What aggravates fibrocystic breast disease?

If female hormones caused you to develop breasts, you have about a 50% chance of experiencing fibrocystic breast changes at some point in your life.

Fibrocystic breasts can be painful and feature lumpy or rope-like textures, which may cause concern, but these changes are completely harmless. It's a benign condition that's neither a symptom of nor a risk factor for breast cancer.

This used to be referred to as "fibrocystic breast disease," but healthcare providers are now more likely to call it simply "fibrocystic breasts" or "fibrocystic breast changes," as it doesn't mean something is wrong with your breasts.

The primary symptom of fibrocystic breast tissue is its lumpy, rope-like texture. If you were to look at fibrocystic tissue under a microscope, you would likely see several components that contribute to this, including:

• Round or oval-shape cysts filled with fluid
• Fibrous tissue that resembles scar tissue (fibrosis)
• Hyperplasia (overgrowth) of cells lining the milk ducts and milk-producing lobules of the breast
• Enlarged breast lobules (adenosis) 

Typically, lumps aren't attached to surrounding tissue but will move slightly when manipulated. 

Many people with fibrocystic breasts have no symptoms beyond that. However, those who experience some often find them unpleasant. The most common symptoms of fibrocystic breasts are:

• Swelling
• Tenderness
• Generalized pain

In some cases, fibrocystic breasts put out a greenish or dark brown nipple discharge that's free of blood and may leak without pressure or squeezing. There also can be pain in the armpit.

Frequently, fibrocystic breast symptoms worsen just before your menstrual period and lessen near the end of the cycle. The actual size of individual lumps may fluctuate with the menstrual cycle as well.

While it should be reassuring to know that not all changes to your breast are worrisome, if you notice thickened areas or changes in texture, it's still a good idea to see your healthcare provider to confirm your suspicion that it's just fibrocystic breast changes.

Bloody nipple discharge or discharge that occurs on just one side or is associated with a lump or skin changes can be a sign of breast cancer; see a healthcare provider immediately if you encounter this symptom.

What spurs breast tissue to develop the lumpy, tender, swollen areas that are characteristic of fibrocystic changes isn't fully understood.

Experts agree, though, that reproductive hormones are closely involved. Estrogen is particularly likely to play a part. 

Fibrocystic breasts are most common between the ages of 20 and 50 or so—in other words, while you still have periods. However, if you're postmenopausal, you may have fibrocystic breast changes due to hormone therapy.

According to the American Cancer Society (ACS), you're most likely to notice changes in your breasts (including symptoms that could indicate cancer) during activities like bathing or dressing.

For this reason, the ACS says that you should be familiar with how your breasts normally look and feel and report any changes to your healthcare provider right away.

This is called breast self-awareness and is preferred over breast self-exams (BSEs) by the ACS, the American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force, among other bodies, based on lack of evidence that regular BSEs are beneficial.

Whether you practice breast self-awareness, do BSEs, or both, you may find it difficult to distinguish fibrocystic changes from potential tumors. While the majority of breast lumps aren't cancerous, you should still get confirmation via a mammogram or ultrasound.

It's sometimes difficult for a regular mammogram to differentiate between fibrocystic tissue and a potentially cancerous lump, so an ultrasound is often the preferred diagnostic test.

If you have dense breasts, you may be urged to have both tests regularly. (Dense breasts are common early in life, as breasts tend to become fattier with age.) Density can only be determined by mammography, not by the look and feel of breasts.

All breast lumps must be investigated to rule out breast cancer and/or to begin immediate treatment if breast cancer is diagnosed.

When screening and/or testing reveal that a lump may be a fluid-filled cyst, sometimes a healthcare provider will choose to do a fine-needle aspiration, in which a thin, hollow needle is used to extract the fluid.

If tests are inconclusive—and your healthcare provider still can't rule out cancer—then a biopsy may be necessary. Most people with fibrocystic breasts don't have abnormal breast cells when a biopsy is performed.

Fibroadenomas are another possible cause behind a breast lump. These benign lumps are made of fibrous and glandular tissue, and they can cause pain.

