Breast Pain And Menstrual Periods

Cyclical Breast Pain With or Without Birth Control Pills

Breast pain or breast tenderness can be related to your menstrual periods. This type of breast pain comes and goes with your cycle (due to natural hormones) or in response to birth control pills, and is called cyclical breast pain. Noncyclical breast pain, in contrast, is not related to menses or occurs after menopause.

Breast pain may also be referred to as mastodynia, mastalgia, mammalgia, or mastitis.

Breast Pain And Menstrual Periods

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

Later in the menstrual cycle as progesterone levels drop, breast pain or tenderness may increase until a period starts. Then, as the menstrual period tapers off, so does cyclical breast pain.

The Breasts Response to Hormones

How do these monthly hormonal changes lead to breast pain? The answer isn't entirely known, but there are a few theories.

The breasts are intended to 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 may partly explain cyclical breast pain.

The enlargement of your milk-producing system may also press against other features within your breast: cysts, fibroadenomas, nerves, ligaments and muscles. Breast skin may become more sensitive than average and nipples may feel sore and irritated.

If pregnancy interrupts the monthly cycle, the breasts will respond to a sustained progesterone level by fully maturing over the next nine months. Many women experience breast tenderness during early pregnancy.

Research suggests that some women experience breast pain have less progesterone than they do estrogen in the second half of their menstrual cycle. Meanwhile, other studies have found that breast pain may be caused by am abnormality in the hormone prolactin.

Breast Pain and Birth Control Pills

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

Birth control pills can be associated with breast pain in either direction; sometimes leading to more pain, and other times actually being prescribed to help relieve pain due to changes in the hormonal cycle. The hormones in birth control pill act much like natural hormones as they affect the breast, but the effects can vary between different women as well as the particular type and brand of oral contraceptives.

Due to these differences between women, it can be hard to predict when a particular birth control pill will cause breast pain, or in contrast, bring relief, and sometimes a woman will need to try a few different pills to determine which one works best for her.

Birth control pills use synthetic hormones to stop ovulation and change your cervical mucus, reducing the chance of a pregnancy. There are two types of birth control pills available in the United States: the combination pill, that contains a combination of estrogen and a progestin, and the minipill, that contains progesterone only.

Combination Birth Control Pills and Breast Pain

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 have different effects on the symptoms women experience, ranging from headaches, to acne, to breast pain.

Combination oral contraceptives work by preventing ovulation in addition to other mechanisms. In the graph above you can see that the combination pill boosts hormone levels and maintains those levels before, during, and after the time that ovulation would normally occur. When used as prescribed, an egg is not released to your uterus, preventing the chance of conception.

In this hormonal climate, breast pain can take on a couple of different patterns. Depending on how much estrogen and progesterone you normally have, your breast pain may be less than normal overall, or it may be worse than normal during menses and less than normal for the balance of your cycle.

The risk of endometrial and ovarian cancer is lower when taking a birth control pill, but your risk of estrogen-positive breast cancer is slightly higher.

Minipills (Progestin Only Pills) And Breast Pain

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 another type of oral contraceptive. Unlike the combination birth control pill which uses synthetic estrogen and progestin, minipills contain progestin only. With the minipill, natural estrogen levels remain the same during the monthly cycle and is one of the reasons why breastfeeding women may opt for this choice. Estrogen signals the release of breast milk, and this process must be unaffected if a woman plans on breastfeeding her newborn baby.

Minipills work by creating a more challenging environment for sperm. The cervical mucus will thicken and the endometrial lining (the lining of your uterus) thins out. Most sperm can't make it past these unfriendly conditions to reach the egg, if it is present. Some women don't ovulate on the minipill, and some don't even have periods, but the experience varies between women.

The dose of progestin in the minipill is usually lower than that found in combination birth control pills. For this reason, the minipill tends to be less forgiving if you miss a dose (it's important to maintain and even level of progesterone every day).

In the graph you can see how the estrogen levels rise and fall in a normal pattern, while the progesterone levels remain constant on the minipill. Because everyone reacts to progesterone in different ways, the degree of breast pain experienced may be better, worse, or unchanged while on the minipill.

Breastfeeding itself may cause many sensations in the breast and nipple, so it can be difficult to sort out what is causing breast pain in nursing mothers who are using the minipill.

Changing Your Hormone Levels Changes Your Breast Pain

Hormones that influence the menstrual cycle also affect breast pain or breast tenderness in premenopausal women.

When you take synthetic hormones in birth control pills or hormone replacement therapy (HRT), your cyclical rhythms will change. Sometimes taking a contraceptive pill will help relieve breast pain and sometimes it may make the pain worse. Give yourself time to let the new cycle establish itself with the pill and keep your doctor informed of your menstrual and breast pain symptoms. Get professional help if your symptoms don't improve, or if you run into problems.

A Word From Verywell

Dealing with breast pain related to your menstrual period or birth control pills can be frustrating. Every woman is different, and a pill that reduced breast pain for one woman may increase discomfort for another. Understanding that it may take time to figure out what works best for you can help.

Keeping a journal of your symptoms can be extremely helpful. Some women note the day of their cycle, and rate their discomfort on a scale of 1 to 10 each day of the cycle. You may wish to enter any other symptoms you are experiencing (such as premenstrual tension), any anxiety or depression you are feeling, menstrual cramps, and more.

Over time, a picture may emerge that can guide you and your doctor to a treatment or change in pills that works best for you.

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Article Sources
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  1. Johns Hopkins Medicine. Breast pain (mastalgia).

  2. U.S. Health and Human Services. Birth control pill. Updated May 14, 2019. 

  3. National Cancer Institute. Oral contraceptives (birth control pills) and cancer risk. Updated February 22, 2018.