Premenstrual swelling and tenderness of both breasts occurs during the second half of the menstrual cycle.

Symptoms of premenstrual breast tenderness may range from mild to severe. Symptoms typically peak just before each menstrual period and improve immediately after or during the menstrual period.

Breast tissue may have dense, rough, "cobblestone" feel to the fingers -- usually more marked in the outer areas. There may also be an intermittent or persistent sense of breast fullness with dull, heavy pain, and tenderness.

During the menstrual cycle, estrogen production increases and peaks just prior to midcycle. This causes enlargement of the breast ducts. Premenstrually, progesterone peaks near the 21st day (in a 28-day cycle) and causes growth of the breast lobules (milk glands).

Premenstrual swelling and tenderness of the breasts is commonly associated with premenstrual syndrome (PMS) and fibrocystic breast disease (benign breast changes). Fibrocystic breast changes are not completely understood, but are believed to hormone related since the condition usually gets better with menopause.

Premenstrual breast tenderness and swelling probably occur to some degree in nearly all women. Symptoms severe enough to cause concern or limit function may occur in many women during their childbearing years. The rate may be lower in women taking birth control pills. Risk factors may include family history, a high fat diet, and too much caffeine.

• Menstrual cycle
• Estrogen medications
• Adolescent pregnancy
• Early pregnancy

Self-care tips include:

• Eating a lower fat diet
• Avoiding caffeine
• Avoiding salt 1-2 weeks before your period starts
• Getting vigorous exercise every day

You should perform a breast self-examination every month.

A well-fitting bra should be worn day and night to provide good breast support.

The effectiveness of vitamin E, vitamin B6, and herbal preparations such as evening primrose oil are somewhat controversial and should be discussed with your health care provider.

Birth control pills may be prescribed to decrease symptoms.

Diuretics (water pills) taken in the premenstrual phase may reduce breast swelling and tenderness.

A prescription medicine called Depo-Provera is available for those who experience premenstrual breast swelling and tenderness. This drug relieves symptoms by eliminating menstrual periods.

Danazol, a synthetic androgen (male hormone), may be used in severe cases when the potential benefit is thought to outweigh the possible bad side effects. If Danazol does not work for you, bromocriptine or tamoxifen may be prescribed.

Call your health care provider if:

• You have new, unusual, or changing lumps in breast tissue.
• You have one-sided (unilateral) lumps in breast tissue.
• You do not know how to properly perform a breast self-examination.
• You are a woman, age 40 or older, and have never had a screening mammogram.
• You have discharge from your nipple, especially if it is a bloody or brown discharge.
• Your symptoms are interfering with your ability to sleep and diet changes and exercise have not helped.

The medical history will be obtained and a physical examination performed. Medical history questions documenting premenstrual breast tenderness may include:

• Does the tenderness occur with every menstrual period?
• Do you know how to do breast self-examination?
• Have you noticed any breast lumps?
• What other symptoms are also present?

Your health care provider will check for breast lumps, and note the qualities of the lump (firm or soft, smooth or bumpy, and so on).

Diagnostic tests:

A mammogram or breast ultrasound may be performed to evaluate any abnormalities found in a breast exam. If a lump is found that is not clearly benign, a breast biopsy may be necessary.

Valea F, Katz V. Breast Diseases. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap. 15.

Braverman PK. Premenstrual syndrome and premenstrual dysphoric disorder. J Pediatr Adolesc Gynecol. Feb 2007; 20(1): 3-12.

Yonkers KA, O'Brien PM. Premenstrual syndrome. Lancet. 2008: 371(9619): 1200-10.