What Causes Cyclical or Menstrual Breast Pain?

Breast pain is known as mastalgia. Mastalgia or breast pain are divided into menstrual or non-menstrual breast pain.

Menstrual breast pain is also known as cyclical breast pain. Cyclical shooting breast pain mostly occurs during 2 to 3 days prior to menstruation and continuous during the period of menstruation. Breast pain is often considered as annoying pain by menstruating female. The various data suggests 70% of female in Europe and USA have experienced at least once breast pain during life time.^{1, 3} Recurring cyclical breast pain is frequently seen in few females during menstrual period.

The symptoms caused by cyclical or menstrual breast pain disappears in 20% to 30% women, but recurs in 60% females.¹ Cyclical shooting breast pain can be mild to moderate in intensity during the initial phase. Such mild pain is often ignored during initial phase. Later, pain becomes severe and shooting in character. Such pain causes significant issue, since it interferes with daily activities. Some of the cyclic breast pain is also triggered by tight fitting bra and avoiding tight fitting bra may reduce the intensity of cyclic breast pain.⁴ Menstrual or cyclical breast pain can continue for prolonged period and thus you must see your primary care physician if pain continues for 2 or 3 menstrual cycle and does not respond to over the counter pain medications.

Many working young females suffer with shooting breast pain during menstruation and ask question why am I having frequent breast pain during menstruation. Obviously such cyclic breast pain is related to hormonal changes that causes menstruation. Breast pain that is continuous and not related to menstruation is known as non-cyclical breast pain. Non-cyclical breast pain is caused by diseases of breast, muscles, rib and sensory nerve. Diseases of muscle and nerve that lies underneath the breast is often misdiagnosed as breast pain.

It is not normal to feel breast pain. Breast pain can be benign and frequent like cyclical shooting breast pain. But, you must not ignore mild breast pain and you must consult your physician. Early investigation of breast pain can prevent advanced stage of breast cancer. All breast pain is not a sign of breast cancer.

The following risk factors were considered as a cause of cyclical breast pain in menstruating female.²

• Smoking
• Drinks frequent coffee
• Taking oral contraceptive
• Involved in Regular exercise

But scientific data published in July 2018 suggests these factors were not considered as high risk factors when compared to general population suffering with cyclical breast pain.³

The following two causes were linked to shooting cyclical breast pain in Menstruating Women:

Hormonal Changes- Menstruation is caused by changes in blood levels of estrogen and progesterone. During the hormonal changes, up and down changes in breast also occurs. The cyclical or menstrual pain begin 3 days prior to menstruation and stays during partial or entire period of menstruation. Such pain often disappears after menopause.

Breast Cyst ⁴– In few cases of cyclic breast pain, the cause of breast pain was presence of breast cyst and breast fibro-adenoma. The cyst and adenoma responds to hormonal physiological changes that occurs during menstrual period. The vascular changes in cyst and adenoma causes cyclical pain.

Left side shooting breast pain during menstrual cycle is often misdiagnosed as a heart pain. Breast examination is normal, when cyclical breast pain is influenced by menstrual hormonal changes. Few cyclic breast pain is caused by fibrocystic or fibro-adenoma disease of breast. The cardiac pain is ruled out if breast examination indicates presence of breast mass. If breast pain continues after 2 to 3 menstrual cycle, then you should consult primary care physician to rule out breast cancer and cardiac pain.

Following are the symptoms of cyclical shooting breast pain.

• Pain- Intensity of breast pain is mild to moderate. Wearing tight fitting bra increases pain intensity. Pain in the breast is mostly bilateral but in few cases pain is unilateral. Pain radiate to side of breast as well as armpit.
• Breast swelling- Occasional female suffering with shooting cyclic breast pain feels heavy and swollen breast.

• Mammography- Mammography examination in most cases comes as a normal test. Mammography is an X-Ray examination of breast. Occasional small cyst or fibro-adenoma mass is seen.
• 3D Mammography- 3D multi-angle mammography gives 3D images like CT scan. The exposure to X-Ray radiation is lot less than CT scan. The findings are similar to mammography.
• Ultrasound Examination- The ultrasound examination of patient suffering with cyclical breast pain is performed to evaluate breast mass that is seen during mammography. The ultrasound waves are passed through the probe into skin and breast tissue. The rebound waves are analyzed by computer software and images are created. Ultrasound examination of breast in most patients suffering with cyclic breast pain does not show any negative findings.

The recurrent cyclic breast pain is treated with diet control, pain medication and hormone therapy. Most breast pain is relieved with NSAIDs and Tylenol. Opioid is avoided, since opioid is not a medication that can help to relieve monthly recurrent breast pain. If over the counter medications are unable to relieve cyclical breast pain, then you must see your physician.

The pain that is not responding to conservative treatment and pain medications, are

treated with Danazol, bromocriptine, and tamoxifen treatment.³.

The various choices of treatment are discussed below.

Diet-

• Avoid caffeine
• Avoid smoking
• Include in diet nuts, sunflower seeds, spinach and broccoli to increase vitamin E consumption.
• Low fat diet
• Topical

Local anesthetics- Mild to moderate shooting breast pain is treated with application of ointment that contains local anesthetics like lidocaine and prilocaine.

• NSAIDs- Ointment containing NSAIDs like diclofenac is found very effective in treating cyclical breast pain.²
• Pain Medications
• Non-steroidal anti-inflammatory drugs (NSAIDs)- Shooting breast pain is motrin, naproxen and tylenol.
• Tylenol- Tylenol is prescribed along with ointment or hormone to relive severe pain.

Medications-

• Birth control pills- Birth control pill helps to regularize the estrogen and progesterone level in blood.
• Danazol²– Danazol a male hormone that balances the estrogen and progesterone hormonal changes. The treatment is effective in treating cyclical breast pain.
• Bromocriptine³– Bromocriptine blocks prolactin in the hypothalamus and decreases secretion of milk. The bromocriptine treatment decreases breast blood supply that results in less pain.
• Tamoxifen⁵– Tamoxifen is an estrogen blocker and prescribed if cyclical mastalgia is caused by increased blood estrogen concentration.
• Gestrinone- Effective in treating cyclical mastalgia resulting in shooting breast pain.⁶
• In developed country 8% of menstruating female suffer with shooting cyclical breast pain. Mastalgia is one of the symptoms of premenopausal syndrome.⁷

References-