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Cyclic Mastalgia

Breast pain, medically termed as cyclic mastalgia is a common complaint experienced by many women before menstruation. Particularly, young women of reproductive age suffer from pain and tenderness of breasts before the onset of periods. The pain normally starts four to five days prior to the monthly cycle, but in few cases the discomfort is experienced right from the ovulation period. The pain is usually felt in both the breasts and more in the upper quadrant portion and rarely around the nipples. The pain subsides soon after menstruation and may persist for few months to years. The incidence of cyclical mastalgia is very rare in post menopausal women. Cyclic Mastalgia is not an indicator of breast cancer as breast pain is rarely a first symptom of this cancer.


The exact cause of the mastalgia is not known, however the condition is linked to the hormonal imbalance. The fluctuation in the level of two important hormones progesterone and estrogen before the periods can lead to cyclic mastalgia. Increased level of estrogen in comparison with progesterone levels during the second half of the month is believed to cause cyclical mastalgia. Women, who take oral contraceptives or hormone replacement therapy during menopause, may be affected by cyclic breast pain. As hormones play a major role in cyclic mastalgia, the condition is also known as hormonal breast soreness. However cyclical mastalgia cannot be totally attributed to hormonal imbalance. The monthly fluid retention swells up the breasts causing pain and tenderness. Low androgen levels, and high prolactin levels also result in cyclic mastalgia. It is also interesting to note that, the severity of the mastalgia increases with the stress related issues and wrong choice of diet.


Managing cyclical mastalgia

Cyclic mastalgia is not a disease and hence does not require any treatment as such. Yet if the pain is persistent, see your gynecologist to rule out other breast related conditions. Your doctor will first assess if the pain is cyclic or non cyclic (not related to monthly cycles). Non cyclic mastalgia occurs due to trauma, breast infection or sometimes it is associated with the chest wall. Once it is confirmed that the mastalgia is cyclic, doctor may merely reassure, counsel and educate you on how to manage the condition. If the pain is severe and disrupting normal life, doctor prescribes some medication such as Tamoxifen, Danazol and Bromocriptine. You may also be given Anti inflammatory gel which is quite effective in alleviating the pain.

There are few natural remedies available for cyclic mastalgia. Following are some of the methods which can be followed at home to manage the mastalgia effectively.

1. Wear a correct fitting bra to provide right support.

2. Avoid caffeine products as caffeine contains a substance called methyxanthine which allows blood vessels to dilate. The dilated blood vessels cause swelling that results in breast soreness.

3. Restrict salt intake as excess salt in the body leads to water retention making the breasts heavy and painful.

4. Following a low fat diet and also a diet that is free of sugars will provide relief to certain extent.

5. Popping in a capsule of evening primrose oil at least for 3 to 4 months is known to give good results. Though, this method has been followed since many years, it is advisable to consult your doctor before starting the course.

6. Taking vitamin E supplements has also been shown to help with breast discomfort.

Breast Cancer

Breast cancer is the second deadliest cancer among women. But it has been noted that with increased awareness and thereby early detection and improved treatment, the number of deaths has reduced. But the incidence of breast cancer has been increasing steadily. Breast cancer is generally noticed in women above the age of 50 years. If a woman has sisters, mother or close blood relatives who have had breast cancer, she is more at risk. Women who have had an early menarche and late menopause are at higher risk for breast cancer. Lifestyle factors such as high alcohol consumption, obesity, diet rich in saturated fat and sedentary lifestyle increases a woman's risk for breast cancer. Long-term use of Hormone Replacement Therapy or HRT increases the risk of breast cancer.


Approximately 8% of breast cancers are hereditary and of these one-half are associated with mutations in genes BRCA1 and BRCA2. A history of a proliferative breast abnormality like atypical Hyperplasia may increase the risk for developing breast cancer. Women who have a family history of BRCA mutation should initiate annual mammography between 25 and 35 years of age. The selective estrogen receptor modulator tamoxifen or raloxifene lowers the risk of developing breast cancer.


Breast Mammogram

Symptoms of breast cancer:

  • Lump or thickening in or near the breast or in the underarm area.
  • Prominently visible veins on the surface of the breast or peeling and scaling should not be ignored.
  • Yellowish green discharge from the nipple can be a possible breast cancer symptom.
  • Nipple discharge may be from infection which is usually purulent and from pregnancy, stimulation or prolactinoma which produces a thin, milky, often bilateral discharge. A suspicious discharge from a single duct can be evaluated with a ductogram.
  • Change in size, shape and appearance need to be carefully observed, as it can be a potential symptom of breast cancer.

Every woman must learn to conduct a BSE (Breast Self Examination) to check for abnormal lumps, irregularities or discharge from the nipples. Such BSE combined with annual check ups by a doctor improves the chances of detecting breast cancer at an early stage. Palpate the breast tissue, axillary area and supra clavicular areas for masses or adenopathy. Physical examination of the breast should be performed in the upright and supine positions. Look for differences in size, retraction of the skin or nipple, prominent venous patterns and signs of inflammation. A mass that is suspicious for breast cancer is usually discrete, solitary, hard, unilateral and non tender. A Mammogram of the breast is routinely advised for women who are at higher risk for developing breast cancer. A clinically suspicious mass should be subjected to a biopsy even if mammography findings are normal.


Breast Cancer - Risk factors

  • Family history of breast or ovarian cancer specifically with BRCA mutations

  • History of breast cancer

  • Increasing age

  • Early age at menarche and late menopause.
  • Prolonged exposure / higher concentrations of endogenous or exogenous estrogen

  • Exposure to ionizing radiation

  • Dense breast tissue

  • atypical Hyperplasia

  • Women with no children or who had their first child after the age 30

  • Sedentary life style

  • High fat content in diet

  • Excessive Alcohol consumption


Though Bilateral mastalgia is rarely associated with breast cancer, it does not totally rule out the possibility. It is usually related to Fibrocystic changes in pre menopausal women with diffuse lumpy breasts.

Breast Cancer - Treatment Options

Appropriate breast cancer treatment is decided on the basis of a number of factors. Breast cancer treatment will depend on a number of factors such as size and location of the breast lump, the stage at which it was detected and the results of hormone receptor tests.
The most common approach for advanced breast cancer is preoperative chemotherapy followed by surgery and radiotherapy. Surgery and chemotherapy are often used in combination. Chemotherapy is breast cancer treatment with anti-cancer drugs administered intravenously or orally. This systemic form of treatment is either administered alone or along with surgical procedures. Chemotherapy is a systemic therapy that affects the entire body by entering the bloodstream. This is used widely in breast cancer treatment to interfere with rapidly dividing cells. Radiation is the use of high-energy rays to prevent breast cancer cells from further growth and division. Though normal cells are also affected by this form of breast cancer treatment, they generally repair themselves and function normally afterwards. Adjuvant systemic therapy consists of administration of hormone therapy, chemotherapy or trastuzumab (a monoclonal antibody directed against HER-2/neu). It benefits most women who are in the early stage of breast cancer, but the magnitude of benefit is greatest for those with node positive disease.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 15, 2019