Fibrocystic Breasts

Topic Overview

This topic covers breast changes that feel lumpy, thick, and tender before your menstrual period. It is not meant for women who have had a breast biopsy showing "atypia" or "hyperplasia." These are cell changes that may lead to cancer.

What are fibrocystic breast changes?

Many women have breasts that feel lumpy, thick, and tender, especially right before their periods. These symptoms are called fibrocystic breast changes. They may also be called cyclic breast changes because they come and go with your menstrual cycle.

Fibrocystic breast changes are normal and harmless. They are not cancer, and they do not increase your chance of getting breast cancer.

But having fibrocystic breast changes can make it harder to find a lump that could be cancer. This is a special concern if you also have a higher than normal risk for breast cancer. So if you or a close family member has had breast cancer, or you have had radiation treatment or a breast biopsy showing atypical ductal hyperplasia (ADH), talk to your doctor about how often you need a breast checkup.

Doing a breast self-exam each month may help you know if an abnormal change occurs.

See a picture of breast anatomy.

What causes fibrocystic breast changes?

Experts think that fibrocystic breast changes are linked to the hormone changes that happen during your menstrual cycle. Each month, your body gets ready for a possible pregnancy. It releases hormones that signal the breasts to make milk. The milk (or mammary) glands get bigger, which may make your breasts feel lumpy and tender. These symptoms go away after you start your period.

You are more likely to have fibrocystic breasts if your mother or sisters have them too.

What are the symptoms?

If you have fibrocystic breasts, you may notice the symptoms right before your menstrual period. They probably get better by the time your period ends. You may find that:

  • Your breasts are swollen.
  • They feel tender or painful. Women often describe this as a dull or aching pain, heaviness, or soreness.
  • Your breasts feel lumpy. Your doctor may call this "generalized breast lumpiness." Lumpy (cystic) areas feel thick. You may have one or more lumps that are always in the same area and that grow and shrink with each menstrual cycle. The lumps move if you push on them. (A lump that is cancer usually does not move but feels stuck to your ribs.)

Symptoms can be on one or both sides and can occur up toward and under the armpit.

Many women first notice fibrocystic breast changes when they are in their 30s. At this age, your hormone levels start to vary more than before.

How are fibrocystic breast changes diagnosed?

If you notice a new breast lump, wait through one menstrual cycle. If it is still there after your period, see your doctor for a breast exam. If you are not having menstrual periods, see your doctor for a breast exam as soon as you notice a new lump.

To diagnose fibrocystic breast changes, your doctor will do a breast exam and ask when you had your last period. If your doctor needs more information, you may have a mammogram, ultrasound, or needle biopsy.

Your doctor can teach you how to check your breasts at home. When you know what’s normal for you, you’re better able to notice changes and know when to get help early instead of waiting for your next checkup.

A self-exam is not a substitute for a mammogram or a clinical breast exam.

How are they treated?

Fibrocystic breast changes are normal. You do not need to do anything about them. If breast pain bothers you:

You can try taking magnesium for the 2 weeks before your period. Taking 400 mg a day may reduce breast pain and other symptoms. Some women may feel better when they give up caffeine, eat a very low-fat diet, or take the herb vitex. Before trying these remedies, talk to your doctor about what is right for you.

Ask your doctor about low-dose birth control pills. For some women, they help reduce breast soreness and swelling before periods. They may be a good choice if your symptoms bother you and you want to prevent pregnancy.

There are stronger medicines your doctor can prescribe for breast pain, but they also have more side effects.

Frequently Asked Questions

Learning about fibrocystic breast changes:

Being diagnosed:

Getting treatment:

Symptoms

Fibrocystic breast changes usually affect both breasts. But they can affect just one. You may notice that symptoms tend to be most obvious right before you start your period and are worse during some cycles than others. Symptoms include:

  • Breast swelling.
  • Breast tenderness or pain. It usually is described as a dull or aching pain, heaviness, or soreness.
  • Breast lumps. "Generalized breast lumpiness" is used to describe this common cyclic breast symptom. Lumpy (cystic) areas feel more dense when you press on them. Lumps can be moved, rather than feeling anchored to muscle underneath. You may also notice one or more specific lumps that are always in the same area and that grow and shrink with each menstrual cycle.

Many women first notice fibrocystic breast changes when they are in their 30s, when their hormone system begins to change and hormone levels tend to fluctuate more than before.

Should I see my doctor?

If your symptoms start during the 2 weeks before your period, consider waiting through your menstrual period to see if symptoms improve.

