Breast Pain (Mastalgia)

What it is

Breast pain is one of the most frequent complaints in the office and, in the vast majority of cases, is not related to cancer. Cyclical mastalgia follows the menstrual cycle, worsens before menstruation and usually affects both breasts, with a feeling of heaviness and swelling; it is linked to hormonal changes and fibrocystic changes. Non-cyclical pain is continuous or irregular, usually located at one point in a single breast, and can have causes such as cysts, mastitis, trauma, medication use, or pain in the chest wall and ribs, which is mistaken for breast pain. The assessment includes a clinical exam and, depending on the case, ultrasound or mammography. Treatment ranges from guidance — a well-fitted bra, reduced caffeine, pain relievers — to specific medications in severe cases.

Most common symptoms

• Pain or a feeling of heaviness in both breasts before menstruation
• Swelling and increased tenderness to the touch
• Continuous or stabbing pain, at one point in a single breast
• Pain that radiates to the armpit or the arm
• Discomfort when wearing a bra, lying face down or hugging
• Chest wall pain mistaken for breast pain

Causes and risk factors

• Hormonal variations of the menstrual cycle
• Fibrocystic changes and breast cysts
• Mastitis, trauma and previous breast surgery
• Use of birth control pills, hormone therapy and some antidepressants
• Muscle or rib pain that manifests in the breast area
• An ill-fitting bra, large breasts and excess caffeine

How it is diagnosed

The consultation begins with a detailed conversation about the pain: whether it follows the menstrual cycle, whether it affects one or both breasts, its location, intensity, and the medications being used. A clinical exam of the breasts and chest wall helps distinguish pain of breast origin from muscle or rib pain. Depending on age and findings, your breast specialist orders ultrasound, performed on site, or mammography. A pain diary may be requested to identify the cyclical pattern.

How we treat it at Femi Saúde

In most cases, the first step is reassurance: a thorough assessment that rules out disease usually eases the worry. For cyclical pain, the breast health team at Femi Saúde recommends simple measures, such as a well-supporting bra, reduced caffeine, physical activity, and pain relievers or anti-inflammatories on the days of greatest discomfort. When the pain is intense and persistent, specific medications may be prescribed for a limited period, with monitoring of their effects. For non-cyclical pain, treatment targets the cause: aspiration of a cyst, treatment of mastitis, or management of muscle pain. The plan is individualized and reviewed at follow-up visits.

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