Breast Pain and Hormones

Breast pain is one of the most common reasons women come to see me, and it's rarely a sign of anything serious. In this video, I'll explain the different kinds of breast pain, what usually helps and when it's best to get checked. Up to seven in ten women have breast pain at some point in their lives. In a large UK study of women referred to clinics with pain alone, only around one in 250 had breast cancer. For most women with sore breasts who haven't needed referral, the chance is lower still. The most common kind of breast pain is cyclical pain, which follows your monthly cycle. It usually affects both breasts with a heavy, aching feeling that builds in the week or so before a period and eases once it starts. It's caused by the normal monthly rise and fall of the hormones oestrogen and progesterone. Non-cyclical pain has no link to your periods and is often felt in one spot, and around half of it settles on its own. For example, chest wall pain comes from the muscles and ribs beneath the breast, and it's often sharp and set off by movement. Anti-inflammatory gel; posture work; and physiotherapy can all help with this kind of pain. Pain can also come from outside the breast altogether, such as from the spine; the shoulder; acid reflux; or, occasionally the heart and lungs. Part of what an assessment does, is work out where your pain is really coming from. For many women, simply knowing that the pain comes from normal breast tissue is a large part of the relief. A properly fitted supportive bra can often help, with a softer bra at night. Taking paracetamol, or rubbing anti-inflammatory gel into the sore area may also ease it, and it's sensible to give these measures around three months. Evening primrose oil is often recommended, but when the trials are pooled together, it reduced pain no more than a dummy treatment would. If you'd like to try it anyway, three months is long enough to know whether it's helping. It shouldn't be taken in pregnancy or if you have epilepsy, so please check first. The pill and HRT can both cause breast tenderness, especially in the first few weeks. For HRT, this tenderness usually settles within three to four months of starting. If it doesn't, changing the type, dose, or way you take it often helps more than stopping. It's also worth noting, the years leading up to the menopause can also bring cyclical pain back. Some other medicines can cause breast pain as a side effect; so a medication review with your GP may help. For the small number of women with severe pain that hasn't settled, there are stronger hormone-based treatments, but these are specialist decisions. Women with polycystic ovary syndrome, or PCOS, often ask whether it affects their breasts. There's no good evidence that PCOS causes breast pain, and it doesn't need any extra breast screening. PCOS often causes irregular or absent periods, and that matters for the womb rather than the breasts. Without regular periods, the womb lining can build up, which raises the risk of cancer. If your periods have stopped, ask your GP about treatment to protect the lining. Endometriosis is driven by oestrogen, so it's natural to wonder whether it raises breast cancer risk. On current evidence it doesn't, and a large genetic study, which avoids many of the biases in earlier research, found no link between the two. Breast pain alone is rarely serious, but some signs mean it should be checked promptly. Please get seen if pain comes with a lump, a skin change or a nipple change, including discharge. Constant pain in one spot lasting several weeks, or new pain after the menopause, also needs checking. A swollen; red; hot breast needs seeing the same day. If you're referred, we'll usually start with an examination, and most women are reassured and go home the same day. It also helps to bring a note of when your pain comes and what you've already tried. If your pain is worrying you - please get in touch with me, or my team.