Breast tenderness

Pain, aching or tenderness in one or both breasts.

The Pakistan Menopause Society lists breast tenderness among the body symptoms of early perimenopause, with headaches, joint and muscle pains and bloating (Table 1). The NHS website lists hormone changes during the menopause among the causes of breast pain.

The NHS website describes breast pain linked to periods as dull, heavy or aching, often in both breasts, sometimes spreading to the armpit. Tender to touch. Sore when you lie on your front. Heavier than usual.

It can also arrive with HRT. NHS inform, the Scottish health service's site, says both hormones in HRT can cause side effects, and lists breast tenderness or swelling among them.

The NHS website points to hormone changes during the menopause, and the Pakistan Menopause Society lists breast tenderness among the symptoms of early perimenopause. Neither goes further into why.

Other things can cause breast pain too. The NHS website lists injuries or sprains to the neck, shoulder or back felt as breast pain, medicines such as the contraceptive pill and some antidepressants, conditions such as mastitis or a breast abscess, and pregnancy.

NHS inform suggests:

• painkillers such as paracetamol or ibuprofen, or a painkilling gel rubbed into the sore area
• a well-fitting, supportive bra, and a well-fitting bra at night too if that helps

The NHS website notes there is little evidence that vitamin E tablets or evening primrose oil help.

If the soreness started with HRT, NHS inform says side effects usually ease over time and to see a GP if they carry on after 3 months. The NHS website also says to speak to a GP if they are severe. The Pakistan Menopause Society lists breast tenderness among the side effects of estrogen that prescribing at the lowest effective dose aims to reduce (section 5.12). Changing the dose, type or route is for your prescriber to decide with you, and HRT risks and benefits covers the wider picture.

The NHS website says to see a GP if breast pain is not improving or painkillers are not helping, or if there is breast cancer in your family.

It says to get an urgent appointment if:

• there is a hard lump in your breast that does not move
• you have nipple discharge, which may have blood in it
• one or both breasts change shape
• the skin looks dimpled, like orange peel
• there is a rash on or around the nipple, or the nipple has turned inwards
• part of the breast is red, hot or swollen, or you have a fever with the pain

The Pakistan Menopause Society also lists a breast lump, nipple discharge or skin change among its red flags, and asks doctors not to delay checking suspicious symptoms (section 2.3 and Table 4).

For many women, the hardest part is not the pain but the examination. Being seen by a stranger, uncovering in a clinic, explaining it to a husband. These are real reasons women put off a check, and they are worth planning around rather than ignoring. Whether a female doctor is available, and whether you can bring someone with you, are fair questions to ask when you book.

The Pakistan Menopause Society says a breast examination should be done when symptoms, risk factors or screening call for it, not routinely for every woman (Table 2). It also asks doctors to promote breast screening suited to a woman's age and risk (Table 4). Breast health covers screening.