Breast Pain and Menstrual Periods

Cyclical Breast Pain With or Without Birth Control Pills

You can experience abdominal cramping, breast pain, or breast tenderness in association with your menstrual periods. This type of breast pain is called cyclical breast pain, and it comes and goes with the menstrual cycle or in response to birth control pills.

Breast pain is often referred to by healthcare providers as mastodynia, mastalgia, and mammalgia.

This article will review why breast pain can be associated with the menstrual cycle and how it can be managed.

Understanding Cyclical Breast Pain

Cyclical Breast Pain and Menstrual Cycle
Cyclical Breast Pain and Menstrual Cycle. Art © Pam Stephan

Cyclical breast pain happens in response to the hormonal ebb and flow of the menstrual cycle.

Every month during the childbearing years, the reproductive system gears up for a potential pregnancy. Estrogen levels rise to a specific point, after which the pituitary gland signals the production of luteinizing hormone (LH), which triggers ovulation. If the egg is not fertilized, the lining of the uterus will be shed during menses.

Right before your period, as progesterone levels begin to drop, breast pain or tenderness may increase until your period starts. As the menstrual period tapers off, the breast pain will typically subside.

These changes in hormone levels greatly influence cyclical breast pain.

With cyclic breast pain, the pain tends to be bilateral (meaning in both breasts). With noncyclical breast pain, the pain is often unilateral (affecting one breast only).

Causes and Contributing Factors

Some women are more prone to cyclical breast pain than others. There are several factors that can impact menstrual breast pain.

Factors that influence patterns of breast pain:

  • Preparation for breastfeeding: The breasts can make milk to nourish a baby at the end of a full-term pregnancy. Breast lobes and ducts respond to the monthly hormonal swings by swelling, which can cause breast pain.
  • Pressure-induced sensitivity: Your enlarging breasts during your cycle may press against other structures within the breast, such as cysts, fibroadenomas (noncancerous tumors), nerves, ligaments, and muscles. Underlying structures may affect cyclical breast pain.
  • Pregnancy: Breast pain is common during pregnancy. As pregnancy interrupts the normal monthly cycle, the breasts will respond to sustained progesterone levels by fully maturing over the next nine months. Breast pain and tenderness are common results.
  • Hormonal imbalances: Research suggests that some people who experience cyclical breast pain have less progesterone and more estrogen in the second half of their menstrual cycle. Other studies have found that breast pain may be caused by abnormally high levels of prolactin, a hormone that also influences lactation (milk production).

Birth Control Pills

Breast Pain and Combination Birth Control Pill
Breast Pain and Combination Birth Control Pill. Art © Pam Stephan

The hormones in birth control pills can affect the breast in different ways. Sometimes, they can trigger breast pain and tenderness; at other times, they are prescribed to relieve cyclical breast pain.

Their effect on the body can differ based on the individual, as well as the types and amounts of hormones in the contraceptive. Because hormone levels can vary slightly between people, it can be difficult to predict if a particular birth control pill will cause breast pain or bring relief. You might need to try different pills to see which works best.

The two types of birth control pills available in the United States are:

Combination Birth Control Pills

The combination birth control pill contains two synthetic hormones. The estrogen component (ethinyl estradiol) is the same in all combination pills, but the dosage can vary.

There are eight different progestins that may be used in combination pills, and these different types may trigger different symptoms, ranging from headaches to acne to breast pain.

Combination birth control pills prevent pregnancy by boosting and maintaining hormones to levels at which ovulation cannot occur. When used as prescribed, they prevent an egg from being released to the uterus.

Under this hormonal stimulation, breast pain can take on a couple of different patterns.

Depending on how much estrogen and progesterone you naturally have in your body, your breast pain may be reduced if the pill restores them to a more normal level, or pain can increase if the pill boosts them to abnormal levels.

Minipills (Progestin-Only Pills)

Minipills - Progestin Only Pills - Breast Pain
Minipills - Progestin Only Pills - Affect Menstrual Cycle and Breast Pain Cycle. Art © Pam Stephan

Minipills, also called POP or progestin-only pills, are a type of oral contraceptive that contain only progestin.

With the minipill, estrogen levels will rise and fall in a normal pattern, while progesterone levels remain constant. This is one of the reasons why the minipill is preferred while breastfeeding. Estrogen is key to lactation, and keeping estrogen at normal (rather than high) levels better enables breastfeeding.

By keeping progestin levels elevated, the minipill creates a more challenging environment for sperm. The cervical mucus will thicken, making it difficult for sperm to reach the egg.

For some women, however, changes in progesterone levels can increase the risk of breast pain. For others, the minipill may be less likely to cause cyclical breast pain if the progesterone levels were already naturally low.

There is no way to predict which might happen for you specifically. It is also important to know that some people will not experience side effects whether they are on the minipill or a combination birth control pill.

Breastfeeding itself can cause nipple and breast pain, so it can sometimes be difficult to know if the oral conceptive contributed to the discomfort.

Hormone Replacement Therapy

Hormones that influence the menstrual cycle also affect breast pain or tenderness in perimenopausal people. For example, taking hormone replacement therapy (HRT) to relieve severe menopausal symptoms causes cyclical rhythms to change. In some cases, this can cause breast pain, the risk of which appears to increase with a higher dose.

Another concern is that the use of HRT can increase breast tissue density. According to research, women who experience new breast pain while on HRT are more likely to experience an increase in breast tissue density than those who don't. This is concerning since increases in breast tissue density are associated with an increased risk of breast cancer.

If you are taking HRT and experience breast pain, speak with your healthcare provider.

When to Call a Healthcare Provider

If you ever notice new changes or lumps on or in your breast, call your healthcare provider. Your physician may want to investigate these further with a mammogram, ultrasound, or biopsy.

If breast pain becomes severe, or if the skin on the breast is red and feels warm to the touch, notify a healthcare provider promptly. This could be a sign of an infection in the skin of the breast.

Summary

Breast pain can be closely related to a woman's menstrual cycle. The fluctuation in hormones during the cycle can make the breast feel painful or tender. Although this type of pain doesn't always require any treatment, using hormonal birth control to help regulate cycles can improve the symptoms.

A Word From Verywell

Keeping a journal of your symptoms may help pinpoint the cause and nature of your cyclical breast pain. By rating breast pain on a scale of 1 to 10 each day of your cycle, a pattern may emerge that can guide you and your healthcare provider to a new treatment plan, such as a change in your oral contraceptive type or dose.

Frequently Asked Questions

  • When should I be concerned about breast pain?

    You should be concerned about breast pain if the pain becomes severe or does not improve. If the pain also comes with redness or swelling of the breast, then it requires urgent medical attention.

  • How can I relieve breast pain during premenstrual syndrome (PMS) leading up to my period?

    There are a few things to do to relieve breast pain. Using Tylenol (acetaminophen) or NSAIDs (nonsteroidal anti-inflammatory drugs) like Advil or Motrin (ibuprofen) can be helpful. Using oral birth control pills may be helpful as well. Sometimes decreasing the amount of caffeine you consume can also help.

  • How long can cyclical breast pain last?

    Cyclical breast pain can last for a week or so, from ovulation to the start of the menstrual period.

  • Can you have cyclical breast pain in only one breast?

    It is possible for the pain to be felt in only one breast, but cyclical breast pain usually affects both breasts.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
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11 Sources
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