Breast pain at menopause: what is it, and what can I do about it?

Breast pain or soreness during your menopause transition is common.

It might feel quite different to the cyclical breast tenderness that most of us become familiar with during our fertile years. During perimenopause, our sex hormone levels can fluctuate wildly as the brain struggles to stimulate our ovaries to release an egg from our dwindling supply – this can create cycles of different lengths, and periods where our oestrogen levels are higher than usual. We also have more “anovulatory” cycles – where, despite stimulation of the ovary, no egg is released – and this means there is no significant production of progesterone in the latter half of our cycles. These hormone imbalances affect any part of our body where the cells have hormone receptors: and our breasts are full of them.

Peri-menopausal breast pain can feel like stabbing, burning pain. It might be sharp, or throbbing. It might affect just one breast, or both. Like most things in menopause, no two women will report their breast pain in the same way. So, what should we do about breast pain if we experience it?

Stay alert to changes in the breast, and seek help when needed

Breast cancer rates rise as we age – the national mammogram screening programme runs from age 50 to 70 to coincide with the years of our lives when we are most likely to be diagnosed with this condition. For this reason, it is important that you stay on top of any changes in how your breasts are feeling. 

Most lumps are found by women or their partners, rather than medics. Although most breast cancers will be diagnosed due to a lump, not pain, it is always important to self-examine when you notice something is different. If you find a lump, or if new breast pain is persistent, you should make sure you see your GP to discuss the issue and consider whether referral to breast clinic is needed. 

Get into the rhythm of checking your breasts on a monthly basis so that you become familiar with how they feel and will be able to spot any changes in the tissue early. It is often easiest to check in the shower or bath, and to have a pattern to the movements you use to ensure you check all the breast tissue properly: it can help to divide each breast into quarters with your nipple in the middle, and check right up into the armpit on both sides.

The following are red-flag symptoms that need checking out immediately with your GP:

• Discharge from the nipple – this might be clear, yellow, green-black or bloody. Though often a benign condition known as duct ectasia, it’s a not-to-be-ignored symptom that needs detailed assessment.
• Increase in breast size
• Redness in the skin of the breast
• Lumps or gristle-like tissue in the breast
• Changes in the appearance of the breast: dimpling, rash, orange peel skin
• Inversion of the nipple

It is also important to consider whether the pain is from the breast or might be being felt more deeply – rib cage pain, indigestion and even angina (pain that comes on with activity and is relieved at rest) should be considered, too. Fibromyalgia can include rib and chest pain and often gets diagnosed around the same age. 

What can I do to relieve breast pain?

So, once you have ruled out any abnormalities by checking your breasts for lumps and changes, what can you do to make things more comfortable?

Check your medications

• HRT/Contraceptive Pills

Women often experience transient breast swelling or tenderness when they start on HRT, and this usually settles down after the first few months. It can help to reduce the oestrogen dose a little, or build it up more slowly. Progesterone can also sometimes cause breast tenderness and it can take some playing with the relative doses to find a combination which is just right for you and your body. This is something we can help you with at Spiced Pear Health, or you may find it useful chatting to your own GP if they have an interest in women’s health. 

• Check your other drugs

Look at the other medications you take on a regular basis. Breast pain is a side effect of several common drugs: usually the pain will be daily, rather than cyclical. Common culprits are:

• Antidepressants (Sertraline, venlafaxine, mirtazepine)
• Antipsychotics (haloperidol)
• Heart drugs (digoxin and spironolactone)

Try herbs and supplements

Evening primrose or starflower oil can be really helpful supplements for women with breast pain, although there is not much research to support this. As with most supplements and herbs, individual women sometimes find them very helpful and it can be well worth giving them a try if this is your preferred approach rather than using prescription only medications.

Topical anti-inflammatories

There is good evidence that using gel-based anti-inflammatory medicines, easily available over the counter, can be a very useful strategy.  Oral anti-inflammatories have more side effects but the gel versions are better tolerated and are often very useful applied directly to the breasts.

Well-fitting Bra & Sleep Support

A very simple and useful trick is to get re-measured for a supportive new bra. Many of us change weight around menopause and our existing bras may no longer be quite the right size or offer enough support. Bras also slowly stretch over time, and degrade through washing. Wearing a good, well fitted and supportive bra is an evidence based solution to help with breast pain, as is investing in a soft sleep bra.

Summary

The good news is that up to a third of women’s breast pain will stop of its own accord given time. Peri-menopause doesn’t go on forever and once your hormones levels out (through time or with help from HRT) the effect of the imbalanced hormones on your breasts will settle down. Like most menopausal problems, a lot can be done if you understand what is happening to your body and feel empowered to seek help. You don’t have to grit your teeth and put up with it – being proactive about these changes can make all the difference to how life feels as you make this transition.