Breast pain (medically called “mastalgia”) is one of the most common PMS symptoms reported by women, with as many as 90% experiencing some type of breast pain at one point or another during her reproductive life. Women with cyclical breast pain are sent for mammograms more often(1), which points to the importance of being properly assessed to avoid unnecessary testing.

Hormones are certainly implicated in cyclical breast pain, since it most often occurs in week 3 and 4 of a woman’s cycle (the luteal phase) and often disappear at the beginning of her period, when hormone levels are the lowest. We suspect that Estrogen sensitivity is part of the problem, because anti-Estrogen drugs (used for breast cancer) improve breast pain, and generally women with breast pain have higher Estrogen, and lower progesterone levels than women without(2). All of this said, testing hormones doesn’t often give us answers with respect to treatment, and so this may be one of the times that testing isn’t indicated(3).

Some women with cyclical breast pain may have elevated levels of prolactin, the milk-producing hormone. Prolactin elevates with stress, and can wreak havoc on your actual cycle. If you have significant breast pain, and experience spotting before your period, or anovulatory cycles (no ovulation) then prolactin testing should be a priority.

I explain to my patients, if we haven’t made a dent in their symptoms by 8 weeks, then perhaps lab work would help us understand their case further. It’s important to point out that only blood hormones have been studied with respect to breast pain (not urine, or salivary tests).

General lifestyle factors help lower cyclical breast pain. Many “Bad Urban Woman Behaviors” worsen PMS. Smoking, dieting, late nights and high stress all worsen generalized PMS, and do influence breast pain. Adopting generalized healthy habits including regular eating, high antioxidant foods and relaxation techniques all support better PMS, and lessen breast pain(5). Caffeine was originally thought to worsen breast pain, but the current literature isn’t quite as clear(6). If you have terrible breast pain, caffeine restriction might be a worthwhile test to see if it helps. I’ve written about the impact of diet on breast pain before.

Funnily enough, even though women feel bloated and as if they are retaining water during their luteal phase, they don’t have any extra body water on testing, and salt restriction doesn’t seem to help(4).

Treatment options for breast pain are not unique to how we support regular PMS symptoms, and include a whole-body approach. Herbs such as Chaste Tree, foods such as flax(7), and supplements such as magnesium(8) and fish oil(9) have all been studied with positive impact on cyclical breast pain.

Chaste tree specifically lowers prolactin as effectively as standard drug therapy, and can alleviate the other cycle-disrupting symptoms caused by this hormone(10). Chaste tree is unique in that it only influences this one hormone(11) (leaving the rest to do their normal jobs!) and the benefit persists for months after discontinuing(11). Some women require different dosing strategies depending on their other symptoms (it’s also one of our better supports for PMDD) and should be prescribed by your Naturopath.

We use symptom tracking forms or PMS apps for our patients to track their symptoms and progress to be sure that your breast pain is actually related to your cycle, and to track success of your plan(12). The Daily Recording of Severity of Problems tracking sheet or a good PMS app can be used for the month leading up to your appointment to help us get off to a solid start on your plan.

 

 

  1. Ader DN, South-Paul J, Adera T, Deuster PA. Cyclical mastalgia: prevalence and associated health and behavioral factors. J Psychosom Obstet Gynaecol. 2001 Jun;22(2):71–6.
  2. Sitruk-Ware R, Sterkers N, Mauvais-Jarvis P. Benign breast disease I: hormonal investigation. Obstet Gynecol. 1979 Apr;53(4):457–60.
  3. Morrow M. The Evaluation of Common Breast Problems. Am Fam Physician. 2000 Apr 15;61(8):2371.
  4. Preece PE, Richards AR, Owen GM, Hughes LE. Mastalgia and total body water. Br Med J. 1975 Nov 29;4(5995):498–500.
  5. Rose DP, Boyar AP, Cohen C, Strong LE. Effect of a low-fat diet on hormone levels in women with cystic breast disease. I. Serum steroids and gonadotropins. J Natl Cancer Inst. 1987 Apr;78(4):623–6.
  6. Kataria K, Dhar A, Srivastava A, Kumar S, Goyal A. A Systematic Review of Current Understanding and Management of Mastalgia. Indian J Surg. 2014 Jun;76(3):217–22.
  7. Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Ahmadpour P, Javadzadeh Y. Effects of Vitex agnus and Flaxseed on cyclic mastalgia: A randomized controlled trial. Complement Ther Med. 2016 Feb;24:90–5.
  8. Walker AF, De Souza MC, Vickers MF, Abeyasekera S, Collins ML, Trinca LA. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health Off Publ Soc Adv Womens Health Res. 1998 Nov;7(9):1157–65.
  9. Vaziri F, Zamani Lari M, Samsami Dehaghani A, Salehi M, Sadeghpour H, Akbarzadeh M, et al. Comparing the Effects of Dietary Flaxseed and Omega-3 Fatty Acids Supplement on Cyclical Mastalgia in Iranian Women: A Randomized Clinical Trial. Int J Fam Med [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][Internet]. 2014 [cited 2016 Oct 31];2014. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147287/
  10. Kilicdag EB, Tarim E, Bagis T, Erkanli S, Aslan E, Ozsahin K, et al. Fructus agni casti and bromocriptine for treatment of hyperprolactinemia and mastalgia. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2004 Jun;85(3):292–3.
  11. Wuttke W, Jarry H, Christoffel V, Spengler B, Seidlová-Wuttke D. Chaste tree (Vitex agnus-castus)–pharmacology and clinical indications. Phytomedicine Int J Phytother Phytopharm. 2003 May;10(4):348–57.
  12. Tavaf-Motamen H, Ader DN, Browne MW, Shriver CD. Clinical evaluation of mastalgia. Arch Surg Chic Ill 1960. 1998 Feb;133(2):211–213; discussion 214.

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