Breast pain (or mastalgia) will affect three quarters (75%) of women during their lives. It may be accompanied by fullness, lumpiness and a heavy or dragging sensation. Mastalgia is not a symptom typical for breast cancer, but any new breast pain should be discussed with your doctor. Cyclical mastalgia Most breast pain varies throughout the menstrual cycle. It is most common in pre-menstrual women in their 20s to 40s. It tends to be more prominent in the week leading up to their period, and there is some relief on menstruation. It is not uncommon for one side to be more tender than the other, or for there to be little or no pain during some cycles. The upper, outer part of the breast is usually the most affected part of the breast. Non-cyclical mastalgia Non-cyclical mastalgia is breast pain that does not appear to vary with the menstrual cycle. This tends to be more common in in women in their 40s and 50s. The cause of non-cyclical mastalgia is not always clear, and it can often be difficult to find the cause. It is important to consider that not all breast pain originates from the breast tissue. A number of conditions, including a wide range of musculoskeletal problems, can cause pain to be referred into the breast. Managing breast pain The most important part of managing breast pain is to exclude any serious cause. Dr Lancashire suggests that women keep a pain chart to keep track of whether the pain is cyclical in nature. This will also aid in identifying when pain relief might be most beneficial. You can download a Breast Pain Score Chart here. One of the simplest things you can do is make sure that you wear a well-fitting bra. In fact, as many as 70% of women wear a bra that does not fit them properly. When buying a bra, it is important to be fitted by someone who has the appropriate knowledge. Pain medications such as paracetamol or non-steriodal anti-inflammatories (NSAIDs) like ibuprofen are proven to be helpful for breast pain. There is some evidence for topical NSAIDs (for example diclofenac gel). Your GP should be involved in the use of these medications as long-term use can have some associated side effects. Many women find that evening primrose oil (1000mg taken four times a day) over a 6 month period is helpful, though recent clinical studies have failed to demonstrate effectiveness. There is no strong evidence for dietary modifications, such as reducing caffeine, chocolate and red wine, or taking vitamin A, B6 or E. For women who have severe or prolonged problems with breast pain despite taking simple measures, Dr Lancashire (in conjunction with your GP) can consider hormone suppressing drugs like tamoxifen or danazol. These medications also carry considerable side effects so the decision to recommend them would only come after lengthy discussions about the side-effects and risks. It is important to remember that women respond differently to various treatments and the key is to find out what works best for you. Dr Lancashire will take an in-depth history, perform a thorough examination, and ensure that all relevant investigations are arranged. If no concerning findings are identified, you can be reassured and he will give you advice on the best management strategies.