Women's health chat with Dr Sarah Brewer

A: Breast pain that is worse before a period is thought to result from hormonal imbalances that occur as part of the menstrual cycle. Symptoms usually improve when menstruation starts, but may be continuous. Discomfort is often described as dull and aching. Often, the pain is greatest in the upper-outer quarter of the breast, from the nipple back toward the armpit. Sometimes the pain may radiate into the armpit and the upper arm. Both breasts are usually affected, but the problem may be worse on one side. Breast tissue may also be swollen and lumpy - a combination often called `chronic mastitis?, although there is no inflammation or infection involved. A better term is chronic (meaning long-term) mastalgia (meaning breast pain).

Lumpiness and pain is usually linked with an increase in the number and size of gland-cells in the breast (adenosis). Because these cells are hormone sensitive, the onset of menopause usually relieves the symptoms. Cyclical mastalgia (breast pain that comes on at a particular point in the menstrual cycle?usually in the run up to the period) is usually helped by simple painkillers such as paracetamol or ibuprofen, reducing the intake of dietary fat, and by wearing a good support bra.

Some cases of cyclical breast pain are linked with lack of essential fatty acids, which act as building blocks for sex hormones. Taking evening primrose supplements at a dose of 3g per day helps 70% of sufferers after 3-4 months of use. Other treatments include drugs to correct hormone imbalances, such danazol, bromocriptine and the combined oral contraceptive pill, but some of these treatments are only used as last resort if breast pain is seriously interfering with your life.
Dr Sarah Brewer

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