PMS (Pre-Menstrual Syndrome) is the name given to the physical and emotional symptoms affecting women's daily life in the 2 weeks before expected period or menstruation. These symptoms usually get better once the period starts and often disappear by the end of period. Nearly all women have some premenstrual symptoms. Each woman's symptoms are unique ranging from simple feeling low, mood changes to bloating or sore breast. The possibility of severe PMS affecting quality of life of a woman and indirectly affecting her social and family is rare, may be 2 and 4 in 100.
Every woman in her life span experience breast pain or discomfort also called as 'Mastalgia'. The most important point to note is, it is rarely associated with breast cancer.
Breast tissue respond to women's hormone i.e., estrogen and progesterone. The amount of milk glands and ducts comparatively more are in younger age than peri-menopausal age, compared to fat, fibrous tissue, lymph nodes, veins and nerves. This can give feeling of lumpiness in young women.
During first half of the menstrual cycle, under the effect of estrogen hormone, there is growth of the milk glands and ducts. During the premenstrual phase, or 10-14 days before next period, levels of the progesterone hormone rise, causing breast tissue to swell and become tender. Additionally, it also causes to water retention . This gives rise to bloating, i.e., fluid retention which can increase bra size and add to breast tenderness. Increased stress can make woman more prone to developing sore breasts, along with other emotional or psychological symptoms of PMS.
With the onset of periods or menstruation there is sudden and significant drop in both these hormones and the breast tissue revert back to normal, hence the pain disappears.
Most common as 2 out of 3 women who are menstruating can experience it. The pain usually affects the outer and upper parts of both breasts, and it might involve your underarm area as well. Sometimes breasts may also become larger, tender and slightly lumpy in the week or so before a period .It affects both the breasts and start 10-12 days prior a period, may become unbearable 2-3 days prior actual onset of the bleeding.
This does not have pattern and common in postmenopausal women. The pain or discomfort or soreness is localised in one area (or areas) of the breast and never uniform in both breasts. The pain may be constant or it can come and go. It can be due to trauma, muscular pain of shoulder or chest muscles, infection, if breastfeeding or costochondritis. It usually responds to painkillers
The cyclical pain quite often settles by itself within 3-6 months, but can come back from time to time.
The treatment options can be dietary modifications (reduction of caffeine intake and animal fat), wearing correct size supportive sports bra, local application of pain relief spray or gel or cold compresses. Review of medications like birth control pills or Hormone replacement therapy can help to treat mastalgia. Sometimes anti-depressants may be used to relieve cyclical breast pain. Oral pain killers or Evening Primrose oil or Vitamin E supplement are commonly used for 3-4 months as a first line of treatment for young women. Occasionally for severe pain the last option is to use drugs to block oestrogen hormone like danazol or tamoxifen which needs to be taken regularly and have significant side effects.
About the author: Dr. Vaishali Joshi is a senior obstetrician and gynaecologist at Kokilaben Hospital, Mumbai
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