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PMS Breast Tenderness: Understanding Cyclical Mastalgia
by Dr. Daniel J. Heller
The medical term for what most women call "breast pain" is mastodynia or mastalgia. It is often felt as breast soreness, tenderness, heaviness, throbbing, and/or aching, although some women feel sharp stabbing or shooting pains. When it occurs premenstrually and is resolved by the onset of the period, it is called PMS breast tenderness, "cyclical mastalgia," or "cyclical mastodynia." And, if you're reading this article, you may already be familiar with the feeling of tender, swollen, painful breasts for days or even weeks before you get your period. Your breasts may become too painful to touch, whether by a partner, a child, or even yourself. Your bra size may increase; for some women, it becomes painful to wear a bra at all. One of the most difficult aspects of recurrent breast pain is that—as with nearly all pain syndromes—the cause is incompletely understood, so treatment options are too often inadequate, involving uncertain outcomes or intolerable side effects.
The most important identifying characteristic of PMS breast tenderness is that it occurs regularly, and cyclically, in the luteal phase of the menstrual cycle, during the two weeks before the period. Sometimes, breast pain is a woman's only premenstrual symptom, but more commonly breast swelling and tenderness are part of the spectrum of PMS (Premenstrual Syndrome), accompanied by other emotional, physical, and cognitive symptoms. The swelling is usually not confined to the breasts, although that can be the most painful area. Your ankles, hands, feet, and abdomen can also feel swollen—indeed, whole-body bloating is one of the most common symptoms of premenstrual syndrome. Premenstrual tenderness usually occurs in both breasts, although for some women the pain is one-sided, or one side can be much worse than the other.
Breast pain of all kinds (not just the premenstrual type) affects up to 70% of women during their lifetime, and is most common between the ages of 30 and 50. While mild breast pain one to four days before your period is considered normal, 11%–30% of women experience moderate to severe mastalgia that can last upwards of five days per month.
Every woman should know that breast pain is rarely a sign of cancer, although breast cancer diagnoses can present with a symptom of breast pain. More often, breast cancer presents with symptoms of a breast lump; a change in the size, feel, or shape of the breast; or fluid from the nipple. Pain and swelling caused by cancer does not rise and fall with cyclical hormonal changes, however. Of course, if you are concerned it is best to consult your healthcare practitioner. In many cases, the most useful thing your practitioner will be able to do for you, in regards to breast pain, is to offer reassurance that your symptoms are benign.
Our PMS Symptoms Library offers informative articles to help you learn and understand how your body and your hormonal cycles work to create optimal physical and emotional wellness. If there is a subject you'd like to see covered, or you have a question about women's health, please let us know. We care, because we know what you're going through!
One of the most common causes of breast pain is "fibrocystic breast disease." This is not a true disease, but rather a condition that that results from normal changes in breast tissue. This condition does wax and wane through the menstrual cycle, but unlike simple cyclical mastalgia, is accompanied by changes you can feel ("lumps and bumps") in your breasts. A couple of myths about FBD persist. First, caffeine does not appear to cause, and caffeine avoidance does not appear to cure, fibrocystic breast changes. Also, women with fibrocystic breast changes are not more likely to develop breast cancer. In fact, one study suggests that women with fibroadenomatous changes may be less likely to develop breast cancer. However, enough confusion and controversy exist about changes in breast tissue and the meaning of mammography and biopsy results, that you are always better off discussing such matters with your healthcare professional.
There are natural measures you can take that can help you overcome breast pain. Most of them would be advantageous to you for overall health regardless of your condition.
First, confirm that you have a well-fitted bra. You may find that a different bra is required premenstrually in order to relieve the breast tenderness. Sports bras can provide better support during activity, and some women find wearing a softer bra during sleep helpful.
Second, consider your stress level. There is evidence that stress worsens cyclical breast pain, and that relaxation therapy can improve it. Even though caffeine has not been proven to worsen breast pain and cyclical mastalgia, some women find that they are sensitive to it. If you suspect sensitivity or that your caffeine intake increases your stress level, a trial of weaning off or avoiding caffeine may be worthwhile. And, of course, there are many benefits to finding a way to handle the stress in your life, and many ways to handle life's stress.
Finally, ground flaxseed has been recommended for breast pain. Flax is an excellent source of fiber and essential fatty acids, and can easily be mixed in liquids or food—but you should never cook it, as this destroys the benefits of the oils in the seed. We recommend buying the preground seed and keeping it sealed in the fridge or freezer—even the heat generated from grinding it yourself is worth avoiding, and most reputable sources of flaxseed grind it at low temperature. Follow the instructions on the label for dosage. Adding fiber and essential omega-3 fats to your diet also helps improve your digestion, immunity, and heart health.