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Answered By:


Julie Gralow, MD

Associate Professor of Medical Oncology University of Washington School of Medicine Seattle, WA

Q:

I am 52 years old and have not had a period for three months. Now, my breasts hurt so bad I can hardly sleep on them. They're sore and tender all the time. In the past, they have been sore right before my period for a couple days, but never for this long. Do I need to worry about anything, or is this probably menopause setting in?

A: 

You're right to consider that menopause is setting in. Only it's important to get the language right; "menopause" per se is really only one day in a woman's life: the day at which she reaches 12 consecutive months without a period. You're currently in the perimenopausal stage, which may last anywhere from a few months to several years.

Changes in your menstrual cycle are a key marker of perimenopause. They often come more frequently than the typical 28 days, you may skip cycles, your menstrual flow may be lighter, heavier or spottier than normal. You may also find your period lasts longer - or for just a couple of days. In other words, all bets are off in terms of predicting the timing, duration and severity of your menstrual cycle once you reach perimenopause.

Having said that, it is quite likely that you are approaching the actual menopause. The average age of menopause in this country is 51.4 years, but normal menopause it can occur any time between age 40 and age 58.

Now let's talk about your breast pain. Breast pain is one of the most common symptoms women experience. There's even a medical name for it: mastalgia, and it's been written about in the medical literature since the early 1800s.

Various studies show various prevalence rates; in one study of 1,171 women attending an ob-gyn clinic in the United States, 69 percent said they experienced regular breast pain before their periods, while 11 percent had moderate to severe breast pain more than seven days a month.

Despite how common it is, however, few women tell their health care professional about their discomfort.

You said in your letter that you typically experienced breast pain before your period. That's very common, with many women reporting tenderness, swelling, pain and lumpiness before their periods. If you have severe pain that goes on longer than just a couple of days before your periods but occurs regularly in conjunction with your period, you're considered to have "cyclic mastalgia." Studies find most women with this kind of pain describe it as "dull, heavy or aching." It's not something to be taken likely, since it can significantly affect your quality of life.

This kind of breast pain, while most common premenopausally, can also occur during perimenopause. As might have guessed, hormonal changes-whether those of your menstrual cycle or those occurring during perimenopause-are thought to be at least partly responsible for the discomfort, but no specific cause-and-effect has been identified.

What you're experiencing may be considered non-cyclic mastalgia, constant or intermittent pain that isn't associated with your menstrual cycle. It accounts for about a third of women seen in breast pain clinics. This kind of pain is most prevalent in postmenopausal women. It can be associated with the use of estrogen and/or progesterone hormone therapies, or be related to some change in your anatomy.

Generally, if it is associated with breast cancer the pain is on both sides, constant and very intense. It is also very rare; in studies looking at the connection between noncyclical breast pain and breast cancer, just two to seven percent of those who came the clinic with breast pain as their only symptom had breast cancer.

So, let's sum up: You probably are close to reaching menopause and your breast pain is most likely related to hormonal changes occurring in your body. Having said all that, I'd still recommend you visit your health care professional if the pain doesn't go away in a week or so. It might also be time for a visit to your gynecologist to talk about menopause and what you might expect.