Fibrocystic Breasts

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 lumpy breasts can make it harder to find a lump that could be cancer. If you have fibrocystic breasts, it is important to learn how to do a breast self-exam. Checking your breasts each month will help you know if an abnormal change occurs.

See a picture of the 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.)

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

How are fibrocystic breast changes diagnosed?

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. Doing regular breast self-exams can help you know how your breasts normally feel. This can help you spot any changes that could point to a problem.

How are they treated?

Fibrocystic breast changes are normal. You do not need to do anything about them. If your symptoms bother you:

• Take an over-the-counter pain medicine like acetaminophen (such as Tylenol) or ibuprofen (such as Advil).
• Wear a bra that gives your breasts good support.

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 birth control pills. In 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.

Frequently Asked Questions

Fibrocystic breast changes can affect one or both breasts. 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. 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 in their 30s, when their hormone system begins to change and hormone levels tend to fluctuate more than before.

Should I see my health professional?

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 health professional 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.
• 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.

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

Most women who see a health professional for breast pain and lumpiness learn that they have fibrocystic, or cyclic, breast changes. Since this is a common condition that has nothing to do with cancer, this is good news. If you are not sure whether your symptoms are cyclic and harmless, see your health professional 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 health professional needs more information to make a firm diagnosis or if you need reassurance, your health professional may recommend a mammogram or a breast ultrasound.

In some cases, your health professional 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 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.

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

Birth control pills (oral contraceptives) may help reduce cyclic breast tenderness and breast swelling before periods. This may be an option if you have symptoms caused by generalized breast lumpiness 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 worsen their breast symptoms. Breast pain can also be a side effect of birth control pills.¹

Rarely, other prescription medications are used to treat severe cyclic breast pain. Because all of these medications 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 medication 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 in the treatment of breast cancer.

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 health professional 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.² For most people, however, this is a drastic change in their usual diet. Discuss extreme diet changes with your health professional.
• Use nonprescription pain medication, such as acetaminophen or ibuprofen, to help relieve pain.

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 health professional before taking any medication 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 health professional about any alternative medicines or supplements that you may try and 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 may be taking.

• Magnesium. Magnesium supplements taken at the recommended daily allowance of 400 mg per 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.³ 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.⁴ Taking more than the recommended maximum of 400 mg per day can cause diarrhea.
• Evening primrose oil. The oil of evening primrose (Oenothera biennis) is a rich source of gamma-linolenic acid (GLA), an essential fatty acid that is thought to lessen the effects, such as pain, of prostaglandins. It may offer mild relief of breast tenderness.⁵ Research has produced mixed findings—some studies suggest that evening primrose oil relieves breast pain, and others have found no benefit.¹
• 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.⁴ Studies have shown that vitex improves breast tenderness, irritability, anger, bloating, cramping, and headaches.³ Several months of daily use are usually needed before it relieves symptoms. Possible side effects include nausea and fatigue.⁴

Home treatments that have not been proven to help breast changes include.

• Avoiding caffeine. Studies have not shown that avoiding caffeine relieves breast pain and generalized lumpiness.¹ However, some women feel that they have a decrease in 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 or generalized lumpiness.¹
• Taking medicines that reduce water retention (diuretics). These medications are not helpful for cyclic breast changes.²

Book

Organizations

• Premenstrual Syndrome (PMS)

Citations

1. Smith RL, et al. (2004). Evaluation and management of breast pain. Mayo Clinical Proceedings, 79(3): 353–372.

2. 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.

3. Dog TL (2001). Integrative treatments for premenstrual syndrome. Alternative Therapies in Health and Medicine, 7(5): 32–39.

4. Girman A, et al. (2003). An integrative medicine approach to premenstrual syndrome. American Journal of Obstetrics and Gynecology, 188(5, Suppl): S56–S65.

5. Dickerson LM, et al. (2003). Premenstrual syndrome. American Family Physician, 76(8): 1743–1752.

Other Works Consulted

• Whitaker-Worth DL, et al. (2000) Dermatologic diseases of the breast and nipple. Journal of the American Academy of Dermatology, 43(5, Part 1): 733–751.

Author:	Kathe Gallagher, MSW	Last Updated March 28, 2005
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine C. Dale Mercer, MD, FRCSC, FACS - General Surgery
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