Background: A descriptive study was conducted to examine prevalence of premenstrual breast symptoms, impact of cyclical mastalgia on various activities, and associated patterns of health care utilization among breast clinic outpatients. Study Design: Patients (n = 231, age < 55 years) completed a questionnaire about lifetime and current pre-menstrual breast discomfort (cyclical mastalgia). Results: Seventy-nine percent reported having regularly experienced cyclical breast symptoms; 48% have asked a health care provider about their mastalgia. Young women (≤ 35 years) were more than three times as likely to have had a mammogram (75%) if they regularly experienced cyclical mastalgia than if they did not (24%; p < 0.05). Current moderate to severe mastalgia lasting 5 days or more monthly was reported by 30% of women. This 'clinical' level of mastalgia interferes with usual sexual activity for 33%, with physical activity for 29%, with social activity for 15%, and with work for 15% of these women. Conclusions: Reported prevalences of mastalgia obtained in this sample are higher than those reported in British studies; possible reasons for these differences are discussed. Cyclical mastalgia is a common problem sometimes severe enough to interfere with normal activity levels, and it is related to excessive use of mammography among young women. Although largely ignored both scientifically and clinically in the United States, this condition merits further biopsychosocial investigation.