Premenstrual Congestion of the Breasts
Dr. Nelson Soucasaux , Brazilian gynecologist
Among all signs and symptoms that characterize the premenstrual syndrome,
mammary (breast) swelling, engorgement and pain constitute some of the more
frequent ones. Even many women who do not complain about other premenstrual
disturbances often report variable degrees of mammary congestion and/or
pain on the days that precede menstruation. As I have observed in my article
"Premenstrual syndrome," mammary congestion
and engorgement are the most frequent objective premenstrual manifestation
and, therefore, the one that is more easily verified at clinical examination.
This happens because the increase of density and volume of the mammary parenchyma
thickenings and nodules that characterize the so-called "functional
mastopathies" (or "benign functional alterations of the breasts")
become more evident in the premenstrual phase. In turn, this premenstrual
increase in the density and thickness of the mammary tissues is mostly due
to the premenstrual congestion and swelling of the breasts.
Even so, concerning the precise etiology (cause) of this mammary congestion
that frequently occurs a few days or a week before the coming of the menses,
we have to recognize that it still remains obscure in the same way
as that of the other edemas and congestive phenomena that take place in
other parts of the female body with the premenstrual period. However, I
would like to remark once again that it is exactly in the breasts that the
water retention and the congestive phenomena that often precede menstruation
become more evident and easily detectable at clinical examination. In this
way, besides the probable action of local causative factors at the mammary
level, there are also indications suggesting the existence of a wider inter-relation
among all premenstrual edematous and congestive manifestations.
The cyclical premenstrual engorgement of the breasts becomes clinically
evident by: 1) a more or less diffuse increase in the volume and/or turgescence
of these organs; 2) an evident increase in the thickness and volume of their
glandular and ductal structures, as well as of the connective tissue that
surrounds them. As it is widely known, all these alterations often go along
with various painful phenomena that occur spontaneously or induced by a
simple touch or pressure. It is important to observe that considerable variations
in the intensity of all those manifestations can be found in the same woman
from one breast to the other a fact that demonstrates the importance
of the specific response of the "target" organ in relation to
the stimuli that cause the congestive reactions. In a similar way to what
happens to most of the other signs and symptoms that appear on the days
that precede the menses, this cyclical premenstrual mammary congestion and
pain also decline quickly with the beginning of menstruation.
Remaining on the etiology of this premenstrual engorgement of the breasts,
it is possible that, in this phase of the cycle, there can be very specific
reactions of the mammary tissues to the estrogens and progesterone to the
interaction between these hormones and/or to the fall of their respective
levels. These very specific reactions might give rise to a local formation
of substances capable of altering the permeability of the capillary vessels
of the breast tissues, resulting in the accumulation of interstitial fluid
and the consequent congestive phenomena. The already mentioned variations
in the intensity of these phenomena from one breast to the other in the
same woman reinforce this hypothesis. On the other hand, the mammary premenstrual
congestion can also be regarded as being only a more localized manifestation
of the systemic water retention that many women present on the days that
precede menstruation and that is part of the premenstrual syndrome .*
Also due to this premenstrual mammary engorgement, women whose breasts
present the thickenings and increased nodularity that characterize the "functional
mastopathies" (or "benign functional alterations of the breasts")
often suffer from stronger premenstrual mammary pain and discomfort.
For years, several treatments have been used and proposed for this premenstrual
mammary congestion and pain. The traditional treatments are commonly based
on the use of hormones (mostly progesterone and progestogens ** ) and diuretics
that cause the elimination of sodium and water, with a consequent reduction
of the mammary edema. Other medicines have also been tried in the last years.
Therefore, it is fundamental to emphasize that each case needs to be carefully
analyzed individually so that the correct treatment can be prescribed.
Though there is no relation between the usual premenstrual mammary congestion
and breast cancer, I would like to emphasize that the clinical management
of all breast problems must necessarily include, as a routine, full attention
to the prevention and early detection of breast cancer.
Note 1: *Another more localized manifestation of these edemas that precede
the menses is the premenstrual pelvic congestion. Though involving mostly
the genitals, this congestive reaction also spreads to other near structures.
Premenstrual pelvic congestion becomes clinically evident by a diffuse painfulness
and sensation of "weight" and discomfort in the lower belly. Lumbosacral
pain is also another frequent symptom.
Note 2: **According to some recent studies, some effects of progesterone
and progestogens (synthetic "progesterones") on the breast glandular
structures are becoming problematic. Even so, from my point of view, it
is still too early to change the basic principles that rule the use of these
hormones for several mammary problems.
Most of the article above is an excerpt from my book "Os Órgãos
Sexuais Femininos: Forma, Função, Símbolo e Arquétipo"
("The Female Sexual Organs: Shape, Function, Symbol and Archetype"),
published by Imago Editora, Rio de Janeiro, 1993. For more information on
the book, see page http://www.nelsonginecologia.med.br/orgaos.htm
, from my website www.nelsonginecologia.med.br .
Copyright Nelson Soucasaux 1993, 2002
Nelson Soucasaux is a gynecologist dedicated to clinical, preventive
and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina
da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several
articles published in medical journals and of the books "Novas Perspectivas
em Ginecologia" ("New Perspectives in Gynecology") and "Os
Órgãos Sexuais Femininos: Forma, Função, Símbolo
e Arquétipo" ("The Female Sexual Organs: Shape, Function,
Symbol and Archetype"), published by Imago Editora, Rio de Janeiro,
© 2001 Harry Finley. It is illegal
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