Womens Health

Breast Pain, Fibrocystic Changes

Frederick R. Jelovsek MD

Breast Pain, Fibrocystic Changes

Fibrocystic changes of the breast

I've been told I have something like a bundle of grapes/tumors in the breast. Can you suggest some reading on this matter or somewhere I can find information to read up on and ask intelligent questions of my physician on my next visit?

I think what you might be referring to is fibrocystic breast changes or disease. There's not a lot of good material for such a common entity.

Here is a site I found:


I hope this helps.


Chest and breasts sore. Pregnant?

I just went to the doctor to see if I was pregnant and found out that I had the flu. The day after, my nausea and other symptoms went away, but my chest and breasts are sore! Could I be pregnant? My husband and I tried a couple of days before I saw the doctor. Could symptoms be setting in now?

Usually the time you can get pregnant is around two weeks before your menses is supposed to start. If you had relations only a few days before you got the test and the test were positive, it wouldn't be from that episode of relations, it would be from earlier. The pregnancy test from most home testing kits can turn positive about 4-5 days before a missed menses (9-10 days after conception) to 3-5 days after a missed menses (about 17-19 days after conception).

You could be pregnant and the test be negative so you should repeat it again in about 7-10 days.


Lump and pain around nipple area

I have a lump and pain around the nipple area of my right breast. It seems to be getting increasingly sore. What should be my course of action and how long should I wait to see if it subsides or disappears before seeing a physician. (I dislike doctors in general).

If the lump is mainly in the breast tissue and not under the areola or nipple then you can wait to see if it goes away after your next menses starts. If it doesn't, have it looked at by doctor. If it involves the nipple or areola or if there is any redness or heat (i.e. signs of infection) you need to see your doctor right away.

Almost all Ob-Gyn offices I know will work a woman in within a day or two for any breast mass or problem. It's a quick exam and the consequences of infection or possible cancer are serious enough to get anyone's attention. If it turns out to be something simple, that is ok; it happens often and no one is felt to be overreacting to want to be seen immediately.


Why does a 20 year old get fibrocystic breast disease?

I have just been diagnosed with FCD (fibrocystic breast disease) after visiting my doctor with complaints of terrible breast pain. I have started a regimen of vitamins B-6 and E once a day, also cut out caffeine, chocolate, etc....all of the "good stuff". My question is why does fibrocystic disease occur in a 20 year old? Also, I started birth control pills six months ago. Could the pills have caused or aggravated this?

A better term is fibrocystic breast changes, not disease or syndrome. This is because over 50% of women age 20-50 have these changes. It is considered a physiology rather than a disease. The normal breast glands seem to get stimulated by your hormones. It goes away after menopause. Why 50% of women get it and why 50% don't is not known. Perhaps genetic, certainly environmental factors such as food ingestion, fats, caffeine, chocolate etc make it worse. The steps you've started should get rid of the tenderness. Caffeine is especially bad. If after 3 months those dietary changes haven't improved the pain, you might severely cut the fats in your diet, even go vegetarian for about 3 months.

Most of the time, fibrocystic breast changes are decreased on birth control pills. Sometimes, however, I've seen certain progestins in different pills make it worse.


What hormone causes breast pain?

Which hormone - estrogen or progesterone - is responsible for breast pain just prior to a woman's menstrual cycle?

There are conflicting studies on this as you can see from the abstracts below. Often progesterone is cited as the culprit probably because breast tenderness is a symptom of the luteal phase when both hormones are present in higher levels. However, progesterone has also been used with success to treat cyclical breast pain. The best I can conclude is that it is the elevated estrogen levels in the second half of the cycle that are primarily responsible for the cyclic breast pain. However progesterone may be associated with noncyclic breast pain perhaps by some enhancing effect.

Double-blind controlled trial of progesterone vaginal cream treatment for cyclical mastodynia in women with benign breast disease.

Nappi C, Affinito P, Di Carlo C, Esposito G, Montemagno U.
Cattedra di Endocrinologia Ginecologica, Universita di Torino, Italy. J Endocrinol Invest 1992 Dec;15(11):801-6.

The clinical effectiveness and safety of vaginal micronized progesterone treatment in mastodynia were evaluated in a double-blind placebo controlled study. Eighty regularly menstruating women affected by severe cyclical mastodynia were randomly assigned to two groups of 40 patients. One group was treated for 6 cycles from the 19th to the 25th day of the cycle with 4 g of vaginal cream containing 2.5% natural progesterone. The other group was similarly treated with placebo. The treatment was preceded by a control cycle. All patients reported every day their breast pain on a 100 mm visual linear analogue scale (VAS). The response of breast tenderness and nodularity to treatment was assessed by clinical examination. Vaginal progesterone resulted significantly more efficacious than placebo in reducing mean ratings of breast pain on VAS and mean scores of breast tenderness to touch. Success of treatment, defined as reduction greater than 50% of basal mean score of breast pain on VAS, was achieved in the 64.9% of patients treated with progesterone and in the 22.2% of patients receiving placebo (p > 0.01). Conversely, at the end of treatment, the improvement in breast nodularity showed a not statistically significant difference between the two groups. No major side-effects were detected.

