Premenstrual breast changes
Premenstrual tenderness and swelling of the breasts; Breast tenderness - premenstrual; Breast swelling - premenstrual
Premenstrual swelling and tenderness of both breasts often occurs during the second half of the menstrual cycle.
The female breast is either of two mammary glands (organs of milk secretion) on the chest.
Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.
Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.
Breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour, texture, or color of the breast and nipple. Next, a manual inspection while standing or lying down should be done to note any unusual lumps or thicknesses and check for discharge.
Considerations
Symptoms of premenstrual breast tenderness may range from mild to severe. Symptoms usually:
- Are most severe just before each menstrual period
- Improve during or right after the menstrual period
Breast tissue may have a dense, bumpy, "cobblestone" feel to the fingers. This feel is usually more in the outer areas, particularly near the armpit. There may also be an off and on or ongoing sense of breast fullness with dull, heavy pain, and tenderness.
If you're a woman, your doctor or gynecologist may have recommended that you examine your breasts every month to check for lumps. You might be wondering, why do I need to do a breast self-exam? Or, you might ask, how do I examine my breasts, and what exactly am I looking for? Well, let's talk about why, and how to examine your breasts. Why examine your breasts? Well, for one thing, it helps you get an idea of how they normally feel. Then if there's ever a problem, you'll be familiar enough with your breasts to spot it. For example, a lump on your breast could be a sign of breast cancer. Finding that lump could allow you to get checked out with a mammogram earlier than you might have done if you didn't do breast self exams. But, this is a two edged sword. Many expert groups no longer recommend routine breast self examination because the consequences of over treatment of benign or normal lumps may outweigh the benefits of early detection. Lumps lead to extra mammograms, which often lead to biopsies, and the biopsies turn out to be benign, or normal, in more than 90% of cases. But, not always. Some expert groups simply recommend breast self awareness. Ultimately, the choice is yours. If you are going to do breast self exam, the best day to do a self exam is about 3 to 5 days after your period ends. Your breasts are naturally less lumpy right after your period, so there's less of a chance that you'll mistake a normal bump for an abnormal growth. If you've already gone through menopause and your periods have stopped, just do your exam on the same day every month. Mark it on your calendar so you won't forget. To do the exam, lie on your back, as it's easier to feel any lumps or changes when you're lying down. First, put your right hand behind your head. Then, using the middle fingers on your left hand, gently but firmly press down, circling your entire breast. Make sure you cover the whole right breast. Squeeze your nipple gently. See if any fluid comes out. Now, sit up, and feel around your armpit. When you're done with the right breast, repeat the whole check on the left side. Next, stand in front of a mirror. With your arms down at your sides, look at both breasts. Check the shape of each breast. Look for any changes in the skin, like dimpling or puckering. Also see if your nipples now turn inward. Now, do the exact same check again with your arms over your head. After you've done a few breast self-exams, you'll become familiar with the look and shape of your breasts. At each exam, you're looking for anything different, like new bumps, changes in the texture of your skin, or discharge from your nipple. If you do notice that something has changed, don't panic, it could mean many different things. But, call your doctor as soon as you can so you can find out what's caused the change, and, if necessary, get it treated.
Causes
Hormone changes during the menstrual cycle may lead to breast swelling. More estrogen is made early in the cycle and it peaks just before mid-cycle. This causes the breast ducts to grow in size. The progesterone level peaks near the 21st day (in a 28-day cycle). This causes growth of the breast lobules (milk glands).
Premenstrual breast swelling is often linked with:
- Premenstrual syndrome (PMS)
- Fibrocystic breast disease (benign breast changes)
Premenstrual breast tenderness and swelling probably occur to some degree in nearly all women. More severe symptoms may occur in many women during their childbearing years. Symptoms may be less in women taking birth control pills.
Risk factors may include:
- Family history
- High-fat diet
- Too much caffeine
Home Care
Self-care tips:
- Eat a lower fat diet.
- Avoid caffeine (coffee, tea, and chocolate).
- Avoid salt 1 to 2 weeks before your period starts.
- Get moderate to vigorous exercise every day.
- Wear a well-fitting bra day and night to provide good breast support.
You should practice breast awareness. Do check your breasts for changes at regular intervals.
The effectiveness of vitamin E, vitamin B6, and herbal preparations such as evening primrose oil are somewhat controversial. This should be discussed with your health care provider.
When to Contact a Medical Professional
Contact your provider if you:
- Have new, unusual, or changing lumps in breast tissue
- Have one-sided (unilateral) lumps in breast tissue
- Do not know how to properly perform breast self-examination
- Are a woman, age 40 years or older, and have never had a screening mammogram
- Have discharge from your nipple, particularly if it is a bloody or brown discharge
- Have symptoms that interfere with your ability to sleep, and diet changes and exercise have not helped
What to Expect at Your Office Visit
Your provider will take your medical history and do a physical examination. The provider will check for breast lumps, and will note the qualities of the lump (firm, soft, smooth, bumpy, and so on).
A mammogram or breast ultrasound may be done. These tests will evaluate any abnormal finding on a breast exam. If a lump is found that is not clearly benign, you may need a breast biopsy.
These medicines from your provider may reduce or eliminate symptoms:
- Injections or shots that contain the hormone progestin (Depoprovera). A single shot works for up to 90 days. These injections are given into the muscles of the upper arm or buttocks. They relieve symptoms by stopping menstrual periods.
- Birth control pills.
- Diuretics (water pills) taken before your menstrual period. These pills may reduce breast swelling and tenderness.
- Danazol may be used in severe cases. Danazol is a manmade androgen (male hormone). If this does not work for you, other medicines may be prescribed.
References
American College of Obstetricians and Gynecologists website. Dysmenorrhea: painful periods.
Expert Panel on Breast Imaging; Jokich PM, Bailey L, et al. ACR appropriateness criteria breast pain. J Am Coll Radiol. 2017;14(5S):S25-S33. PMID: 28473081
Mendiratta V, Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 35.
Sandadi S, Rock DT, Orr JW, Valea FA. Breast diseases: detection, management, and surveillance of breast disease. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 15.
Sasaki J, Gelezke A, Kass RB, Klimberg VS, Copeland EM, Bland KI. Etiology and management of benign breast disease. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 5.
Version Info
Last reviewed on: 4/19/2022
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
