What causes breast swelling just before menstruation and how is it treated?

Premenstrual Breast Swelling: Causes and Management

Breast swelling and tenderness just before periods is cyclical mastalgia caused by hormonal fluctuations during the luteal phase of your menstrual cycle, and for most women, reassurance alone resolves symptoms in 86% of mild cases without any medication needed. 1

Understanding the Cause

Cyclical mastalgia represents 70% of all breast pain cases and is directly related to hormonal fluctuations of the menstrual cycle. 2 The key characteristics include:

• Hormonal mechanism: The pain worsens during the luteal phase (after ovulation, before menstruation) and improves once menstruation begins 2
• Pattern: Bilateral or diffuse breast involvement without a precise, reproducible point of tenderness 2
• Predictability: Follows a consistent pattern with each menstrual cycle 2

When Imaging Is NOT Needed

For cyclical breast pain alone, imaging is not necessary beyond routine age-appropriate screening. 2 The risk of cancer in women presenting with breast pain as the only symptom is extremely low (1.2-6.7%). 1 Cyclical pain alone does not require diagnostic imaging. 2

First-Line Treatment Approach

Reassurance as Primary Therapy

• Reassurance that breast pain alone rarely indicates cancer is crucial and often sufficient for symptom resolution 1
• After appropriate reassurance, 86% of mild cases and 52% of severe cases resolve without further intervention 1

Non-Pharmacological Measures

Start with these simple interventions before considering any medication:

• Supportive bra: Wear a well-fitted supportive bra, especially during exercise 1
• Temperature therapy: Apply ice packs or heating pads for comfort 1
• Exercise: Regular physical activity helps alleviate symptoms 1
• Proper breast support: For women with large breasts, a properly fitted supportive bra is essential 1

What Does NOT Work

• Caffeine restriction: Despite widespread belief, there is no convincing scientific evidence that eliminating or reducing caffeine intake significantly affects breast pain 1, 3

Second-Line Treatment (If Simple Measures Fail)

Over-the-counter NSAIDs (such as ibuprofen) can provide symptomatic relief and should be the next step if non-pharmacological measures are insufficient. 1

Complementary Options

For women seeking additional relief:

• Acupressure: Bilateral stimulation of Large Intestine-4 (LI4) acupressure point during symptomatic periods can be offered as adjunctive therapy 1
• Patients can perform self-stimulation at home to reduce symptoms 1

Important Pitfalls to Avoid

• Don't dismiss without evaluation: While rare, some cancers (especially invasive lobular and anaplastic carcinomas) can present with pain 1
• Don't order unnecessary imaging: Avoid ordering imaging for diffuse, non-focal breast pain when clinical exam is normal 1
• Don't assume it's always hormonal: If the pain becomes focal, unilateral, or loses its cyclical pattern, reevaluation is needed as this suggests noncyclical mastalgia requiring different management 2

When to Seek Further Evaluation

Consider diagnostic imaging if:

• Pain becomes focal and unilateral rather than diffuse 2
• Pain loses its cyclical relationship to menstruation 2
• A palpable mass develops 3
• Pain persists despite appropriate conservative management 4