# Mastalgia (Breast pain) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: RCOG Guidelines on Management of Breast Pain 2018 · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Mastalgia - disease-level clinical article (mastalgia-clinical.txt) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text MASTALGIA (BREAST PAIN) Sources: RCOG Guidelines on Management of Breast Pain 2018 · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) Review status: REVIEWED against MSF Essential Drugs 2024 - paracetamol (oral), Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560), Mastalgia - disease-level clinical article (mastalgia-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Cyclic breast pain recurs on both sides, worsens before the period, and eases with menstruation [breast pain] - Noncyclic pain is one-sided, continuous or intermittent, and unrelated to the menstrual cycle [breast pain] - Extramammary pain sits at the outer edges of the breast and often comes on with activity SIGNS - what you find (2) - Pressing on a specific chest-wall spot reproduces the pain in extramammary mastalgia [breast pain] - A very lateral or medial one-sided location in the breast points away from a true breast origin for the pain TESTS (7) - No imaging is needed for cyclic or diffuse noncyclic pain with a normal breast exam and no high-risk factors - Imaging is reserved for noncyclic focal pain or an abnormal finding on clinical examination - MRI is not indicated for evaluating mastalgia by itself - Women 40 and older start with mammography or tomosynthesis, adding ultrasound for BI-RADS 1 to 3 findings - Ultrasound also picks up about 40% of benign palpable masses that mammography alone misses - Women under 30 start with ultrasound because of denser breast tissue and lower cancer risk - Core biopsy is generally favored over fine-needle aspiration for its higher sensitivity and specificity IF NOT THIS - what else fits (7) - Referred pain from a musculoskeletal cause such as costochondritis - Structural causes such as an ill-fitting bra or macromastia - Medication side effects, including contraceptives, SSRIs, and digoxin - Referred cardiovascular pain, for example from ischemic heart disease - Referred gastrointestinal pain, for example from peptic ulcer disease - Referred respiratory pain, for example from pleuritis or pneumonitis - Breast cancer is a differential to exclude, though it rarely presents with pain Source StatPearls "Mastalgia" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g 3 or 4 times daily (max. 4 g daily) - as needed during painful symptomatic days Peds Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Simple analgesic offered first when reassurance and a properly fitted support bra alone do not control cyclical or non-cyclical breast pain. Caution Reassurance and proper fitting support bra benefit up to 80% of cyclical mastalgia. Examine for focal breast mass, skin changes, or nipple discharge. Refer to specialist breast clinic if discrete mass or bloody nipple discharge is present. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Mastalgia - disease-level clinical article (mastalgia-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The physical exam red flags that mean the pain needs evaluation for malignancy rather than symptomatic analgesia are a lump, skin changes, nipple retraction or discharge, and ulceration. 3. IBUPROFEN [2nd line] Adult 400 mg 3 times daily after food Peds 12 years and over: 200-400 mg three times daily after food (Adolescents >=12 years: 200-400 mg 3 times daily after food) Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) Why NSAID stepped up to when paracetamol alone does not control breast pain, targeting the inflammatory component of mastalgia. Caution Topical NSAID gel applied to painful areas has fewer GI side effects than oral NSAIDs. Evaluate relationship to menstrual cycle (cyclical vs non-cyclical). Exclude musculoskeletal chest wall pain (Tietze syndrome). Consult a doctor if symptoms persist or worsen, or if required for more than 10 days. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)