Understanding Breast Pain during Perimenopause
Breast pain is a common concern for women, particularly during perimenopause, and is one of the leading reasons for referrals to breast clinics. While breast pain can understandably cause anxiety about breast cancer, it is important to note that it is associated with cancer in fewer than 0.4% of cases.
If you notice any new symptoms in your breasts, it’s essential to consult your healthcare provider. But what exactly causes breast pain? Can it be relieved? And which breast changes should raise concern?
Types of Breast Pain
There are three primary types of breast pain:
Cyclical Breast Pain
This pain is linked to your menstrual cycle and is a common, normal occurrence. It results from hormonal fluctuations that make the breasts more sensitive, often causing breast lumpiness alongside the pain. The discomfort typically occurs in the two weeks before your period and usually subsides once menstruation begins. It can affect one or both breasts and sometimes radiates into the nipple and armpit.
Non-Cyclical Breast Pain
This pain isn’t related to your menstrual cycle and can occur intermittently or persistently. The cause is often unknown, but it can be linked to factors such as stress, anxiety, benign breast conditions (like cysts), previous surgery, injury, or certain medications, including antidepressants. Non-cyclical pain often resolves on its own.
Chest Wall Pain
Sometimes, the pain felt in the breast is actually due to issues in the chest wall, ribs, or where muscles attach to the breastbone (costochondritis). This pain can worsen with movements like breathing or coughing, and may be tender when pressing on the chest wall. Causes of chest wall pain include over-exercising, heavy lifting, trauma, angina, gallstones, chest infections, or acid reflux.
Perimenopause can intensify cyclical breast pain due to hormone fluctuations, as can starting hormone replacement therapy (HRT) or hormonal contraception. After menopause, cyclical pain tends to decrease as monthly hormone shifts cease.
How to Relieve Breast Pain
After consulting with your healthcare professional, you can be reassured that breast pain is usually harmless and often resolves on its own. If the pain is bothersome, applying anti-inflammatory gels, such as ibuprofen or diclofenac, may provide relief, with application up to four times a day.
Research indicates that taking Starflower oil capsules (1000mg/day) can help alleviate breast pain. These are available over-the-counter at most pharmacies and health food stores. However, they are not recommended during pregnancy, for women with epilepsy, or those on Tamoxifen.
Wearing a comfortable, non-wired bra or a sports bra—especially at night—can also provide support and relief.
Be Aware of Concerning Symptoms
Do you regularly check your breasts for changes? If not, ask your healthcare professional for guidance or visit resources like Breast Cancer Now or CoppaFeel for more information. Symptoms to watch out for include:
- A lump in the breast or armpit
- Nipple discharge
- New indentations or dimpling in the breast
- Thickened or reddened skin
If you notice any of these changes, contact your GP, who will likely refer you to a breast clinic for further evaluation. This may include a physical examination and additional tests, such as a mammogram or ultrasound.
Further Investigations
A mammogram is an X-ray of the breast where the breast is compressed by a plate for imaging. Two views are taken of each breast—one from top to bottom and one from side to side, which may include the armpit. Although it can be uncomfortable, the procedure is quick, and the compression is not harmful. The radiation exposure is minimal, roughly equivalent to the radiation received during a 5-hour flight.
After a mammogram, you may be referred for a tomogram, which provides a more detailed view of any changes detected.
Mammograms are typically not offered to women under 40 unless there is a significant family history of cancer. In the UK, the NHS Breast Screening program invites women aged 50-70 for routine screening every three years.
Ultrasounds are painless and do not involve breast compression. They use sound waves to create an image of the breast tissue and are often used in conjunction with mammograms to provide additional views, especially for women with dense breasts. Unlike mammograms, ultrasounds do not involve radiation.
MRI scans use magnets and radio waves to generate detailed breast images and are often employed for women with dense breast tissue or those at high risk due to family history or genetic mutations (such as BRCA). MRIs do not use radiation.
Breast Density
Breast density refers to the proportion of glandular and fibrous tissue in the breast compared to fatty tissue. As women age, glandular tissue typically decreases, and fat tissue increases, causing changes in breast appearance.
Around 50% of women over 40 have some level of breast density, with about 10% having extremely dense breasts. Dense breast tissue can make mammograms harder to interpret and may increase breast cancer risk by 2-4 times, depending on density. However, denser breasts are more common in younger women, who typically have a lower overall risk of breast cancer.
HRT may slightly increase breast density, but there is no evidence to suggest it raises the risk of breast cancer for women with dense breasts.
If you notice any unusual changes in your breasts, it’s important to seek medical advice. Your healthcare provider can refer you for further investigation if necessary.
For additional information, you may want to explore our resource on benign breast conditions (non-cancerous).
