Download MRS-Q13

13. Are your breasts much more tender or lumpy before your period?
Most breast pain, swelling, sensitivity is related to hormonal imbalance.
Additional medical history questions may include:
How long have you had the symptoms?
Are one or both of your breasts affected?
Do you have any nipple discharge?
Do you perform breast self-examination?
Have you noticed any lumps or anything unusual when you examine your breasts?
When was your last mammogram?
What other symptoms do you have? Do you have fever?
What medicines do you take?
Breast pain is often an indication of excess estrogen, which may follow the patient’s menstrual
cycle. Recommend maintaining a calendar for a couple of weeks and see if she can find a
pattern. Gentle phytotherapy can help restore balance between estrogen and progesterone levels,
and taking a high-quality multivitamin/mineral with an omega-3 supplement can help maintain
balance. Some degree of breast tenderness is normal. The discomfort may be caused by
hormonal changes due to:
Menstruation
Pregnancy - breast tenderness tends to be more common during the first trimester and in women
who are pregnant at a young age
Puberty - in both girls and boys
Breast-feeding
Approach of menopause - once menstrual periods have stopped completely, breast tenderness
often goes away unless patient is taking hormone replacement therapy
Soon after childbirth, your breasts may become swollen with milk. This can be very painful and
is usually accompanied by swelling. If you also have an area of redness, call your health care
provider.
Other common causes of breast pain include:
Alcoholism with liver damage
Fibrocystic breast changes
Injury
Mastitis
Premenstrual syndrome (PMS)
Fibrocystic breast tissue is common. Such tissue contains breast lumps and bumps that tend to be
more tender just before a woman’s menstrual period.
Certain medications may also cause breast pain, including digitalis preparations, aldomet,
aldactone. certain diuretics, anadrol, and chlorpromazine.
Tests that may be done include:
Breast biopsy
Culture of nipple discharge to test for infection
Cytology of nipple discharge
Fine needle aspiration - to remove fluid that may have collected in a cyst
Mammography
Treatment may include the following:
Pain relievers
Diet changes
Medication changes
Schedule a follow-up visit in case the symptoms have not gone away in a given period of time.
Referral to a specialist if the symptoms do not go away or patient has a complicated condition.
Sources:
Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am. 2002; 29(1): 1-20.
Dickerson LM. Premenstrual syndrome. Am Fam Physician. 2003; 67(8): 1743-1752.
Millet AV. Clinical management of breast pain: a review. Obstet Gynecol Surv. 2002; 57(7):
451-461.