Premenstrual Breast Pain and Tenderness

• Researched and written by: Vaibhavi Kodnani, UG Dip. (Comm. Design, 4 yrs)
• Medical inputs by: Dr Poonguzhali Liston, MBBS, MS OBG, FMAS, DRM, FRM, CIMP
• Medically reviewed by: Dr Yash Bahuguna, MBBS, MS, DNB, ISGE Certified Practitioner for PCOS

TL;DR

• Breast pain and tenderness is a common physical symptom of premenstrual syndrome (PMS).

• The symptoms generally appear 1–2 weeks before the period and resolve as bleeding begins. 

• During the luteal phase, the hormones estrogen, progesterone, and prolactin cause changes in the breasts in preparation for potential milk production should pregnancy occur. This results in premenstrual breast pain and tenderness.

• Strategies like supportive innerwear or heat and cold therapy can ease symptoms. Lifestyle changes such as routine exercise, hydration, relaxation techniques, and a diet rich in omega-3 fatty acids may help reduce breast discomfort over time. 

• If breast pain persists after period ends accompanied with other symptoms such as lumps, nipple discharge, or swelling, it needs immediate medical care.

What Should You Know About Breast Pain?

Breast pain (mastalgia) is classified into two types: cyclical and non-cyclical. Cyclical breast pain is related to the menstrual cycle, while non-cyclical breast pain has other underlying causes.

Cyclical breast pain is the most common type, affecting about 47% of women. It is also known as premenstrual breast pain as it begins in the luteal phase, about two weeks before periods and intensifies in the premenstrual phase, around a week before the period. The pain and discomfort resolve as menstrual bleeding begins.

What Are the Symptoms of PMS Breast Pain and Tenderness?

Breast pain and tenderness is one of the physical symptoms of premenstrual syndrome (PMS). Not everyone will experience it, but those who do, may notice a dull, aching pain, usually in both their breasts.

Breasts may also feel tender and lumpy, meaning they can be sensitive to touch. They may appear heavier and fuller than usual, along with tightness or pressure. The pain may sometimes radiate to the armpit or upper arm. 

PMS breast symptoms can impact everyday life: 

• The constant ache or heaviness in your breasts may increase irritability.

• Everyday bras, underwire bras, and fitted clothing may be uncomfortable to wear.

• Touching your breasts can be painful.

• Sleeping on your side or stomach may cause discomfort.

• Exercising and other physical activities may be challenging. 

What Causes Premenstrual Breast Swelling and Tenderness?

Breast changes before periods are related to shifts in hormone levels in the luteal and premenstrual phase. The changes happen in preparation for potential milk production should pregnancy occur.

Role of estrogen

Estrogen levels peak around ovulation and remain relatively high in the luteal phase. It causes the breast ducts, aka a network of tubes within the breasts that carry milk, to grow and enlarge. This increases breast tenderness.

Role of progesterone 

Progesterone levels rise in the luteal phase, which causes various changes in the breasts. It leads to enlargement of the milk-producing glands. Additionally, it causes fluid retention and swelling in the breast stroma, which refers to the supportive connective tissues of the breast. Together, these changes make the breasts feel full, heavy, and painful. 

If pregnancy does not happen, the progesterone levels drop, which marks the beginning of the premenstrual phase. It can further worsen breast discomfort. 

Role of prolactin

Prolactin is a hormone responsible for breast development and milk production during pregnancy and breastfeeding. Before menstruation, prolactin levels increase. It secretes fluid in the enlarged breast ducts (tubes), causing swelling (edema). This contributes to breast tenderness, heaviness, and increased sensitivity, making pain more noticeable.

How Can You Tell Your Breast Pain Is Not Related to Your Period?

Breast pain that is not caused by hormonal changes in the menstrual cycle is known as non-cyclical breast pain. Non-cyclical breast pain accounts for about 23% of women. It generally affects women aged 40 years and above, especially those who are nearing perimenopause. 

Common causes include breast lumps or cysts, large breasts, breast infections, previous breast surgery or injury, or breast cancer. 

Here are some signs that indicate your breast pain is not related to your menstrual cycle: 

• Your breast pain does not worsen before periods or resolve once menstrual bleeding begins.

• Your pain is persistent or comes and goes unpredictably.

• You notice constant pain in one breast (though it can occur in both breasts too).

• You feel a specific area of your breast hurts rather than the whole breast.

• You have other symptoms along with it such as burning sensation, redness, fever, lumps, or nipple discharge.
  
  

Remember: Paying attention to the timing, location, and type of breast pain, and associated symptoms will help you identify whether it is related to your menstrual cycle or not. You can maintain the records in a diary and seek medical advice if you notice any unusual changes. 

