Fibrocystic breast disease

Definition

Fibrocystic breast disease is a commonly used phrase to describe painful, lumpy breasts.

The word "disease" may make you worry that the breasts are abnormal. However, doctors say this is not really a disease. Some doctors or nurse say "fibrocystic change" intstead.

Alternative Names

Mammary dysplasia; Diffuse cystic mastopathy; Benign breast disease

Causes

Hormones made in the ovaries can make a woman's breasts feel swollen, lumpy, or painful before or during menstruation each month. 

Some women feel that eating chocolate, drinking caffeine, or eating a high-fat diet cause their symptoms, but there is no clear proof of this.

Fibrocystic changes in the breast with the menstrual cycle affect over half of women. It most commonly starts during the 30s. Women who take birth control pills have fewer symptoms. Women who take hormone replacement therapy may have more symptoms. Symptoms usually get better after menopause.

Symptoms

Symptoms are usually worse right before the menstrual period, and then improve after the period starts.

Symptoms can include:

• Pain or discomfort in both breasts
• The pain commonly comes and goes with the period, but can last through the whole month
• Breasts that feel full, swollen, and heavy
• Pain or discomfort under the arms
• Thick or lumpy breasts

You may notice a lump in the same area that becomes larger before your menstrual cycle, and then shrinks afterward. These type of lumps will move if you push on them. They do not not feel stuck or fixed to anything.

Some women will have discharge from the nipple. If the discharge is clear, red, or bloody, talk to your health care provider right away.

Exams and Tests

Tell your doctor or nurse if you notice any breast changes. 

Your health care provider will examine you. This will include a breast exam.  

Ask you doctor or nurse how often you should have a mammogram to screen for breast cancer. Usually women should have a mammogram every year, beginning at age 40.

You may need further tests if you have:

• A lump found during a breast exam
• Abnormal screening mammogram

Another mammogram and breast ultrasound may be done.

Treatment

If you have painful breasts, the following may help:

• Take medication such as acetaminophen or ibuprofen
• Use heat or ice on the breast
• Wear a well-fitting bra

Although some women believe that eating less fat, caffeine, or chocolate helps with their symptoms, there is no good evidence that this helps.

Vitamin E, thiamine, magnesium, and evening primrose oil are not harmful in most cases, but they have not shown any benefit in most studies. Before taking any medication or supplement, be sure to talk with your health care provider.

Most women are not as worried about their symptoms if their breast exam and imaging tests are normal. Remember that most of these symptoms will go away over time.

Outlook (Prognosis)

Fibrocystic breast changes do not increase your risk of breast cancer. Symptoms usually improve after menopause.

Possible Complications

Women who have very lumpy breasts may be more difficult to examine. Mammograms may be harder to interpret. Therefore, early cancer might be more difficult to detect.

When to Contact a Medical Professional

Call your health care provider if:

• You find any new or different lumps on your breast self exam
• You have a new discharge from the nipple or any discharge becomes bloody or clear
• You have any redness or puckering of the skin, or flattening or indentation of the nipple

Prevention

There is no proof that anything you do or don't do will prevent symptoms.

References

Miltenburg DM, Speights VO Jr. Benign breast disease. Obstet Gynecol Clin North Am. 2008;35:285-300.

Valea FA, Katz VL. Breast diseases: diagnosis and treatment of benign and malignant disease. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 15.

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