular schedule, may happen only once, or may endure for long periods of time. It may occur in only one breast (unilateral) or in both (bilateral).

There are a number of different terms used to describe breast pain including mastodynia, mastalgia, mammalgia, or mastitis (though the term mastitis is more often is used to describe an infection or inflammation of the breasts).

Most of the time breast pain does not mean breast cancer, though some people do have pain with breast cancer and the symptom should never be dismissed.

Cyclical Breast Pain

Cyclical Breast Pain and Menstrual Cycle
Differences between the causes of cyclical and noncyclical breast pain. Art © Pam Stephan

To define the cause of your pain, one of the first questions your doctor will ask is whether your breast pain is cyclical—occurring at regular intervals associated with your period, or noncyclical—unrelated to your menstrual period or occurring after menopause.

Cyclical breast pain happens during a woman's menstrual cycle or at least varies in intensity at different points in the cycle. A range of sensations in one or both breasts can accompany the hormonal ebb and flow that a premenopausal woman normally experiences. 

Breast pain is often one of the components of premenstrual syndrome (PMS) and can present along with fatigue, irritability, and abnormal hormone levels. Breast pain may also occur before your periods without the other common symptoms of PMS.

Breast pain associated with PMS is often achy with a sensation of your breast feeling full, heavy, or swollen. The discomfort often begins a few days before your period starts and may continue until your period has stopped, though it often decreases in severity as time goes on.

"Normal" Cyclical Pain

Cyclical breast pain may be normal and associated with normal hormonal changes. This is the most common cause, and even though "normal" can be as severe and interfere with life as much as pain due to medical conditions. If you are living with this kind of pain it's important not to dismiss the pain, or feel that as a woman you need to "suck it up" and just deal with it.

Associated Conditions

Cyclical breast pain may also be due to benign breast conditions known as fibrocystic breast changes or mammary duct ectasia.

With fibrocystic breast changes, you may note generalized achiness with diffuse areas of your tenderness in your breasts. Your breasts may also feel firm and thick. Both microcysts (which can't be felt) and macrocysts (which can be felt) may occur. Larger cysts can be seen on ultrasound, and a needle biopsy to drain the cyst may be needed to diagnose the condition.

Mammary duct ectasia is more common in perimenopausal (women nearing menopause) women and often causes tenderness in the nipple and areola. Less commonly, duct ectasia may occur in older people or adolescents.

Breast pain associated with oral contraceptive use isn't uncommon and may require changing to a different combination birth control pill. Fortunately, there are many different options available, and your doctor can help you select a pill that's less likely to cause breast pain if needed.

Noncyclical Breast Pain

Noncyclical breast pain is unrelated to your menstrual cycle or occurs after menopause. The pain may vary in intensity, but instead of changes caused by hormones, may be caused by an illness or injury, weight gain, breast surgery, or certain medications.

Noncyclical breast pain may occur in both breasts or only one breast. You may have pain in one specific area, or it may be generalized.

Wearing an ill-fitting bra is a common cause of noncyclical breast pain, but it won't cause breast cancer.

Breast cancer is an uncommon cause of breast pain, and the majority of breast cancers do not cause pain. With that said, it is a symptom that many women with breast cancer ignore.

A 2017 study found that more than one in five women with breast cancer experience pain in the three months leading to their diagnosis. Some forms of breast cancer, such as inflammatory breast cancer, typically start with pain.

Differentiating Breast Pain Causes

Your breasts rest on your chest wall muscles and ribs and lie above your heart, lungs, and other structures of the chest. Within your breasts are a rich supply of nerves, blood vessels, and connective tissues. Pain from any of these tissues can sometimes appear to arise in the breasts even though it does not.

Arthritis in your spine or ribs may cause noncyclical breast pain, as well as muscle strains that affect the muscles of your chest. Nerves can be pinched or veins inflamed leading to pain.

If your pain is in your left breast it's important to make sure that your pain isn't related to heart disease. Chest pain related to a heart attack is often different in women than in men and can be vague and subtle in character. Sometimes it can even be mistaken as breast pain.

Managing Breast Pain

If you are premenopausal, you may be able to distinguish if your pain is cyclical or noncyclical by keeping a chart of your cycle and tracking your pain. Many women find journaling their pain invaluable in both identifying the pattern of their pain, but determining what seems to make it worse and what makes it better.

If your pain is persisting, you should see your doctor about having a clinical breast exam. Certainly, if you notice a lump, changes in your skin such as redness, thickening, or an orange peel appearance you should see your doctor right away.

Some women forego seeing their doctor believing that breast pain is something that women simply need to live with. But the same women are often relieved to learn that treatment options are, in fact, available.

Treatment Options

Treatments that have been effective for non-cancer related cyclical and noncyclical breast pain include topical anti-inflammatory medications such as Topricin (diclofenac), oral anti-inflammatory drugs such as Advil (ibuprofen), and hormonal treatments such as Parlodel (bromocriptine) or Danocrine (danazol).

Topical anti-inflammatory medications can be used regularly and don't have the potential to cause stomach problems as do oral drugs.

For severe, persistent pain, the surgical removal of a breast (mastectomy) may be considered. This is extremely rare. For generalized mastalgia, mastectomy is not advised. Research suggests that 50% of such procedures will not improve pain. Moreover, complications arising from reconstructive surgery may result in pain and other severe symptoms.

If your body and breasts have changed, it may simply be time for a bra-fitting session and/or a change to newer, supportive bras.

A Word From Verywell

With breast cancer affecting roughly one in eight women, symptoms related to the breasts can sometimes cause significant anxiety. It's important to talk to your doctor if you are experiencing this fear. Sometimes reviewing risk factors and making sure you are up to date on appropriate screening can reduce anxiety and help with pain.

It's important to note that conventional mammograms are not enough for people who are suspected to have familial breast cancer, such as those who have BRCA mutations or other gene mutations associated with breast cancer. In people who are high risk (have a lifetime risk of developing breast cancer that is 20% or higher), breast MRI screening is often recommended as mammograms can miss up to 15% of cancers.

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Article Sources

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