The presence of a single fibroadenoma doesn't increase your risk of breast cancer, but having a complex one or more than one does indicate a higher risk.

If your breasts aren't bothering you, there is no need to treat fibrocystic breasts. If you do experience pain, you have several treatment and management options to consider.

You may get relief from extremely painful breasts by wearing a bra that provides more support. Being fitted for a bra by a specialist is an ideal way to find one that's the right size and shape for you.

If the band is too tight or the cup is too small, the fabric, underwire, or other structural elements of the bra may be putting unnecessary pressure on your breasts.

If you play a sport or spend a lot of time working out, you may want to invest in a good sports bra as well. Consider wearing one to bed during periods, when your breasts are likely to be extra sensitive.

Heat may help alleviate pain from pressure and swelling. Use a regular heating pad or make your own using a tube sock and rice.

A cold compress or gentle massage may help as well.

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) such as Advil or Motrin (ibuprofen) or other pain relievers such as Tylenol (acetaminophen) may help ease soreness caused by fibrocystic breast changes.

Diclofenac, which has the same ingredient as an oral NSAID, is also available in a topical form. Ask your healthcare provider what type and dose might work best for you. Your healthcare provider may prescribe prescription versions of these or related medications, as well. 

Birth control pills are sometimes prescribed for pain related to fibrocystic breast changes, as they may help regulate levels of hormones linked to them. Decreasing the dose of estrogen in a birth control pill can be effective as well.

A drug called tamoxifen and androgens (male hormones) also may be used, but because these drugs can have severe side effects, they are typically only recommended if symptoms are severe and not relieved by other treatments.

Applying 15 to 20 milligrams of progesterone cream per day, starting with ovulation and going until a day or two before your period, sometimes helps breast tissue return to normal in three to four months. Once you have achieved symptom relief, you can gradually taper your dose until you find the lowest amount that's effective. Ask your healthcare provider about a prescription if you don't already have one.

If you're postmenopausal and taking estrogen, talk to your healthcare provider about reducing your dose or stopping hormone therapy altogether.

It also may help to decrease sources of estrogen from your diet, such as commercially-raised meats, which sometimes contain excessive amounts of hormones.

Evening primrose oil contains an omega-6 fatty acid called gamma-linolenic acid that may make breast tissues less sensitive to hormonal changes. You can find it in drugstores and health food stores, usually in capsule form. It has been studied in many trials, though hasn't been shown to be more effective than placebo.

Research also suggests fish oil, another source of essential fatty acids, may also help reduce pain associated with fibrocystic breasts changes, even though it wasn't more than placebo. Other vitamin suggestions include vitamin B6 or a B-complex, and magnesium.

Although there's little research supporting a link between diet and fibrocystic breasts, anecdotal reports hint that certain changes may help relieve symptoms in some people. Together, they represent a nutritionally smart approach to eating, so they may improve your general health.

First, cut down on:

• Caffeine from coffee, tea, soda, energy drinks, and chocolate
• Added sugar
• Sodium
• Fat

Then, include more:

• Fiber (30 grams a day is recommended)
• Fruits, vegetables, and whole grains

In extreme cases, cysts or lumps that cause pain can be removed. Options include:

• Fine-needle aspiration: A hair-thin needle is inserted through the breast and into the cyst to drain fluid. This causes the cyst to collapse, which should relieve pain; it can also confirm the lump isn't a tumor.
• Surgical excision: A cyst that's persistent (won't collapse even after being aspirated several times) may need to be surgically removed.

If your healthcare provider appears to be dismissing your complaints, see someone else if possible. With all the options available, you shouldn't have to endure chronic pain without treatment.

If you're having trouble dealing with it, and especially if you could be depressed, talk to your healthcare provider. You may benefit from therapy and/or antidepressant medications.

Lastly, dedicating time to some of the self-care measures above can go a long way in making you feel that you're doing all you can to ease your discomfort.

Finding any lump or abnormality in your breast can make you worry about breast cancer. Try not to let your mind race. Get it checked out, but do your best to focus on the fact that cancer is far less likely than something like fibrocystic changes.