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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.