Breast Pain And Menstrual Periods

Cyclical Breast Pain With or Without Birth Control Pills

Breast pain or tenderness can be related to your menstrual periods. This type of pain, called cyclical breast pain, comes and goes with your menstrual cycle or in response to birth control pills. Noncyclical breast pain, by contrast, is not related to changes in your hormone levels.

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

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 fertile 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.

Later in the menstrual cycle, as progesterone levels begin to drop, breast pain or tenderness may increase until your period starts. As the menstrual period tapers off, the cyclical breast pain will typically subside. It is these changes in hormone levels that 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 Theories

Scientists don't entirely understand the mechanisms that cause cyclical breast pain, but there are a few theories:

  • Preparation for breastfeeding: 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 in itself can cause breast pain. 
  • Pressure-induced sensitivity: The enlargement of your breasts during your cycle may also press against other structures within the breast, such as cysts, fibroadenomas, nerves, ligaments, and muscles. This suggests that a person's physiology may predispose them to 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 is a common result.
  • 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.

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 type and brand of oral contraceptive used. Because everyone's hormone levels are different, it can be difficult to predict if a particular birth control pill will cause breast pain or bring relief. Sometimes, different pills need to be tried to see which works best.

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

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 and acne to breast pain.

Combination birth control pills prevent pregnancy by boosting and maintaining hormone levels to levels where ovulation cannot occur. When used as prescribed, an egg is not released to your uterus.

In this hormonal climate, 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 increased if it 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 another type of oral contraceptive that contains 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 for 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.

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

Again, there is no way to predict which might happen. It is also important to remember that some people will experience no 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 ascertain if the oral conceptive contributed in any way.

Hormone Replacement Therapy

Hormones that influence the menstrual cycle also affect breast pain or tenderness in perimenopausal people. For example, when you take hormone replacement therapy (HRT) to relieve severe menopause symptoms, your cyclical rhythms will change. In some cases, this can cause breast pain, the risk of which appears to increase with the size of the 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 on HRT and experience breast pain, speak with your healthcare provider.

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 picture may emerge that can guide you and your healthcare provider to a new treatment plan, including a change in the oral contraceptive type or dose.

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Article Sources
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