Premenstrual breast swelling and tenderness, or cyclical mastalgia, is a common concern among women. The symptom is part of a group of symptoms called premenstrual syndrome, or PMS. Premenstrual breast swelling and tenderness can also be a sign of fibrocystic breast disease. Fibrocystic breast disease is a term used to describe painful, lumpy breasts prior to the menstrual period.
Women with this condition often notice large, benign (noncancerous) lumps in their breasts prior to their monthly periods. These lumps may move when pushed on, and typically shrink once your period has ended.
PMS-related breast soreness can range in severity. Symptoms often peak just before menstruation begins, then fade during or immediately following a menstrual period. Most of the time, the symptoms are more of an annoyance than a serious medical concern. Nonetheless, whenever you are worried about changes in your breasts, consult your doctor. Sore breasts can be a symptom of menopause and a variety of health conditions.
Fluctuating hormone levels account for most episodes of premenstrual breast swelling and tenderness. Your hormones rise and fall during a normal menstrual cycle. The exact timing of the hormonal changes varies for each woman. Estrogen causes the breast ducts to enlarge. Progesterone production causes the milk glands to swell. Both of these events can cause your breasts to feel sore.
Estrogen and progesterone both increase during the second half of the cycle — days 14 to 28 in a “typical” 28-day cycle. Estrogen peaks in the middle of the cycle, while progesterone levels rise during the week before menstruation.
Medications that contain estrogen can also cause breast changes such as tenderness and swelling.
Tenderness and heaviness in both breasts are the main symptoms of premenstrual pain and swelling. A dull aching in the breasts can also be a problem for some women. Your breast tissue could feel dense or coarse to the touch. Symptoms tend to appear the week before your period and disappear almost immediately when menstrual bleeding begins. Most women do not experience severe pain.
In some cases, breast tenderness affects the everyday routines of some women of childbearing age, and is not necessarily connected to the menstrual cycle.
Due to the natural change in hormone levels that occur as a woman ages, premenstrual breast swelling and tenderness usually improves as menopause approaches. The symptoms of PMS can closely resemble those of early pregnancy; learn how to distinguish between the two.
When to call your doctor
Sudden or worrisome breast changes should be discussed with your doctor. While most premenstrual breast pain and swelling is harmless, these symptoms could be warning signs of infection or other medical conditions. Contact your health provider if you notice:
- new or changing breast lumps
- discharge from the nipple, especially if discharge is brown or bloody
- breast pain that interferes with your ability to sleep or perform daily tasks
- unilateral lumps, or lumps that occur only in one breast
Your doctor will perform a physical examination, including a breast exam, and will ask for more information about your symptoms. Your doctor may ask the following questions:
- Have you noticed any discharge from the nipple?
- What other symptoms (if any) are you experiencing?
- Does breast pain and tenderness occur with each menstrual period?
During a breast exam, your doctor will feel for any lumps, and will take notes about the physical qualities of the lumps. If asked, your doctor can also show you how to properly perform a breast self-exam.
If your doctor detects any abnormal changes, they may perform a mammogram (or an ultrasound if you are under age 35). A mammogram uses X-ray imaging to view the inside of the breast. During this test, the breast is placed between an X-ray plate and a plastic plate and compressed, or flattened, to create a clear image. This test may cause temporary discomfort or a pinching sensation. In some cases, a biopsy (tissue sample from the breast lump) may be necessary if lumps appear to be malignant (cancerous).
Premenstrual breast pain can be treated effectively with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
These medications can also relieve cramping associated with PMS.
Women with moderate to severe breast swelling and discomfort should consult their doctor about the best course of treatment. Diuretics can reduce swelling, tenderness, and water retention. However, diuretic medications increase your urine output and can also increase your risk of dehydration. Use such prescriptions carefully under your doctor’s direction.
Hormonal birth control, including oral contraceptive pills, could also calm your premenstrual breast symptoms. Ask your healthcare provider about these options if you experience severe breast pain and are not interested in becoming pregnant in the near future.
If your pain is severe, your doctor may recommend the drug Danazol, which is used to treat endometriosis and symptoms of fibrotic breast disease. This drug can have serious side effects so it should only be used if other treatments don’t work.
Lifestyle changes can also help manage premenstrual breast swelling and tenderness. Wear a supportive sports bra when symptoms are at their worst. You may choose to wear the bra at night as well, to provide extra support while you sleep.
Diet can play a role in breast pain. Caffeine, alcohol, and foods that are high in fat and salt can increase discomfort. Reducing or eliminating these substances from your diet in the week or two before your period may help manage or prevent symptoms.
Certain vitamins and minerals may also help relieve breast pain and related PMS symptoms. The U.S. Department of Health and Human Services Office on Women’s Health recommends consuming 400 international units (IU) of vitamin E and 400 milligrams of magnesium daily to help ease PMS symptoms. Since supplements are not monitored by the FDA, choose from a reputable manufacturer.
Choose a variety of foods rich in these nutrients, such as:
- corn, olive, safflower, and canola oils
- oat bran
- brown rice
Your doctor may also recommend vitamin supplements.
Self-examinations can also help monitor any changes in breast tissue. According to the American Cancer Society (ACS), women in their 20s and 30s should perform breast self-exams once per month, typically after their monthly period, when swelling and tenderness are minimal. Mammograms are advised after age 45 and may be considered earlier. Your doctor may recommend mammograms every two years or more if there is low risk.
Exercise can also improve breast soreness, cramps, and fatigue associated with PMS.
Premenstrual breast tenderness and swelling is often effectively managed with home care and medication when necessary. Discuss your condition with your healthcare provider if lifestyle changes and medications do not help you feel better.