Call to schedule an appointment if any of the following occurs:

  • You have breast tenderness and miss a menstrual period. This could mean you are pregnant. Contact your doctor for a pregnancy test.
  • You have signs of breast infection, including sudden breast swelling, redness, or pain with or without a fever.
  • You have discharge from your nipple that looks like pus or blood.
  • Sharp pain occurs suddenly without a known cause (such as an injury) and has continued for 2 weeks or more.
  • Increasing or persistent pain occurs in one or both breasts, particularly if the pain stays in one area of the breast.
  • You notice a new lump in your breast that is still there after your menstrual period.
  • You notice a dimple or pucker in the skin or nipple.

For more information about breast symptoms, see the topic Breast Problems.

Exams and Tests

Breast self-exams are a good way for you to learn what your breasts normally look and feel like. When you know what’s normal for you, you're better able to notice changes and know when to get help early instead of waiting for your next checkup.

A self-exam is not a substitute for a mammogram or a clinical breast exam.

Most women who see a doctor for breast pain and lumpiness learn that they have fibrocystic, or cyclic, breast changes. Because this is a common condition that has nothing to do with cancer, this is good news. But if you have a new lump that does not go away after a menstrual period, it might not be cyclic. If you are not sure whether your symptoms are cyclic and harmless, see your doctor for a clinical breast exam.

Because fibrocystic breast pain and lumps are a noncancerous condition, most women who have it do not require additional exams or tests. If your doctor needs more information to make a firm diagnosis or if you need reassurance, your doctor may recommend:

In some cases, your doctor may also recommend:

  • A urine or blood pregnancy test if there is a chance that you may be pregnant. Breast tenderness and a missed period are signs of possible pregnancy.
  • A breast needle biopsy, which involves using a hollow needle to withdraw a small amount of tissue for testing.
  • An MRI, which uses a magnetic field and pulses of radio wave energy to provide computerized pictures of the breast. An MRI can show trauma, infection, inflammation, or tumors.

Treatment Overview

Most women who have fibrocystic breast changes or cyclic breast pain do not require treatment from their doctor. Cystic or tender breasts are a normal premenstrual condition, and fibrocystic changes do not lead to breast cancer. Unless your pain is severe and long-standing, home treatment measures are likely to relieve your symptoms. For more information, see the Home Treatment section of this topic.

Low-dose birth control pills (oral contraceptives) may help reduce cyclic breast tenderness and breast swelling before periods. This may be an option if you have cyclic breast pain and you also want to prevent pregnancy.

  • Birth control pills have very few serious side effects and may be taken safely by most nonsmoking women through their 40s.
  • Some women find that birth control pills make their breast symptoms worse. Breast pain can also be a side effect of birth control pills.2

In very rare cases, other prescription medicines are used to treat severe cyclic breast pain. Because all of these medicines can cause serious side effects, they are used only in cases of severe pain.

  • Danazol is a man-made form of the male hormone testosterone. This medicine stops your menstrual cycle and puts your body into a menopause-like state.
  • Bromocriptine reduces the production of prolactin, a hormone that is involved in breast development.
  • Tamoxifen blocks the effects of estrogen in the body. It is often used to treat breast cancer or to help prevent breast cancer in high-risk women.
  • Toremifene also blocks the effects of estrogen. One small study has shown that toremifene relieves breast pain and has fewer side effects than tamoxifen.3
  • Goserelin injections stop your ovaries from working. This stops your menstrual cycle and puts your body into a menopause-like state.1 Significant side effects include hot flashes and weakened bones (bone density loss).

Home Treatment

If you have cyclic breast pain that comes and goes with your menstrual cycle or fibrocystic breast changes, home treatment measures may be enough to help you manage any pain or discomfort. (If you have missed a menstrual period and have tender breasts, see your doctor for a pregnancy test before using home treatment.) The following home treatments may be helpful.

  • Wear a supportive bra or sports bra to restrict the motion of tender breasts.
  • Reduce dietary fat to 15% or less of your dietary intake. This may reduce breast pain over time. A small study has shown that making this long-term dietary change significantly reduces breast pain.4 For most people, though, this is a drastic change in their usual diet. Discuss extreme diet changes with your doctor.
  • Try a nonprescription pain reliever to help relieve pain. Your choices include acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. If this does not help, try applying an NSAID cream to your breasts 3 times a day.1, 5, 6 You can get NSAID cream with a prescription from your doctor.

