Breast tenderness, painful breasts or mastodynia is characterized by a feeling of swelling and tightness in the breast area, which in most cases is due to hormonal changes during the female menstrual cycle and occurs in the run-up to menstruation. Breast tenderness and associated discomfort disappear with the onset of menopause.
What is breast tenderness?
Breast tenderness or mastodynia is a cycle-dependent sensation of swelling and tension in the breast that usually occurs before menstruation. Breast tenderness or mastodynia is a cycle-dependent sensation of swelling and tension in the breast, usually occurring before menstruation, often associated with premenstrual syndrome (PMS). Cyclic breast tenderness is to be distinguished from so-called mastalgia, a cycle-independent, rather stabbing and unilaterally as well as continuously occurring pain in the breast area, which can also affect men, although the two terms are often used synonymously. The more frequently encountered cycle-dependent breast tenderness is classified neither as a disease in the strict sense nor as a risk factor for breast carcinoma (breast tumor), but as a functional disorder that is not due to an organic impairment. In contrast, unlike breast tenderness, cycle-independent breast pain can also be caused by organic disorders such as diseases of the heart or spinal changes, among others.
Causes
Cycle-dependent breast tenderness is usually due to hormonal causes, although the underlying mechanisms are not well understood. During the menstrual cycle, pregnancy, and lactation, the female mammary gland is subject to hormonal fluctuations that cause the breasts to swell during the second half of the cycle. Due to an imbalanced estrogen and/or prolactin balance in the second half of the cycle, water retention (edema) occurs in the breasts, which can cause a feeling of tightness or breast tenderness on average one week before menstruation. Accordingly, cyclic breast tenderness is often associated with premenstrual syndrome (PMS). In addition, cyclic breast tenderness may be caused or further exacerbated by fibrocystic mastopathy (benign change in breast tissue). In some cases, cyclic breast tenderness will also be due to impaired oocyte maturation in the ovaries (corpus luteum insufficiency).
Diseases with this symptom
- Mastitis puerperalis
- Mastitis
- Mastopathy
- Premenstrual syndrome
- Breast cysts
- Breast cancer
- Pathological mammary gland secretion
- Benign breast tumors
- Lipoma
Diagnosis and course
Breast tenderness is diagnosed based on the specific breast discomfort and its location, although differential diagnosis to distinguish it from breast tenderness that is not related to the menstrual cycle may be useful if the affected woman keeps a pain diary in which she records the time, location, and severity of the pain. To determine the underlying causes of breast tenderness, the concentration of the various hormones involved in the female cycle (estrogen, prolactin, progestins) can be determined in a blood test. In addition, imaging techniques (mammography, breast ultrasonography) can be used to determine the cause of breast tenderness and to differentiate it from mastalgia, which is often due to organic causes such as heart disease, spinal changes, breast carcinoma, mastitis (inflammation of the breast), or the use of certain medications (including diuretics, chlorpromazine). Cyclic breast tenderness is usually uncomfortable, but does not lead to any other health consequences. In most cases, cyclic breast tenderness (mastodynia) disappears with the onset of menopause.
Complications
In the female sex, the cycle plays a major role. Before menstruation, there is increased water retention – edema – in the breasts. The edema triggers a stronger feeling of tension, which is unpleasant for many women. At the same time, the legs, feet, hands and eyelids may also swell. The swelling leads to an increase in weight, so that many women feel uncomfortable before menstruation.Sometimes mood swings, nervousness and listlessness can occur during this phase. In the case of a so-called premenstrual syndrome, the psychological complaints can severely interfere with everyday life. Cyclic breast tenderness is often unpleasant, but usually harmless. Complications or health consequences are not to be expected. In most cases, the discomfort disappears at the beginning of the menopause. Breast tenderness often occurs during pregnancy. If the pain is more severe, women feel restricted in their freedom of movement. Mothers can experience problems with breast tenderness during breastfeeding. Especially in the case of milk engorgement, there may be not only feelings of tightness, but also redness, inflammation, muscle and limb pain, and fever. Breast tenderness in women of childbearing age may also be related to a condition called fibrocystic mastopathy. Individual forms of fibrocystic mastopathy may slightly increase the risk of breast cancer.
