Premenstrual breast tenderness

Pre-menstrual breast tenderness is a breast pain or discomfort that recurs cyclically each month; it usually begins in the two weeks before menstruation, increases progressively until the actual menstrual period begins, and gets better when it ends.

It is related to the hormonal fluctuations of the menstrual cycle.

Its manifestations are pain in both breasts and it may appear as a single symptom or be associated with other symptoms such as abdominal distension, irritability, mastalgia, artralgia, lumbar pain and cramps, in addition to the premenstrual syndrome.

Diagnosis is clinical and is based on history and physical examination. The physical examination focuses on ruling out physical abnormalities that wouldn't normally be present.

In the majority of women with premenstrual mastalgia without suspicious findings, imaging is not recommended. If the diagnosis is in doubt, a breast scan may be needed to rule out other conditions.

Treatment of premenstrual mastalgia includes lifestyle changes (a balanced and varied diet, rich in vegetables and low in saturated fats, reduced consumption of tobacco, alcohol and caffeine) or the use of evening primrose and vitex agnus castus supplements. The use of non-steroidal anti-inflammatory drugs (NSAIDs) and certain diuretics can be effective. If the cyclic discomfort is very severe, oral contraceptives may be used to regulate cyclic hormonal changes. The use of topical creams containing progesterone may also reduce the symptoms.