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. Premenstrual swelling and tenderness of the breasts is commonly associated with premenstrual syndrome (PMS) and fibrocystic breast disease (benign breast changes). The cause of fibrocystic breast disease is not completely understood, but is believed to be associated with ovarian hormones since the condition usually subsides 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 as many as 60% to 70% of women during their childbearing years. The incidence may be lower in women taking oral contraceptives (birth control pills). Risk factors may include family history and diet (excessive dietary fat or caffeine intake).
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