Pain During Menopause | PDF
By Robert Smink, MD
Lankenau Medical Center Surgeon
Most women have experienced breast pain at some point in their
lives. During the reproductive years it is often cyclic. Though
menopause brings an end to monthly cycles, women can still have breast
discomfort. The following article by Dr. Robert M. Smink of Lankenau
Medical Center discusses the sources for these symptoms and outlines
some treatment options. — Beverly
Vaughn, MD, Medical Coordinator, Menopause & You
Pain in the breast is a common symptom in women of all ages. In the
perimenopausal years this discomfort becomes more prominent primarily
due to the hormonal changes that occur during this significant event.
Although hormonal influences are the most common cause of pain at this
time, dietary effects, mechanical issues, or infection can also cause
pain. Breast cancer must also be considered; however, the vast majority
of breast tumors are painless. In addition, breast pain is frequently
asymmetric without any obvious explanation.
All female hormones, including estrogen, progesterone and prolactin,
have an effect on breast tissues. The cyclic production of these
hormones causes intermittent stimulation of tissues in the breast and
can therefore result in breast discomfort. Hormonal effects are most
obvious when the stimulation changes, especially during menopause. Thus
the perimenopausal years can be fraught with increasing complaints of
breast pain. This type of pain tends to have a cyclic quality. Most
commonly, the pain intensifies in the week prior to the onset of menses
and begins to resolve several days into the period.
During this time the patient may also notice fullness, lumpiness or
tenderness in the breast. These symptoms are classic for what is
referred to as fibrocystic "change" or "condition" but should not be
referred to as "fibrocystic disease". This symptom complex is entirely
normal in the menstruating or perimenopausal female; thus, it does not
represent a disease process. Frequently these symptoms abate within
several years following menopause. Unless women take hormone replacement
therapy following menopause, they rarely have cyclic, hormone-induced
pain once menopause has concluded.
In addition to the cyclic type of pain discussed above, women frequently
have pain from cysts which are sacs filled with fluid. The fluid is
frequently tan, yellow, green, grayish black, or in rare instances even
bloody. The fluid can be clear or cloudy in appearance. Only bloody
fluid is of any concern; all other fluids are completely normal. Cysts
are frequently caused by hormonal changes. They may present with either
localized pain or the appearance of a mass. Cysts can be diagnosed by
mammography, but ultrasound is a more sensitive modality for diagnosis
of a cyst.
When ultrasound confirms that a cyst is present and filled with clear
fluid, no further treatment is necessary. If the patient has pain or a
large mass is present, the cyst can be easily aspirated by the surgeon.
Aspiration is a virtually painless office procedure which takes but a
Dietary substances, such as a group of compounds called methylxanthines,
have been implicated in causing breast pain. These substances include
caffeine and chocolate, as well as certain wines and nuts. In the
absence of other obvious causes for pain, avoidance of these substances
is worth trying. Few patients achieve any significant degree of
improvement; and even then, it takes at least one to two months before
relief is noted.
Medications such as vitamin E and diuretics have not demonstrated any
significant improvement in clinical trials. Reassurance by the physician
is often sufficient to relieve the patient's anxieties. Other measures
such as sports bras, ice, or antiinflammatory medications can be
effective. However these symptoms tend to resolve over time even without
Breast infections are uncommon in peri- or postmenopausal patients. They
are associated with redness, swelling, or even drainage of pus. Since
the breast is covered by skin, any skin infection can also occur on the
breast. Most of these infections are treated easily with surgical
drainage or antibiotics, but must be differentiated from inflammatory
carcinoma of the breast, a rare but serious form of breast cancer. In
addition, pain in other organs can be attributed to the breast. Women
can present with pain believed to originate in the breast but which is
found to have another source. The most common such causes are muscle
strains or arthritis in the rib cage. Less frequently, patients present
with pain which originates in the lungs or even in the heart.
Another cause of breast pain in the postmenopausal patient is the
mechanical effect of gravity. As the supporting ligaments of the breast
weaken or rupture, the breast tends to "droop". This event can be
associated with pain as the breast pulls on the underlying muscle.
Again, use of a sports bra can be helpful in reducing the patient's
Finally, the issue of breast cancer cannot be overlooked in a patient
who presents with pain. As mentioned earlier, cancer is a rare cause of
breast pain. However, it must be investigated in all situations. The
physician will obtain a history, do an examination and then order tests
for more definitive diagnosis. These tests might include mammography,
ultrasonography, or even an MRI. A needle aspiration biopsy to obtain
cells from the area of concern may also be performed. If all of the
above studies are negative for evidence of breast cancer, then the
patient can be reassured that there is no malignancy present.
Breast pain is a common symptom in patients of all ages but particularly
in perimenopausal women. The vast majority of pain is caused by a benign
process. However, each patient should be evaluated carefully by an
experienced breast surgeon to rule out any serious underlying problem.
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
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