Painful Breasts During Perimenopause, Menopause, and Post-Menopause
As my mother often mentioned regarding my teenage years, I was a “late bloomer!” My period and my breasts came late to the party. All of my friends began developing around the age of 13, while my body decided to torture me and have me wait until I was 16.
I had training bra envy for years while I prayed for a bump, a ripple, or a bud. I skipped the whole training bra and finally convinced my Mom to buy me a padded bra when in reality a couple of Band-Aids would have worked fine.
Then, finally, they came. I was quite excited and frankly, have always felt fondly of them. (Pun intended!)
But over the years, my breasts have become quite the handful!
According to the National Cancer Institute, as your period nears, extra fluid in your breasts can make them feel more tender, lumpy, or swollen than other times of the month. Without a normal cycle to count on, it becomes pretty much impossible for perimenopausal women to know when those breasts are going to start throbbing.
I reached out to the Executive Director of The North American Menopause Society, Dr. JoAnn V. Pinkerton, MD, NCMP, Professor of Obstetrics and Gynecology and Division Director Midlife Health at the University of Virginia Health System, to explain why perimenopausal and post-menopausal women experience painful breasts.
I remember always having painful breasts before my period and during my pregnancies, however, I was hoping that with the onset of menopause that these issues would subside. Dr. Pinkerton confirmed that breast discomfort, pain or breast heaviness is associated with changes in hormones during the menstrual cycle. These changes are more common or more bothersome the week before the menstrual cycle and usually, improves once the menstrual period begins. This is most likely related to fibrocystic breast changes where breast lumps may be small or large cysts filled with fluid.
She further explained cyclic pain may disappear after menopause. Although some women may continue to experience pain as there is still some ovarian stimulation in the first five years of menopause.
Pinkerton said, “Noncyclic pain is often in one breast and may be described as burning, sharp or even stabbing pain, which could be caused by a cyst or a benign breast tumor such as a fibroadenoma.”
Pinkerton said that many women who think they have breast pain actually have pain along the cartilage of the ribs, called costochondritis which may be related to heavy lifting or nerve irritation. Warm soaks, nonsteroidal anti-inflammatory medication and avoiding overuse often helps.
“Breast infection, mastitis, is associated with a reddened breast, often warm to the touch, and needs evaluation and usually antibiotics,” I remember that my daughter experienced this when she was nursing. This is NOT fun!
According to Pinkerton, stress, dietary changes such as too much caffeine or certain medications are associated with breast pain, such as Aldomet, Aldactone, diuretics, and chlorpromazine.
Many of us fear the onset of breast pain can be a precursor to breast cancer. I found Dr. Pinkerton’s response very helpful:
“Generally, breast cancers are NOT described as painful. Thus breast pain is usually NOT a sign of breast cancer. Having said that, any time a woman has NEW breast pain, with or without a lump, it needs to be evaluated.”
The big question is, “How do we know when we need to go to our healthcare professional to get breast tenderness or pain checked?” She provided us with this simple symptoms guide:
Cyclic breast pain which persists past the next period
Breast pain plus a new lump may need imaging or further testing.
Breast pain with a nipple discharge, particularly a blood nipple discharge
Breast pain with a reddened, warm breast
Persistent unexplained, new breast pain
I asked Pinkerton if there are any lifestyle changes that a woman can incorporate to help alleviate the tenderness/pain.
“Although it is difficult to prove that dietary changes cause or relieve breast pain, we recommend them none the less. For women with tender, fibrocystic breasts, particularly tender premenstrual (before the period), we recommend avoiding excess caffeine (coffee, tea, chocolate), limiting alcohol to one drink or less, and avoiding salty food and ‘binging’ on carbohydrates.”
I receive emails from women who are on hormone therapy (HT) and feeling fantastic. Their symptoms of hot flashes, night sweats, insomnia, depression, and dry vagina – gone! However, sometimes they experience breast tenderness. They are afraid to back off of their estrogen, as they do not want those debilitating symptoms to return.
“As women age, they need less estrogen to keep their menopausal symptoms at bay. If women are doing well on hormone therapy and have no contraindications, there is no major length of time that women need to stop their hormones. In general, women under 60 and within 10 years of menopause have the best benefit to risk ratio for taking hormone therapy. After 3-5 years on a stable hormone dose, I will recommend that we work to find the lowest dose that keeps menopausal symptoms at bay. How long to stay on hormone therapy needs to be individualized for women- based on their health risks and the benefits of hot flashes, sleep, quality of life, bone protection and vaginal issues.”
“Good news is that we have so many FDA-approved options for women in much lower doses than available in the past- oral, patch, gel, lotion, spray, ring- if women need or want to continue hormones, we can minimize the risks by lowering doses or changing to transdermal (through the skin).”
I was curious if there were any specific supplements that might help the tenderness such as primrose oil, iodine, Vitamin B or E?
“We normally recommend dietary changes first. Supplements may help breast tenderness, although it is difficult to prove this in studies. We normally recommend evening primrose oil as our first choice, although there is some evidence that iodine supplements may help alleviate menstrual related breast tenderness. Women who have thyroid concerns or take Lithium or Thorazine should avoid iodine supplements. Vitamin B6 and vitamin E have been shown to help premenstrual syndrome and may have some benefit in helping decrease breast tenderness.”
It was so comforting to learn that breast tenderness is manageable and is unlikely to indicate a serious problem.
Take good care of those breast friends!
My Motto: Suffering in silence is OUT! Reaching out is IN!