Berry’s Tips: How to Relieve Breast Pain Before Your Period

You can manage breast pain before periods at home with a combination of exercise, diet, heat and cold therapy, and supportive garments. 

Wear a well-fitted and supportive bra

When breasts are tender before a period, any movement can worsen the pain. Additionally, gravity can pull your breasts downward which can be uncomfortable. Wearing the right size of bra that adequately covers and supports your breasts throughout the day can be beneficial. You can also choose to wear it at night if your breasts feel heavy or when the pain disrupts your sleep.

Here’s a simple guide you can follow to help you choose a bra for pain support. 

Choose the right size of bra

• Timing: Take the measurements during the premenstrual phase for maximum accuracy. Due to fluid retention, breasts increase in size, which means your cup size may go up by ½–1 as well. 

• Band size: Measure your underbust (rib cage) snugly in inches or centimeters.  

• Overbust size: Measure your overbust (fullest part) a little loosely in inches or centimeters.  

• Cup size: Calculate the difference between overbust and underbust. Use an online measurement chart to determine the corresponding cup size, which is represented by a letter (A, B, C, and so on).

• Example: In a size 34B, 34 refers to the band size (underbust measurement in inches), while B is the cup size (overbust - underbust measurement). 

• Fit check: The bra should snugly cover your breasts from all sides. The band should stay in place without feeling too tight. The bra must have wide straps that don’t dig into your skin and cause marks. You should be able to breathe, raise your arms, and move around comfortably without the bra getting displaced. 

Opt for the right material

Choose bras made with breathable fabrics such as cotton or modal. Ensure they have minimal seams to maximize comfort. 

Wear the right type

Wear bras that secure the breasts in place, minimise movement, and ensure comfort. It includes: 

• Soft, wide-strapped daily bras

• Sports bras (especially during exercise or other physical activities)
  
  

Avoid bras that can compress the sensitive breast tissue and increase strain on the chest and back muscles, worsening pain. It includes:

• Tight-fitting bras

• Underwire bras 

• Ill-fitting bras with the band or cup too large/small

Use alternating heat and cold therapy

Using heat therapy can help improve the blood flow in your breasts and relax the breast tissue. When you follow it up with cold therapy, it can reduce inflammation, pain, and sensitivity. 

Remember 

• If heat therapy worsens your pain, avoid it and use cold therapy instead—and vice versa.

• Do not apply extreme temperatures directly to the skin as it can increase the risk of burns or frostbite. 

• Avoid using this method of pain relief if it causes numbness, tingling, or extreme pain.

If you choose to try this method, here’s a step-by-step guide you can follow: 

• Apply heat for 10–15 minutes. You can use a warm pack, hot water bottle, or even take a hot shower.

• Next, apply an ice pack for 5–10 minutes. Remember to wrap the ice pack in cloth to protect your skin.

• Follow it up with heat application again.

• You can safely do this method 1–3 times a day with a gap of a few hours between each session.

The entire process of alternating between heat and cold therapy should take about 25–40 minutes. 

Stay hydrated

Dehydration can worsen water retention during the premenstrual phase, which may increase breast pain. Drinking around 2–2.5 litres of water throughout the day can keep you well-hydrated and help flush out excess salts and fluid from the body.

Eat foods rich in omega-3 fatty acids

Omega-3 fatty acids are healthy fats that can help reduce inflammation and pain sensitivity in the breasts before your period. There are three main types of omega-3 fatty acids: ALA (alpha-linolenic acid), EPA (eicosapentaenoic acid), and DHA (docosahexaenoic acid). EPA + DHA are the most effective for premenstrual breast pain. 

You can get ALA through plant-based sources like flaxseeds, chia seeds, walnuts, mustard oil, soybeans, and tofu. The body can convert ALA into EPA and DHA, but the conversion is inefficient, generally under 10%. Animal-based sources are rich in EPA and DHA. It includes fatty fish such as Indian mackerel (bangda), sardines (mathi), hilsa (ilish), salmon, tuna, and rohu or catla. 

Evidence suggests 1–2 grams of EPA + DHA per day. Here’s how you can achieve it through food sources:

If you are unable to get the required omega-3 fatty acids through food, you can consider taking an omega-3 supplement after consulting your doctor. 

FYI: You can discuss vitamin E supplements and evening primrose oil with your doctor as some studies suggest they help with breast discomfort. Additionally, some women may experience increased breast pain after starting birth control pills. If this happens, your doctor can suggest dosage changes or alternatives. 