When should you see a doctor?
Breast tenderness (mastodynia) is mostly harmless and due to innocuous causes. For example, breast tenderness often occurs as part of the female cycle due to hormonal fluctuations and the associated tissue changes, and disappears again with the onset of menstruation. If this is not the case, a doctor (gynecologist) should be consulted. Men are also subject to hormonal fluctuations, which can lead to breast tenderness or pain. Feelings of tightness or pain in the breast that occur for the first time and are not cycle-related should always be clarified by a doctor. A gynecologist or urologist or andrologist (for men) should be consulted in particular if additional complaints are observed. These include, above all, hardening or lumps that are palpable in the breast or armpit, as well as changes that do not occur in both breasts at the same time or lead to a different size of both breasts. A doctor should also be consulted if there is redness of the skin on the breast, changes in one or both nipples, or a leakage of fluid. If the breast tenderness is not due to a gynecological or urological cause, the affected person is referred to another specialist (for example, to a cardiologist in the case of a suspected cardiovascular disease) depending on the suspected disease.
Treatment and therapy
The therapy of cycle-dependent breast tenderness depends strongly on the specific symptoms present and the cause of the condition. For example, in some cases, simple techniques such as wearing an adequately fitting brassiere or eating a healthy and balanced diet provide sufficient relief, with dietary changes including abstaining from caffeine, teein as well as nicotine, alcohol and excessive consumption of sweets (especially chocolate). Increasing physical activity is also helpful in some cases. If such measures are not sufficient, hormonally active preparations (testosterone-containing agents, antiestrogens or prolactin inhibitors) can be used to minimize the disturbed balance. For example, if there is a deficiency of progestins, especially progesterone, progesterone-containing gels are used for application to the breast. In some cases, anti-inflammatory painkillers are also used to relieve pain. If fibrocystic mastopathy is present, which may be associated with cyst formation, larger cysts can be punctured to relieve symptoms and thus minimize pressure within the breast (breast tenderness). In the presence of cycle-independent breast pain (mastalgia), therapeutic measures are usually directed at treating the underlying primary disease.
Outlook and prognosis
In most cases, mastodynia does not occur over a long period of time and disappears relatively quickly. Women in particular are affected by mastodynia during menstruation. It causes tension and swelling of the breasts, which feel relatively uncomfortable. If the swellings do not subside on their own, they must be examined by a doctor. In some cases, patients also suffer from mood swings and a lack of drive. Mild irritability may also occur. In many cases, mastodynia is also a sign of pregnancy. However, a definite answer can only be given by a test. In most cases, the tightening disappears by itself and is not treated.Other brassieres can also be used to counteract the symptom. If the pain is severe, painkillers can be used. However, this should not become a permanent solution, as painkillers in high doses are very stressful for the body. Any cysts that may be present are surgically removed. In most cases, there is a positive course of the disease and the symptom can be relieved.
Prevention
Since the exact underlying mechanisms for cyclic breast tenderness are not clearly understood, the symptoms can only be prevented to a limited extent. However, physical activity, a change in diet while avoiding nicotine, caffeine, chocolate, and animal fats, and a healthy body weight can reduce the extent of breast tenderness symptoms.
What you can do yourself
What women can do themselves about breast tenderness depends on the causes and severity of mastodynia. Often, even small changes such as abstaining from alcohol and cigarettes, as well as moderate exercise and wearing a well-fitting brassiere, will bring relief. If breast tenderness occurs during menstruation, natural remedies such as lady’s mantle tea or fenugreek can help. If the breasts are not only tense during menstruation, but also occasionally painful, over-the-counter painkillers from the pharmacy can help. Painful or tense breasts during breastfeeding often require an adjustment in breastfeeding technique. Breast tenderness during pregnancy and breastfeeding should therefore be discussed with the midwife. Tensioning breasts are also a common side effect during menopause. Women who do not want to take artificial hormones then can try a therapy with herbal phytoestrogens. An estrogen surplus can also cause an unpleasant swelling of the mammary glands with a feeling of tension in men. Men are often embarrassed by this phenomenon. However, since taut breasts can also hide serious diseases, those affected should not be afraid to have the causes clarified quickly by a doctor.