Influence of parenteral progesterones on the prevalence and severity of mastalgia in premenopausal women: a multi-institutional cross-sectional study.
Euhus DM, Uyehara C.
Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
J Am Coll Surg 1997 Jun;184(6):596-604.

More than 30 percent of women seen in surgical breast clinics suffer from mastalgia. Although the causes of mastalgia are poorly understood, imbalances in estrogen and progesterone effects in the breast have been implicated. Progesterones have been proposed as a treatment for mastalgia, but the literature supporting their use is conflicting and currently inconclusive. STUDY DESIGN: The prevalence and severity of mastalgia in women receiving parenteral progesterones for contraception was compared to that of a randomly selected, age-matched control group using a validated survey instrument. Surveys were completed by 671 case subjects and 1,433 randomly selected, age-matched control subjects. RESULTS: Nine percent of women using medroxyprogesterone acetate (Depo-Provera, Upjohn, Kalamazoo, Mich) reported frequent breast pain compared to 21 percent of control subjects (OR 0.220, p > 0.001). The prevalence of clinically significant breast pain was 2.3 percent in the progesterone group compared to 4.9 percent in the control group (p > 0.02). Focal, noncyclic mastalgia predominated in the progesterone group with continued breast pain (78.8 percent), while diffuse, cyclic breast pain was more common in the control group (67.7 percent, p > 0.001). CONCLUSIONS: Medroxyprogesterone acetate effectively suppresses cyclic mastalgia in reproductive-age women and warrants additional study as a primary therapy.


Fibrocystic changes

I became pregnant and had an abortion because we cannot afford a child just now. After this I developed breast tenderness especially on the sides which felt lumpy. Everyone said this was normal and not to worry. Ever since, about 4 days before my period, my breasts get fuller and painful lumps appear in the sides of my breasts. Now this happens even after my period. Is this normal or is it something serious?

Often, breast tenderness like you describe is due to fibrocystic change in the breast. Caffeine and chocolate make this worse. You may want to discontinue them. Have your doctor examine the breasts within about 10 days of the start of your menses and at least a month after discontinuing the caffeine and chocolate.


Pain/swelling under arms

For the past 4 to 5 menstrual periods I have noticed swelling and a dull ache in the lymph nodes under both arms. I went to the doctor about 2 months ago, for what I thought was an unrelated "rash" of red and white spots in my throat which was also quite sore. At the time the doctor thought I might have mono but did not do a formal test becaue he said that finding out for sure wouldn't change the course of treatment. (I suspect the main reason was the HMO wanted to save money). I mentioned the lymph node pain associated with my periods at that time, but I was not having my period then and on examination the doctor did not find anything unusual. I'm 34 and have never had this problem before. Is this normal?

Lymph nodes can sometimes appear swollen or become noticeable just before the menses because of fluid retention but such symptoms are otherwise unrelated to the menses. Under the arms, there may be the same lymph tissue or there can be breast tissue fairly high going into the armpit (axilla). There is no way to diagnose this specifically other than by biopsy. However, that is not usually done unless the process is very local and not general.

You and your doctors will need to keep looking for causes of the lymph node swelling that may be due to infection or inflammation.


Lesion and painful area in breast

I am 34 years old and recently went to my regular family doctor because of a painful lesion on my breast. Almost 2 years ago I had a questionable mammogram and a similar lesion on the same breast and I had a steriotactic biopsy. The biopsy reported no malignancy but nothing more. This time the doctor said nothing except that the lesion is superficial. I am not due for a regular mammogram for 3 months. Why does it hurt so bad underneath the lesion inside the breast? What should I do?

You should ask your family doctor for a referral to a breast specialist.


Fibrocystic pain

I have pain due to fibrocystic disease of the breasts. Are there vitamins or other things I can take to help reduce this problem?

Vitamin E and oil of evening primrose have been reported to help somewhat. However, neither of them appear to be as affective as discontinuing all caffeine and chocolate.



Breast soreness - fibrocystic disease

For the past 2 days both my breasts have been very sore and tender. They also seem to be a little bigger. I do have fibrocystic breast disease in my left breast. I also had 2 biopsies in my left breast almost 2 years ago and I have to go every year for a mammogram. My last period was just about 2 1/2 weeks ago so I don't think it would be premenstrual soreness. My tubes were tied after my last son who is now 6 1/2 so I doubt I would be pregnant. Any suggestions?

You are in the luteal phase of your cycle and breast tenderness is not uncommon then. If you have not had fibrocystic changes before in the right breast and have luteal phase tenderness, it may be that you have increased your caffeine or chocolate or something different dietary to give you this increased tenderness. It is hard to say if this is a permanent change or just a temporary, month or two change.. You will just have to wait and see. In general, pain is not a sign of breast cancer but almost always related to cystic change. There are exceptions. If this recurs in the next cycle, you may want to have an exam just to be sure there is not something more going on.


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