Breast pain before periods: what is normal and when to get it checked

Sore, swollen or tender breasts in the days before a period are very common and, for most people, are a normal response to the hormone changes of the menstrual cycle. Breast Cancer Now calls this cyclical breast pain and says many women feel discomfort and lumpiness in both breasts a week or so before a period. The NHS lists breast tenderness among the most common symptoms of premenstrual syndrome.

What matters most is the pattern. Pain that builds in the days before a period and settles once bleeding starts is the classic picture. Pain that is constant, confined to one spot, linked to a new lump, or accompanied by changes to the skin or nipple deserves a different kind of attention, and those signs are set out below.

The NHS says pain linked to periods tends to feel dull, heavy or aching, to affect both breasts and sometimes to spread to the armpit. Breast Cancer Now gives a wider range of descriptions: heaviness, tenderness, a burning, prickling or stabbing pain, or a feeling of tightness. It also notes that the pain can vary from mild to severe, that the breasts may be sore to touch, and that the pain can spread to the armpit, down the arm and to the shoulder blade.

Most people find the pain eases or disappears once the period starts, although Breast Cancer Now points out that in some women it may settle by itself and then come back later. It usually stops after the menopause, though people taking HRT can still have breast pain. Breast pain can also be associated with starting or changing a hormonal contraceptive.

Doctors separate breast pain into cyclical pain, which follows the menstrual cycle, and non-cyclical pain, which does not. Breast Cancer Now says non-cyclical pain is often hard to attribute to a single cause, may be continuous or come and go, and can affect one or both breasts, the whole breast or just one area. Things it may be related to are listed in the table.

A third possibility is chest wall pain, which feels as though it comes from the breast but actually arises in the muscles or structures of the chest. The NHS makes a similar point, noting that injuries or sprains to the neck, shoulder or back can be felt as breast pain.

The NHS suggests paracetamol or ibuprofen, or rubbing painkilling gel on the breasts, and wearing a properly fitted bra during the day and a soft bra to sleep in. Breast Cancer Now agrees that a supportive, well-fitting bra during the day, during physical activity and at night can help.

Breast Cancer Now also describes a few other options with a more cautious evidence base. A GP may suggest dietary changes such as a low-fat diet, more fibre or less caffeine and alcohol, but it says there is limited evidence that these work. Some women have found relaxation therapy useful. If pain began when a contraceptive pill was started, changing to a different pill may help, and if it started on HRT and does not settle after a short time, the GP should be told. Evening primrose or starflower oil may be suggested, although research has shown that extra GLA does not always help.

Because pain is the symptom, painkillers are reasonable, but medicines such as ibuprofen are not suitable for everyone. Breast Cancer Now advises being assessed by a doctor first if you have asthma, stomach ulcers or kidney problems.

Breast pain by itself is not usually a symptom of breast cancer, according to the NHS page on cancer symptoms. But the NHS lists several signs that should be seen quickly, and it says these can be signs of something more serious. It advises asking for an urgent GP appointment or contacting NHS 111 if you have breast pain with any of the following.

• A very high temperature, or feeling hot, cold or shivery.

• Any part of the breast that is red, hot or swollen.

• A hard lump in the breast that does not move around.

• Nipple discharge, which may be streaked with blood.

• One or both breasts changing shape.

• Dimpled skin, like orange peel.

• A rash on or around the nipple, or a nipple that has sunk into the breast.

The NHS advises seeing a GP about breast pain if it is not improving or painkillers are not helping, if there is a history of breast cancer in the family, or if there are signs of pregnancy, in which case a pregnancy test first may be sensible. Its page on breast cancer symptoms also lists pain in the breast or armpit together with a family history of breast or ovarian cancer as a reason to see a GP.

Breast Cancer Now says the GP will examine your breasts and ask what type of pain you have and how often it occurs. You may be asked to complete a simple pain chart to show whether it follows your periods. A GP may ask you to lean forward during the examination to help judge whether pain is inside the breast or in the chest wall, and may refer you to a breast clinic for a more detailed assessment. Many people are reassured that their pain is a normal part of the monthly cycle.