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Breast pain - cyclical - Management
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How do I know my patient has cyclical breast pain?

  • Clinical features that indicate a diagnosis of cyclical breast pain include:
    • Pain that varies in intensity from one menstrual cycle to another.
    • Pain relating to the same time in the cycle, usually starting 1–3 days before the onset of menses and improving after menses.
    • Tender breasts without a discrete lump but with generalized swelling and lumpiness.
    • Pain localized to the upper outer quadrant of the breast and extending to the axilla.
  • For women with moderate-to-severe pain, consider the use of a breast pain record chart to aid diagnosis.
    • Include a daily pain score recorded on a visual analogue scale.
    • Use the chart for at least 2 months to assess the severity and timing of breast pain.
    • Analyse the chart for features indicative of cyclical breast pain.
  • Exclude:
    • Pregnancy.
    • Malignancy (refer urgently) suggested by:
      • Women 30 years of age and older with a discrete lump that persists after the next menstrual period, or presents after the menopause.
      • Women younger than 30 years of age with a lump that enlarges, or has other features associated with cancer (fixed and hard), or in whom there are other reasons for concern (such as family history).
      • Women who have previously had histologically-confirmed breast cancer, who present with a further lump or suspicious symptoms.
      • Unilateral eczematous skin, or nipple changes, or nipple distortion of recent onset.
      • Spontaneous unilateral bloody nipple discharge.
    • Infection, suggested by:
      • Localized breast swelling, redness, warmth, and pain.
      • Associated systemic symptoms such as fever, vomiting, and discharge from a lump or the nipple.

Basis for recommendation

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