The link between breast discomfort and menopause

Aches and pains in midlife can sometimes feel like a collection you started by accident: knee one day, lower back another, neck by the weekend. And then you enter the menopause transition and can add a new one to your list: breast discomfort.

Breast pain can affect up to 70% of women at some point in their lives, and it becomes more common during the menopause transition as the result of fluctuating hormones. This guide will explain what’s typical for breasts during the menopause transition, when you should seek medical care, and treatments to help you feel more comfortable when dealing with breast tenderness in menopause.

Perimenopause, or the period leading up to menopause, can cause breast tenderness as a result of your hormones going up and down (this is the same reason you might have noticed tender breasts during specific parts of your menstrual cycle). But once you become postmenopausal, your hormones don’t fluctuate as much and breast discomfort often becomes less common. 

Types of breast pain and typical patterns

The two main forms of breast pain to be aware of are cyclic and noncyclic.

Cyclic breast pain

Cyclic breast pain is the most common form. It is usually mild to moderate in intensity, more generalized, and bilateral (meaning it happens in both breasts). It’s primarily linked to menstruation and the monthly fluctuations of estrogen and progesterone. These hormones can have a stimulating effect and can increase the number and size of milk ducts and glands in the breast, causing it to retain water. As a result, women may experience painful, tender, and lumpy breasts a few days prior to menstruation. The discomfort may also spread to the armpit and arm, but tends to subside after menstruation. 

This link to hormones is why cyclical breast pain may increase in perimenopause (the phase of menopause when estrogen and progesterone levels fluctuate erratically). Some studies have found the symptoms resolve with the onset of menopause, as levels of the hormones become more steady.

Noncyclic breast pain

Noncyclic breast pain is less common than cyclical, occurring in just one-third of cases. It’s linked to structural or anatomical factors rather than hormonal ones, and doesn’t follow an obvious pattern. It is often unilateral (one breast) and may affect the whole breast or just a part of it.

Pain may be caused by the stretching of breast ligaments (due to large breasts), injury, or breast surgery. But it could also be the result of cystic or solid breast masses, or a benign tumor. Noncyclic breast pain can also be caused by malignancy (a cancerous tumor), so it’s important to seek medical advice to determine the cause.

Studies suggest that noncyclic breast pain usually affects women who are over 40, and often those who are perimenopausal.

Perimenopause breast pain may feel different from other types of breast pain experienced earlier in life. It may include burning, soreness, sharp, throbbing, or stabbing pains.

Breasts’ composition shifts as you get older. As estrogen levels drop through menopause, the gland tissues shrink, and the breasts appear less full. The connective tissues supporting the breasts become less elastic, so they have less support, which may contribute to discomfort. Fluctuating estrogen and progesterone during perimenopause can also influence fluid retention and breast tissue sensitivity — causing sore breasts.

What changes after menopause

You reach menopause 12 months after your last period. At this point, your hormones stabilize at a much lower level than they were before perimenopause. This means that cyclic tenderness usually lessens. That said, you may still experience breast tenderness after menopause, as noncyclic pain isn’t influenced by hormones.

It’s natural to be worried by pain in your breast, especially if it's new, which is why it’s always good to bring it up with your clinician. While breast pain doesn’t usually mean cancer, there are some signs you should look for that would imply something more serious is going on.

Symptoms of breast cancer include but are not limited to:

• New lump in the breast or armpit

• Thickening or swelling of any part of the breast

• Skin change — like irritation or dimpling

• Nipple change — it may become inverted, or you might notice redness or flaky skin around the nipple or breast

• Unusual discharge from either nipple

• Pain in the breast or nipple

• Change in the size or shape of the breast

When to worry about breast pain after menopause

If you experience redness, a fever, pain that’s focal (localized to one specific area), wakes you from your sleep, or persists for longer than a few weeks, you should visit your clinician. Any breast pain after menopause should also be checked out.

If your breast pain comes with any of the breast cancer symptoms listed above, or if you experience shooting pains, aches, or burning feelings in either or both breasts, it’s important to visit your clinician. They may decide to perform a mammogram, ultrasound, MRI, or biopsy to figure out what’s going on.

What to bring up at your medical visit

Knowing what to tell your clinician may help you to feel empowered at your menopause and breast pain appointment. Try to keep a recent symptom log, ensuring you’ve noted down the following:

• Where you have pain

• When it hurts

• Menstrual cycle history 

• Any new medications 

• Your caffeine intake

• Any changes to how your bra fits

• Family history of breast cancer

• Prior breast imaging

While breast discomfort that impacts your quality of life warrants clinical advice, you may be able to find relief for mild breast pain during menopause with the following lifestyle strategies.

