Alternative Names: Premenstrual tenderness and swelling of the breasts

Considerations:

Symptoms of premenstrual breast tenderness may range from mild to severe. Symptoms typically peak just before each menstrual period and improve immediately after or during the menstrual period. Breast tissue may have dense, rough, "cobblestone" feel to the fingers -- usually more marked in the outer areas. There may also be an intermittent or persistent sense of breast fullness with dull, heavy pain, and tenderness.

During the menstrual cycle, estrogen production increases and peaks just prior to midcycle. This causes enlargement of the breast ducts. Premenstrually, progesterone peaks near the 21st day (in a 28-day cycle) and causes growth of the breast lobules.

Premenstrual swelling and tenderness of the breasts is commonly associated with premenstrual syndrome (PMS) and fibrocystic breast disease (benign breast changes). The cause of fibrocystic breast disease is not completely understood, but is believed to be associated with ovarian hormones since the condition usually subsides with menopause.

Premenstrual breast tenderness and swelling probably occur to some degree in nearly all women. Symptoms severe enough to cause concern or limit function may occur in as many as 60% to 70% of women during their childbearing years. The incidence may be lower in women taking oral contraceptives (birth control pills). Risk factors may include family history and diet (excessive dietary fat or caffeine intake).

Common Causes:

• Menstrual cycle
• Estrogen medications (taken after menopause)
• Adolescent pregnancy
• First-trimester pregnancy

Home Care:

Self-care may include restricting dietary fat to approximately 25% of total daily calorie intake and eliminating caffeine. Breast self-examination should be performed monthly.

A well-fitting bra should be worn to provide good breast support.

The effectiveness of vitamin E, vitamin B6, and herbal preparations such as evening primrose oil are somewhat controversial and should be discussed with your health care provider.

Oral contraceptives may be prescribed to decrease symptoms.

Depo-Provera, a long-acting injection of medroxyprogesterone acetate used as a contraceptive, is also available for those who experience premenstrual breast swelling and tenderness. Depo-Provera relieves symptoms by eliminating menstrual periods.

Danazol, a synthetic androgen (male hormone), may be used in severe cases when the potential benefit is thought to outweigh the potential adverse effects.

Call your health care provider if:

• You have unilateral (one-sided), new, unusual, or changing lumps in breast tissue.
• You do not know how to properly perform a breast self-examination.
• You are a woman, age 40 or older, and have never had a screening mammogram.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed. Medical history questions documenting premenstrual breast tenderness in detail may include:

• Does the tenderness occur with every menstrual period?
• Do you know how to do breast self-examination?
• Have you noticed any breast lumps?
• What other symptoms are also present?

Your health care provider will check for breast lumps, and note the qualities of the lump (firm or soft, smooth or bumpy, and so on).

Diagnostic tests:

A mammogram is usually performed if the woman is over age 40. If a lump is found that is not clearly benign, a breast biopsy may be necessary.

Prevention: