General Gynecology · Breast Health

Breast tenderness and swelling experiences related to menstrual cycles and ovulation in healthy premenopausal women: Secondary analysis of the 1-year "Prospective Ovulation Cohort"

Wood M, Shirin S, Goshtasebi A, Prior JC

Published May 12, 2025 PloS one, 20(5), e0321205
DOI 10.1371/journal.pone.0321205 PMID 40354418 PMC PMC12068584

RRM Academy Synopsis

Breast tenderness peaks late in ovulatory cycles of healthy women

In a one-year prospective cohort of 53 healthy premenopausal women, breast tenderness and swelling in ovulatory cycles reached their maximum in the late luteal phase. Both were absent in the follicular phase. Across the whole cohort, they were greater in normally ovulatory cycles than in cycles with ovulatory disturbances.

Key Findings

  • Of 720 cycles, 694 had documentable ovulatory status: 495 were normally ovulatory (71%), 181 had a short luteal phase (26%), and 18 were anovulatory (3%).
  • The median Breast Tenderness Score (intensity multiplied by days) was 6.0 in 495 normally ovulatory cycles and 3.0 in 199 cycles with ovulatory disturbances (P = .005).
  • Median days of breast enlargement were 5.0 in 491 normally ovulatory cycles and 3.0 in 199 cycles with ovulatory disturbances (P = .002).
  • Within the 47 women with both cycle types, median Breast Tenderness Scores were 5.9 in 420 normally ovulatory cycles and 5.7 in 199 cycles with ovulatory disturbances, and tenderness did not differ.
  • Tenderness and swelling were positively correlated (r = 0.315, P = .001) across 676 ovulatory cycles from 53 women, and both reached maximal values in the late luteal phase.

Interpretation

This cohort study followed healthy, non-smoking women aged 20 to 41 from 1984 to 1986. The researchers confirmed ovulation using Quantitative Basal Temperature analysis, a method validated in two earlier blinded studies. The authors note that hormone levels were not measured. The findings support larger studies of breast symptoms across the ovulatory cycle.

RRM Context

Restorative reproductive medicine treats the ovulatory cycle as a vital sign and relies on charting the cycle to confirm ovulation. In this cohort, 199 of the 694 cycles with documentable ovulatory status (29%) had a short luteal phase or no ovulation. Yet 97% of all 720 cycles were of normal length. The authors cite earlier studies placing ovulatory disturbances in up to one third of regular cycles.

Abstract

Breast tenderness and swelling are associated with premenstrual symptoms but are not well described in healthy women. In this 1-year prospective observational study, we examined daily breast tenderness and swelling to determine whether differences existed between normally ovulatory and ovulatory disturbed (short luteal phase and anovulatory) cycles in a cohort of community dwelling, non-smoking, healthy premenopausal women. Enrolment required two consecutive normal-length and normally ovulatory cycles by Quantitative Basal Temperature© analysis. Women (n = 53) ages 20-41 recorded their daily breast experiences in the Menstrual Cycle Diary© across an average of 13.6 cycles. In all 720 cycles, the median breast tenderness was 1.4 (on a 0-4 scale, range 0.0-3.0), in cycles with a mean length of 28.1 days (95% CI 27.5-28.8). Comparison of breast tenderness and breast size (changes from usual) parameters between all normally ovulatory cycles and all ovulatory disturbed cycles in the whole cohort showed significantly higher levels in normally ovulatory (luteal length ≥10 days) in both Breast Tenderness Score [intensity X duration in days; 6.0 (range 1.0-14.0) vs. 3.0 (0.0-11.0) (P=.005)] and breast size [4.0 (2.0-4.0) vs. 4.0 (0.0-4.0) (P=.034]). However, within-woman in the forty-seven women with both normally ovulatory and ovulatory disturbed cycles, breast tenderness (intensity, duration, and Breast Tenderness Score), did not differ between normally ovulatory cycles and cycles with ovulatory disturbances. This study also demonstrated that in all ovulatory cycles, the timing of breast tenderness increased in parallel with breast swelling; the maximum for both was in the late luteal phase.

Topics

By this author

Related research

General Gynecology › Breast Health › Benign Breast Conditions · Menstrual Cycle › Cycle Physiology › Luteal Phase · Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency
Mary Wood, Sonia Shirin, Azita Goshtasebi, Jerilynn C Prior
M Wood, S Shirin, A Goshtasebi, J Prior
PMID 40354418 40354418 DOI 10.1371/journal.pone.0321205 10.1371/journal.pone.0321205 Wood et al. 2025, Wood 2025