Alternative medicines or supplements may help relieve breast tenderness, discomfort, or pain. As with all alternative therapies, it is important to follow the directions on the label. Do not exceed the maximum recommended dose. If you are or could be pregnant, talk with your doctor before taking any medicine or supplement.

You can buy vitamin and mineral supplements and herbal remedies in drugstores, grocery stores, and health food stores. Be sure to tell your doctor about any alternative medicines or supplements that you may try. Ask him or her how much is safe for you to take. Also be aware that some of these substances may interact with other medicines you are taking.

  • Magnesium. Magnesium supplements taken at the recommended daily allowance of 400 mg a day in the second half of the menstrual cycle (usually the 2 weeks before the next period) can relieve cyclic breast pain as well as other premenstrual symptoms.7 Some women with premenstrual syndrome have low magnesium levels, which are linked to abnormal levels of chemicals (prostaglandins) that increase pain and inflammation. Magnesium is also likely to improve premenstrual mood symptoms.8 Taking more than the recommended maximum of 400 mg a day can cause diarrhea.
  • Vitex (chasteberry). Although the action of vitex (Vitex agnus-castus) on the body isn't well understood, it does seem to change hormone levels that affect ovulation and estrogen production.8 Studies have shown that vitex improves breast tenderness, irritability, anger, bloating, cramping, and headaches.7 Several months of daily use are usually needed before it relieves symptoms. Possible side effects include acne, itchy skin or rash, nausea, headache, and fatigue.8, 9

There are some home treatments that seem to work for some women, but have not been proved as ways to help breast changes. These include:

  • Avoiding caffeine. Studies have not shown that avoiding caffeine relieves breast pain and generalized lumpiness.2 But some women feel that they have less breast pain and lumpiness when they decrease the amount of caffeine they consume. Eliminating caffeine from your diet may have other health benefits.
  • Taking vitamin E. There is no evidence that vitamin E relieves breast pain.1
  • Taking medicines that reduce water retention (diuretics). Research suggests that these medicines are not helpful for cyclic breast changes.4
  • Evening primrose oil. The oil of evening primrose is a rich source of gamma-linolenic acid (GLA), an essential fatty acid. The latest research has shown that evening primrose oil is no better than a placebo, even after 6 months of treatment for breast pain.1

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone: 1-800-ACS-2345 (1-800-227-2345)
TDD: 1-866-228-4327 toll-free
Web Address: www.cancer.org
 

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.


American College of Obstetricians and Gynecologists (ACOG)
409 12th Street SW
P.O. Box 96920
Washington, DC  20090-6920
Phone: (202) 638-5577
E-mail: resources@acog.org
Web Address: www.acog.org
 

American College of Obstetricians and Gynecologists (ACOG) is a nonprofit organization of professionals who provide health care for women, including teens. The ACOG Resource Center publishes manuals and patient education materials. The Web publications section of the site has patient education pamphlets on many women's health topics, including reproductive health, breast-feeding, violence, and quitting smoking.


References

Citations

  1. Bundred N (2007). Breast pain, search date January 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  2. Smith RL, et al. (2004). Evaluation and management of breast pain. Mayo Clinical Proceedings, 79(3): 353–372.
  3. Oksa S, et al. (2006). Toremifene for premenstrual mastalgia: A randomised, placebo-controlled crossover study. British Journal of Obstetrics and Gynecology, 113: 713–718.
  4. Fentiman IS (2004). Management of breast pain. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 57–62. Philadelphia: Lippincott Williams and Wilkins.
  5. Colak T, et al. (2003). Efficacy of topical nonsteroidal antiinflammatory drugs in mastalgia treatment. Journal of the American College of Surgeons, 196: 525–530.
  6. Qureshi S, Sultan N (2005). Topical nonsteroidal anti-inflammatory drugs versus oil of evening primrose in the treatment of mastalgia. Surgeon, 3(1): 7–10.
  7. Dog TL (2001). Integrative treatments for premenstrual syndrome. Alternative Therapies in Health and Medicine, 7(5): 32–39.
  8. Girman A, et al. (2003). An integrative medicine approach to premenstrual syndrome. American Journal of Obstetrics and Gynecology, 188(5, Suppl): S56–S65.
  9. Daniele C, et al. (2005). Vitex agnus castus: A systematic review of adverse events. Drug Safety, 28(4): 319–332.

Credits

Author Sandy Jocoy, RN
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Last Updated March 16, 2009

related physicians

related services

Bon Secours International| Sisters of Bon Secours USA| Bon Secours Health System

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Privacy Policy. How this information was developed to help you make better health decisions.

© 1995-2010 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.