Know Thy Breasts

Know Thy Breasts

Date: 11 Nov 2017

Written by: Samantha Mainland

Ageing is a normal process in life, and as we age, we may notice some breast changes that are either temporary, permanent or life-threatening. It is important, that you keep an eye on your breast health, note any changes, and act accordingly. Your breasts should be loved, regularly examined and looked after.

Why do I get sore breasts before my period?

It is common for your breasts to become swollen, engorged, heavy or painful prior to a bleed. This pain, is known as mastalgia, and has been linked quite heavily to your hormones, namely oestrogen. However, whether this response is due to an increase in oestrogen levels, or an increase in oestrogen sensitivity is yet to be established. Throughout your cycle your oestrogen levels fluctuate, and it is during the second half of your cycle that your oestrogen builds. This is typically the time hormonal breast pain is felt. This oestrogen response can cause your milk ducts and glands to swell, trapping fluid in the breasts, creating a picture of swelling and engorgement. The increased size, and increased weight can result in pain and discomfort.

Hormonal breast swelling tends to significantly reduce, or stop, when you start to bleed, or before you finish bleeding. This cyclical breast pain is quite normal, however, it is usually not very severe. Pain that interferes with your quality of life, or impacts your day-to- day routine is not considered to be normal.

Why are my breasts hurting more now that I am in perimenopause?

Hormonal breast pain is commonly, and significantly linked to your oestrogen response. As we all perimenopause is a time where your hormones become unbalanced. It is the time that your progesterone temporarily ‘checks-out’ every other cycle, and your body has the potential to become quite sensitive to your hormones. Perimenopause is one of the most common times that your oestrogen and progesterone levels become unbalanced, tipping in favour of oestrogen, expressed as either oestrogen sensitivity, or oestrogen dominance. Either way, this whole time can be a nightmare. At the Australian Menopause Centre hear quite a bit about breast pain.

What does hormonal breast pain feel like?

Hormone related breast pain is the most common cause of the pain presenting in women in their 30s, 40s and 50s. As alluded to above, this type of breast pain is strongly considered to be the result of an oestrogen response. This breast pain typically occurs in both breasts and is described as achy and heavy, usually affecting the upper and outer sections of the breast, with some women explaining the sensation as a radiating pain extending to the underarm region.

The most logical and common reason behind hormonal breast pain revolves around oestrogen and its fluid retaining property. Perimenopause is a time for oestrogen dominance or oestrogen sensitivity, and this can quite commonly lead to the swelling and engorgement of the breasts, and result in breast pain. Often the feeling of pain comes from this swelling or heaviness. Most commonly, the pain is felt in both breasts.

Should I be concerned about breast cancer?

Everyone has a risk of developing breast cancer (even men). It is important that you are familiar with your breasts, and that you are aware of any changes as they occur. Fortunately, breast pain alone is not usually a sign of breast cancer. The most common symptoms of breast cancer include lump in the breast, changes to the skin of the breast (irritation, redness, discolouration, dimpling of the skin and/or a texture similar to that of an orange), nipple changes/discharge, and/or a lump under your arm. If you notice any of these symptoms, call your doctor and make an appointment.

What else causes breast pain?

Hormone fluctuations, namely oestrogen, are not the only causes for breast pain. Certain medications, including the oral contraceptive can lead to breast pain, so can incorrect HRT dosing, breast cysts, pregnancy, mastitis, fibroids, chest pain, strenuous exercise and incorrect bra size, to name a few. If you experience pain that does not settle with a bleed, or pain that disrupts your lifestyle, speak with your healthcare practitioner.

What can I do about it?

If your breast pain is interrupting your lifestyle, and your GP has cleared you of any serious causes, then it’s time to look at treatment options. If your breast pain is hormone related, call the friendly team at the Australian Menopause Centre. Further treatment options include:

Check your bra size. Your bra size should be professionally checked every time you buy a new bra. As your body changes, your bra size should also change.

>Evening Primrose Oil (EPO). There is evidence showing that low levels of the essential fatty acid gamolenic acid can contribute to cyclical breast pain. EPO is rich in gamolenic acid, and many of our women have found significant benefits.

Adjust your diet. Some people have found that limiting their caffeine and alcohol intake, as well as reducing the bad fats have reduced the severity of breast pain.

Stress less. Interestingly, stress has been found to be involved in the severity of the pain. Consider relaxation techniques like meditation, reading or aromatherapy.

Does the use of bio-identical hormones increase my risk of breast cancer?

Back in 2002, the results from the Women’s Health Initiative (WHI) were released – a large trial looking at the effect of long-term use of synthetic progestogen (Provera) and synthetic oestrogen (Premarin) in women. The trial was stopped early because it showed that women who were prescribed this combination had a higher risk of developing breast cancer. Once the results were analysed, it became clear that this increase in breast cancer risk related to the use of synthetic progestogen (progestin). The International Menopause Society states: ‘the increased risk of breast cancer thus seems primarily, but not exclusively, associated with the use of a progestin with oestrogen therapy’. The use of progestin also demonstrated an increased risk of developing heart disease and deep vein thrombosis (DVT) when used in combination with oestrogen. Side effects from progestin include mood swings, depression, and fluid retention.

In contrast, with the introduction of bio-identical progesterone, a hormone that is biochemically identical to human progesterone and sourced from a plant (wild yam), there is a significantly lower risk of developing breast cancer, it has been shown to be safer for heart disease than the synthetic progestins and it has a lower risk of causing a deep vein thrombosis. Side effects in women using bio-identical progesterone are minimal.