Breast Pain During Menopause: What’s Normal, What’s Not

Breast pain is often shrugged off as a normal part of being a woman—and it is: About seven out of 10 experience this discomfort at some point in their lives. ¹ Many women come to realize that achy, tender, heavy-feeling breasts are a telltale sign their period is days away. But then, when they enter perimenopause, things change. In addition to cyclical discomfort, breast pain can crop up at random times during the menopause transition.

Blame it on your hormones.

Understanding what causes perimenopause breast pain and what to expect during this time and after can help you find practical solutions to reduce any discomfort and recognize if something more serious may be going on.

About the Experts

Marilyn Lajoie, M.D., a physician who focuses on hormone health.

Nicole Sandhu, MD, an internist at the Mayo Clinic who works in the health system’s breast clinic.

What Causes Perimenopause Breast Pain?

The most likely culprit for perimenopause breast pain is the same unpredictable hormone shifts that cause other perimenopausal symptoms. Changes in breast tissue can also play a role. 

Hormonal fluctuations

The breast is a dynamic organ that constantly responds to hormonal fluctuations throughout the menstrual cycle. ^{2 3}  Estrogen and progesterone, two hormones that play a role in breast changes (among many other things), decline overall as you approach menopause, but they also fluctuate daily. 

Shifts in these hormones—as well as elevated prolactin levels during the luteal phase (which starts about 14 before menstruation)—can cause what’s known as cyclical breast pain. “It’s likely that the sensations experienced are due to the combination of tissue effects that the hormones have,” says Nicole Sandhu, M.D., an internist at the Mayo Clinic who works in the health system’s breast clinic.

Also called cyclical mastalgia, this type of pain typically starts three to five days before your period and stops when bleeding begins, says Marilyn Lajoie, M.D., a physician who focuses on hormone health. Research suggests this pain is often, but not always, part of PMS. ⁴ 

Some research also suggests that the sex hormone binding globulin—a protein that transports sex hormones in the blood—might contribute to cyclical breast pain by increasing levels of free estrogen, which could amplify fluid retention in breast tissue. ⁵

Changes in breast tissue

Yo-yoing hormones can also exacerbate a common condition called fibrocystic breast tissue, where small fluid-filled cysts and bumpy tissue form in the breast. When the cysts become inflamed, the breasts tend to be more sensitive. 

Estrogen dominance—when estrogen levels are high relative to progesterone—is believed to play a role in fibrocystic breast changes, Lajoie says. Before perimenopause, you might not have noticed any breast discomfort. But as your cycle becomes more erratic, breast pain can become more pronounced. If cysts grow significantly, your doctor may recommend an ultrasound or needle biopsy to rule out other conditions.

What Does Perimenopause Breast Pain Feel Like?

Breast pain during perimenopause can show up as: 

• Tenderness
• Swelling
• Heaviness
• A dull ache
• Nipple sensitivity 
• Sharp, stabbing pains in one or both breasts

The pain can range from moderate to severe. Most of the time, it develops in both breasts. It usually surfaces in the upper outside quadrant of the breast, Lajoie adds, and sometimes radiates into the underarm.

What Stage of Menopause Is Breast Tenderness Linked To?

The majority of breast pain during the menopause transition occurs during perimenopause. One study found 34 percent of women reported breast tenderness during early perimenopause. ⁶ 

Unfortunately, women who have cyclical breast pain during their reproductive years tend to have more severe tenderness and pain as they transition to menopause, says Lajoie. In a Mayo Clinic study, about a quarter of perimenopausal women reported extreme breast pain. ⁷

What Causes Breast Pain After Menopause?

Once you’ve gone a full year without a period, hormone fluctuations stabilize, and cyclical breast pain typically stops. However, post-menopause breast pain can still occur, often due to: ^{8 910}

• Cysts 
• Stretching of breast tissue 
• Trauma to the breast
• Hormone therapy
  

When Should You See a Doctor About Breast Pain?

While most breast pain in menopause is benign, see a doctor if you experience:

• Pain in a specific area of one breast, especially if you feel a lump or the skin is warm or red
• Changes in skin texture, such as dimpling
• Nipple inversion 

These symptoms don’t necessarily indicate cancer, but they warrant further evaluation, Lajoie says.

How to Treat Sore and Tender Breasts

If your breasts are sore, research has found some at-home remedies can help menopause breast pain:

• Apply a warm compress to promote blood flow
• Wear a supportive bra to reduce pressure on the breast tissue
• Using non-steroidal anti-inflammatory drug (NSAID) creams for pain relief
• Doing strength-training exercises such as pushups to help improve circulation to the breast tissue and pectoral muscles ¹¹

Lifestyle changes for menopause breast pain

Lifestyle changes, such as reducing caffeine intake, quitting smoking, eating a low-fat diet, taking B vitamins, and using evening primrose oil, may help alleviate breast pain, but the efficacy of these methods isn’t well-supported in research. ¹² Studies on them have produced inconsistent results. ¹³

However, the lack of high-quality evidence might have to do with the difficulty of performing double-blinded, randomized trials, Lajoie suggests. “Many times we rely on anecdotal evidence from our patients,” she adds. If you’re interested in trying these options for menopause breast pain, talk to your doctor. 

Can HRT help menopause breast pain?

For many women, the key to resolving cyclical breast pain during perimenopause is recalibrating unbalanced hormones, Lajoie says.

Hormonal replacement therapy (HRT, also called menopause hormone therapy or MHT) isn’t typically prescribed for breast pain alone, but if you’re taking it to relieve other perimenopause symptoms, you may find it provides some relief.

Lajoie warns that your breasts might be more sensitive initially as your body adjusts to new hormone levels. But after a few weeks, your body will adjust to this “new normal” hormonal state, and discomfort should subside.

Systemic HRT (delivered via patch, pill, or cream) is the most effective for addressing the root cause of perimenopausal symptoms like breast pain.

Other medications prescribed for perimenopausal symptoms might also help relieve breast pain, Lajoie adds. These include: 

• Antidepressants
• Gabapentin (a drug for nerve pain)
• Clonidine (a medication for high blood pressure)

Finally, there are a few drugs used specifically for breast pain (rather than for perimenopausal symptoms), but they have potential adverse effects and are typically reserved for severe pain that doesn’t respond to other treatments. Two are Tamoxifen, a drug best known for use in breast cancer treatment, and Danazol.