Monthly Breast Pain

  I am 37 years old.  I have 2 children ages 5 and 3. I nurse the 3yo about 2times a day (morning and bedtime).  Since about last December I 've been experencing pain and swelling in my left breast starting around day 20 of my cycle.  My breast also gets very hard and my child doesn't seem to want to nurse on that side.  It is NOT a clogged duct.  Any thoughts on what might be the problem?  My doctor says to wait till I've weanned my child and have a mamagram.  I am very concerned and it is very uncomfortable (quite painful even).  Any input would be greatly appricated.
  Thank you Jane
Dear Jane:
Breast pain in the second half of the menstrual cycle is a common symptom. The presumed mechanism is the influence of progesterone to "prepare the breast" for lactation. I realize that you are already lactating; the hormones are produced and act on the breast nonetheless. Why this is painful to some, but not all women, is unclear.
The second issue is the development of fibrocystic change in the breasts. All women develop this to some degree due to the repeated "preparation for pregnancy" and then reversal of these changes with the menstrual cycle. Ducts in the breast become blocked, form small fluid-filled spaces (cysts) and the stimulation of the duct linining with changes in the fluid volume are the presumed mechanisms of pain.
Therapies to consider are: 1. Discontinuing breast feeding to assess the impact of cycle hormones alone. 2. Non-steroidal anti-inflammatory drugs (Advil, 3 tablets 4 times daily or Aleve, 2 tablets 3 times daily) in last 7-10 days of the menstrual cycle. 3. Oil of Primrose, 1500 mg daily (a long-standing natural remedy available at health food stores and pharmacies; safe and largely unproven by scientific testing). 4. Danazol, 200 mg daily is CONTRAINDICATED during breast feeding.
This information is provided for general information purposes only and is not a medical consultation. If you have specific questions, please contact your physician.