• New bras: Wearing the right bra size provides you with support and can help reduce pain — and it’s estimated that 70% of women are wearing the incorrect size! A bra fitting can help you figure out what size you should be wearing. It may also help to wear a sports bra when sleeping if the pain is bothersome.

• Diet tweaks: Some women find that avoiding caffeine and nicotine may provide some breast pain relief in menopause.  Experiment by cutting back on coffee, chocolate, tea, and soft drinks to see if that helps. You may also notice less pain if you reduce your saturated fat intake and eat more unsaturated fatty acids and fiber instead.

• Natural remedies: Studies suggest that, alone or in combination, evening primrose oil and vitamin E (an antioxidant) may provide relief for breast pain. Talk with your clinician before taking a supplement to make sure it’s safe for you.

• Ice packs or warm compresses: A cold compress may help to reduce swelling, while a warm compress may help to soothe the muscles around the breast.

• Non-steroidal anti-inflammatory drugs (NSAIDs): Occasional use of painkillers like NSAIDs or acetaminophen is sometimes used as treatment. Remember to seek advice from your clinician for any over-the-counter options to help with sore breasts in menopause.

• Exercise: The release of endorphins from physical activity could have a positive impact on your sensitivity to pain.

• Relaxation therapy: Psychological issues may lead to physical illness. This is why studies suggest that yoga and meditation may be effective in reducing hormonal breast pain.

Medications may be advised by your clinician if you have severe breast pain from menopause, or if the pain has not gotten better with non-medication strategies.

NSAIDs (like ibuprofen) and acetaminophen are effective in 80% of women with breast pain and usually cause minimal side effects. Your clinician may prescribe stronger doses of the painkillers or topical forms that go right on your skin (this can help you avoid GI issues that come from using NSAIDs for a prolonged period of time). Danazol is a prescription medication specifically FDA-approved to treat breast pain. 

As with any medication, it’s essential to understand individual risks and benefits. And once you start a treatment plan, it’s important to follow up with your menopause care clinician if you notice any side effects. 

Menopausal hormone therapy and breast pain

In some women, prescription hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), may relieve their breast pain. Or it could make the pain more predictable. 

On the other hand, breast tenderness can also be a side effect for some women on HRT — especially in older women and women furthest from  menopause. Your clinician may suggest adjusting the dosage or form of menopause medication if symptoms are bothersome.

As well as breast discomfort, some women may also experience changes in nipple sensitivity or feel sensations of itchiness on their breasts during menopause. Nipple changes may be a symptom of breast cancer, so you should see your clinician if you notice any, including any discharge or if they become inverted.

Ongoing or new breast pain after menopause could be noncyclic or caused by factors outside the breast. These include (but are not limited to):

• Infection: An infection of the breast or an abscess could cause pain.

• Injury: Trauma to the breast can result in localized pain.

• Medications: Some prescription medications may cause breast pain, like certain cardiovascular disease and psychiatric medications.

• Support problems: Heavy breasts may stretch ligaments in the breast and cause shoulder, back, neck, and breast pain.

• Costochondritis: This is an inflammation of the costal cartilages, which join the ribs to the breastbone. It can cause a burning sensation in your breast. 

• Cancer: In rare cases, breast pain could be a symptom of cancer. Rule out this possibility by talking about your breast pain with your clinician.

• Arthritis: In the neck or upper back, arthritis could affect sensory nerves and cause numbness or breast pain.

Never ignore any concerning changes. Remember that any pain that’s persistent or concerning warrants advice from a clinician.

A breast pain evaluation will typically include a discussion of your medical history, an exam, a risk review, and imaging if needed. Your clinician will work with you to determine the best course of action and devise an appropriate menopause care plan.

Safety first: screening and follow‑up

It’s important to be up to date with your breast cancer screening and seek medical care with your clinician if you experience breast pain. A thorough clinical assessment and breast imaging (if recommended) is important to rule out anything concerning. 

Getting checked out by your clinician may help to reduce the anxiety you have around breast changes or pain, improve your quality of life, and help you to feel empowered over your menopause journey.

Make sure to follow up with your clinician, too, if symptoms change or don’t improve.

To best advocate for yourself in your breast pain evaluation, come prepared with information about your symptoms. This way, you can feel empowered when discussing your concerns and asking for perimenopause or menopause support.

A checklist to prepare for your clinician visits could include:

• Symptom timeline

• Any triggers or patterns you may have seen

• Current medications and supplements

While breast pain can be worrying, remember that perimenopausal breast tenderness is common and often manageable. As always, speak to your clinician if you experience any new or concerning symptoms, and seek medical advice for persistent pain, pain accompanied by other changes, or pain localized to one specific area. 

Work with your clinician to tailor menopause relief, rule out concerning causes of breast pain, and feel empowered on your menopause journey.