Engage in exercise

Engaging in light physical activity can help you manage PMS breast discomfort. However, you will notice maximum benefits if you are consistent with your exercise routine throughout the month. 

Exercising can help in various ways. It releases endorphins, your body’s natural painkillers, easing stress and discomfort. Additionally, it improves blood circulation and reduces fluid retention associated with breast pain. Regular exercise can also help maintain better posture that can eventually reduce strain on the chest and back muscles. 

You can include the following exercises in your routine:

• Low-impact cardiovascular exercises: Brisk walking, running, cycling, and swimming at least 30 minutes most days of the week

• Upper-body strength training and posture improvement exercises: Scapular retractions, chest stretches, shoulder stability exercises, gentle Yoga poses such as cat cow and child’s pose

Practice relaxation techniques

Stress, anxiety, and depression can increase stress hormones like cortisol in the body. It can disrupt the estrogen and progesterone balance, which may worsen the breast symptoms. It may also impact the nervous system, affecting how the body perceives pain. 

Practicing relaxation techniques are effective ways to manage stress and related conditions. Breathing exercises, meditation, Yoga, and progressive muscle relaxation are some of the recommended methods. 

Should You Avoid Anything to Prevent Worsening of PMS-Related Breast Symptoms?

Certain dietary habits and techniques like massage may worsen your breast soreness. Here’s why you can consider avoiding the following:

Fat, salt, and sugar

Some evidence suggests that switching to a low-fat diet can reduce weight, cholesterol, and estrogen levels, thus reducing severe breast symptoms. It is recommended to reduce saturated fats like butter, cheese, fried foods, and red meats. 

Additionally, you can also consider reducing salt and sugar a week or two before your period. This may help limit fluid retention and inflammation associated with breast tenderness. 

Caffeine

Researchers are not clear on whether caffeine reduction actually eases breast pain. However, many women have noted a difference in their symptoms upon cutting down coffee, tea, sodas, and other caffeinated beverages. It may be worth trying to see if it helps you.

Massage

While massage therapy is an effective pain-relief and relaxation technique, it may not be helpful for managing breast symptoms. During the premenstrual phase, the breasts are more sensitive to touch, so even a light massage can stimulate the nerves and increase discomfort. Moreover, massage can increase blood flow in the area and stretch the swollen connective tissues, worsening breast tenderness.

FYI: Smoking and alcohol are also known to worsen premenstrual symptoms, including breast pain. Hence, it’s better to avoid them too.

A Quick Note on Breast Self-Exam

A monthly breast self-exam is crucial. It helps you become aware of how your breasts normally look and feel, so you can notice any unusual changes early. However, the timing of breast self-exams matter the most. You must not perform it a week before your period for two reasons: 

• Premenstrual breasts are tender and lumpy due to natural hormonal fluctuations. You may easily misinterpret these normal changes as abnormalities.

• Breasts are also more sensitive during the premenstrual phase. Actions like pressing breasts or squeezing nipples may be painful or uncomfortable.
  

To ensure maximum accuracy and comfort, consider performing the breast exam a few days after your period ends, when symptoms subside.

When Should You See a Healthcare Provider?

If you experience mild breast pain before your period that eases with relief strategies and resolves once bleeding begins, it’s a normal PMS symptom. However, in case you notice the following signs, it would be best to consult a doctor to understand the underlying cause and receive prompt care. 

• Home relief strategies do not help: Your breast soreness is severe and none of the home relief strategies help ease them.

• Persistent symptoms: Your breast pain and tenderness do not resolve once your period begins and continues throughout the month.

• Breast changes: You notice new lumps, shape changes such as a dent, redness, or swelling in your breast. 

• Nipple changes: Your nipples look different. You also notice sudden nipple discharge that is brown or bloody. 

• Effect on quality of life: Your breast pain or associated symptoms are affecting your quality of life.

The Bottom Line

Mild premenstrual breast pain and tenderness are normal. You may notice them around 1–2 weeks before your period. You can try various relief strategies to manage your symptoms such as heat and cold therapy, supportive innerwear, or staying hydrated. However, if breast pain is severe, persistent or accompanied by other breast or nipple changes, it’s best to consult a doctor. 

FAQs

Which part of the breast hurts in PMS?

Usually, both the breasts feel sore during PMS, instead of pain being limited to one breast or a specific area.

How many days before your period should your breasts be tender?

PMS breast pain starts in the luteal phase, around 2 weeks before the period. 

How long does pre-period breast pain last?

Premenstrual breast pain can last anywhere between 1–2 weeks and resolves almost immediately as bleeding begins.

References

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