As women approach menopause, they experience a shift in their hormones. During perimenopause, these changes can cause sore breasts, also called mastalgia. Women may experience cyclical breast pain related to their menstrual cycles that start a couple of weeks before their period. However, sore breasts can also continue into menopause when menstrual cycles have ended.
Before menopause, women have a rise in estrogen levels in the first half of their cycle. In the second half of the month, estrogen levels drop, and progesterone levels rise as they get closer to their time for menstruation. As the estrogen and progesterone balance changes, breasts may hurt as the glandular tissue in their breasts increases in size, leading to more fluid retention and breast pain.
Both breasts are typically involved with cyclic breast pain. The discomfort can extend up into the outer quadrants of the breasts near the armpits and feel tender, sore, and achy. Breast pain is the most common symptom women contact their medical providers for, and it is estimated that 70-80% of women experience it.
During perimenopause, the period of time preceding menopause, a women’s cycle regularity is disrupted, and estrogen levels can erratically surge. Sore breasts with perimenopause are common. “Breast tenderness was a symptom for 34% of women in early perimenopause, and the symptoms of breast tenderness decreased in the late perimenopausal and postmenopausal time periods.”
Once women go through menopause, which is considered the time when they no longer have menstrual cycles for 12 consecutive months, breast pain may diminish as they no longer produce as much estrogen. While “cyclic mastalgia is most common between ages 35-45”, some women continue to have sore breasts with menopause, particularly if they are on hormone replacement therapy.
Reasons for sore breasts other than perimenopause or menopause
Having sore breasts in menopause creates a natural concern that there may be something more serious going on. Women often fear that it is a symptom of breast cancer, which is uncommon.
When breasts hurt, and the cause is not related to hormone cycles, it is called noncyclic breast pain. Noncyclic breast pain can be due to a medical problem or a physical reason and is not typically due to perimenopause or menopause changes in your body. Noncyclic breast pain may only occur to one breast or can make both breasts hurt.
- Infection: Women who are lactating may develop mastitis or an inflammation of a clogged milk duct that can cause pain, redness, warmth, and tenderness. Antibiotics may be needed if an infection develops.
- Tumors: Breast pain is rarely a symptom of cancer, but benign tumors or cysts can cause breast pain, more commonly in one breast. If a cyst is large or very uncomfortable, your doctor may remove the fluid to resolve the pain.
- Fibrocystic breasts: More than half of women develop fibrocystic breasts sometime in their life. They can cause cyclic breast pain from lumps that change in size during the menstrual cycle or if they are on hormone therapy during menopause.
- Medication: Birth control pills or hormone therapy can contribute to breast pain. Other medications such as those to treat cardiac conditions or psychiatric drugs can also be a cause.
- Injury: Straining a pectoralis muscle can cause breast pain. Inflammation of the cartilage that attaches to the breastbone (costochondritis) may cause burning pain that radiates, making the breast hurt closer to the center of the chest.
- Lack of Support: Large breasts can cause sore breasts as the weight pulls on the surrounding tissue and ligaments.
- Chronic pain conditions: Fibromyalgia, arthritis, and other chronic pain conditions can contribute to breast pain in addition to other areas of the body that hurt.
Treatments and remedies for common causes of sore breasts
Breast pain or discomfort should be discussed with a doctor so she can examine whether there is a cause for concern. She will perform a routine breast exam and palpate the areas that hurt. If she is concerned, she may order a mammogram or an ultrasound for further evaluation if she finds any lumps or changes in the nipples.
Once the doctor determines that the breast pain or sore breasts in perimenopause or menopause does not need medical treatment, a woman can focus on reducing what is making her breasts hurt.
- Support: Wearing a well-fitted bra provides better support to the breasts. Wearing the bra at nighttime can help during those times when having more breast pain. Purchase a special sports bra to wear when exercising.
- Supplements: Evening primrose oil, Vitamin E or Vitamin D may help with breast pain though it could take up to six months to see a benefit.
- Diet changes: Reducing the consumption of high fat foods may help with breast pain by lowering estrogen levels. Stick with lean proteins such as fish, chicken, or tofu. Caffeine, which is often hidden in energy drinks and chocolate, can also be a contributor.
Some have found increasing Omega–3 fatty acids by consuming more fish, dark leafy green vegetables, or flax seeds improve breast discomfort.
- Smoking and exercise: Quitting smoking and increasing physical activity have been shown to improve breast pain symptoms by reducing estrogen levels. Exercises such as yoga can also help you relax.
- Pain relief treatments: Taking over-the-counter analgesics such as acetaminophen or non-steroidal anti-inflammatory drugs NSAIDS or topical NSAIDs have been found to relieve pain. Warm compresses or ice packs applied to the breast areas that hurt may provide temporary relief.
- Hormones: For those who continue to have more severe breast pain, medications such as Tamoxifen, Danazol, and Bromocriptine but they all have side effects that may be worse than the breast pain, so are only used in special circumstances.
- Time: As difficult as it is to wait, sore breasts in menopause may decrease with the passage of time.