Research shows that most women (approximately 70 percent) are familiar with the dull, throbbing, discomfort of premenstrual breast pain, which doctors refer to as cyclical mastalgia.

The pain is normal and usually comes just before the period, and disappears just after the menstrual cycle arrives. For more information, we called Dr. Kelly Culwell, an OBGYN and former medical officer at the World Health Organization. Here’s what you need to know.

What causes it?
The symptoms of premenstrual breast pain include tenderness and heaviness of the breasts, and they can also feel dense to the touch. These symptoms are usually a sign of PMS, and are caused by hormonal changes during the menstrual cycle. During ovulation, estrogen increases and causes the breast ducts to enlarge, which can cause pain. Progesterone, a hormone that regulates the menstrual cycle, causes milk glands to swell, which can produce pain. “Every woman is different, so sometimes women have the most breast tenderness mid-cycle, right before ovulation, because that’s when the estrogen levels are the highest,” Culwell says. “But in other women, the symptoms occur right before the period, when hormones drop dramatically, which is what brings on menstruation.”

How age affects breast pain and tenderness?
Younger women tend to have more dramatic fluctuations in hormones, which can make breast pain worse. Accordingly, premenstrual breast pain often improves with age as menopause approaches. “There might be times in your life that [premenstrual breast pain is] more dramatic than others,” Dr. Culwell says. “As you start to get older and kind of get into the perimenopausal area, you’re not ovulating with each cycle, and so you’re not getting that same sort of hormonal fluctuation.”

What can you do to feel better?
Researchers believe that certain diets can make premenstrual breast pain worse by triggering hormone fluctuations. With this in mind, they suggest cutting caffeine, as well as foods high in fat and salt. Certain vitamins and minerals, such as vitamin E and magnesium, as well as hazelnuts, spinach, corn, bananas, oat bran, and avocados, can also help. Painkillers like acetaminophen and ibuprofen can reduce the pain too.

When should you be concerned?
Premenstrual breast pain is normal and common. But there’s also another form of breast pain, called noncyclic breast pain, that’s not related to the menstrual cycle and should be monitored if symptoms occur. You’ll usually feel the pain in one specific area of the breast; it can be caused by infection, medications, injury, and in very rare cases, breast cancer. Women are encouraged to pay attention to any changes in your breasts and speak to a doctor if you notice anything unusual, such as discharge from the nipples, new or changing breast lumps, lumps in one breast, or pain that makes it difficult to sleep.

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