Public Education Pamphlets

The SOGC provides the following public education pamphlets designed for patients, clinics and health-care facilities. This material has been reviewed and endorsed by the SOGC’s subject matter experts.

Breast Pain

What is Mastalgia?

Mastalgia (mas-TAL-juh) is the medical name for breast pain and may affect up to 70% of women in their lifetime. It is normal for women to have 2-3 days of mild breast pain just before their menstrual period. For others the pain can last more than 5 days. It can be so bad it is not comfortable to wear a T-shirt or to be hugged. Sometimes the pain may not be related to the menstrual period at all. Breast pain may be in both breasts, only one breast, or only in one part of a breast. It may go to other areas such as the armpit or the arm. There are 3 main types of breast pain:

Cyclical

This kind of pain is worse closer to the menstrual period. The amount of pain can change from month to month.

Non-cyclical

The pain does not change with the menstrual period. It may be there all the time or it may come and go without a pattern.

Chest Wall Pain

This is not true breast pain but affects the muscles and other tissues beneath the breast.
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How common is mastalgia?

Cyclical breast pain affects up to 40% of women before menopause, most often in their 30’s. In about 8% of these women the pain will be severe and interfere with their normal activities. The pain can go on for many years but most times it will go away after menopause. In 20% of women it disappears on its own. Non-cyclical breast pain is less common. It occurs more often in older women.
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Is breast pain related to cancer?

It is very rare for breast pain to be caused by cancer if there is no lump present. Talk to your doctor if you are worried.
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Should I stop drinking coffee?

Caffeine does not cause breast pain. Although some women find their pain is less when they reduce or cut out caffeine, studies have not been able to prove this. Caffeine is found in coffee, black and green tea, cola drinks, chocolate, cocoa and some over the counter cold/pain medications.
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Do I need to change my diet?

One study has shown that reducing fat in the diet can decrease cyclical breast pain in some women. However, more research is needed before women would be advised to make this change.
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What effect does the birth control pill have on breast pain?

The birth control pill may cause breast pain, increase or decrease it. Some women may get breast pain for the first time when starting on the birth control pill or changing to a different one. The mastalgia may slowly disappear. If not, a lower dose or another brand could be tried.
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How is hormone replacement therapy related to mastalgia?

Starting hormone replacement therapy can sometimes bring on breast pain that often settles down after a while. But it can remain a problem for some women. If you think your pain is linked to the hormone therapy, talk with your doctor. Sometimes changing the dosage or the form may help or you may wish to stop it.
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What causes breast pain?

two women laughingThe cause of breast pain is not known but it may be related to:
  • Hormonal changes
  • Fibrocystic changes in the breast
  • Cysts in the breast
  • Inflammation of the breast bone and ribs
If you already have breast pain, being pregnant does not usually change it.
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Are there any supplements or herbs that might help?

Vitamins E and B6 have not been proven to be helpful in the treatment of mastalgia. Herbs for the treatment of mastalgia have not been well researched. They cannot be recommended at this time. In fact, ginseng may cause breast pain. Evening primrose oil. A few studies have shown a dose of 3000 mg a day to be helpful in treating breast pain. However, the best studies do not support its use. Talk with a pharmacist about any possible side effects or drug interactions. Flaxseed. Two tablespoons of crushed flaxseed (not flaxseed oil) taken daily for 3 months was found to be effective for cyclical breast pain in one study. Talk with a pharmacist about any possible side effects or drug interactions.
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What prescription medications can I take?

Danazol and Tamoxifen can be used to treat mastalgia. You may wish to discuss them with your doctor. Both drugs come with side effects that need to be thought about. However using the lowest dose of the medication can often lessen these side effects.
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Would surgery help?

Surgery, in the form of mastectomy or partial mastectomy has not proven to be a useful treatment for mastalgia.
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What can I do if I have mastalgia?

  • Have a complete breast examination. Knowing that you don’t have cancer often makes it easier to cope with the pain.
  • Keep track of the pain. Keep a daily diary and write down if you have pain and if it is mild, moderate or severe. Record the first day of your menstrual period. It may be helpful to mark down any days you have increased stress.
  • Make sure you are wearing the right type and size of bra. The bra should give good support. If in doubt you can go to a store that can fit you for a bra.
  • Look for ways to reduce stress and relax.
  • Talk with your doctor or pharmacist about pain medication. Ones that may help are ibuprofen (e.g. Advil, Motrin); acetaminophen (e.g. Tylenol); diclofenac gel - a nonsteroidal anti-inflammatory medication (by prescription).
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Choosing a bra that fits well

For your bra to provide support it needs to fit properly. The 10 Step Check
  1. Back is not riding up
  2. Shoulder straps are not digging in
  3. Fits close to breast bone in centre
  4. Breast is not bulging out of cups
  5. There are no bulges at armpits
  6. Fabric is not wrinkling or pulling
  7. Underwire is fl at against body
  8. Finger can be slipped comfortably under band beneath cups
  9. Nipple line is midway between shoulder and elbow
  10. Feels comfortable and stays in place
Tip: Lean forward and let your breasts fall into your bra before fastening. Body Size Guideline
  • First - Measure (in inches) chest above breasts just under arms (body size).
  • Second - Measure gently around high point of bust line and compare with body size.
The difference between the numbers gives you the cup size - see chart below:
No difference
=
AA cup
+ 1 inch
=
A cup
+ 2 inches
=
B cup
+ 3 inches
=
C cup
+ 4 inches
=
D cup