Question 13 - HRT and Breast Soreness

Dear Dr. N,

My periods stopped 3 years ago when I was 49. I didn’t think I needed to take hormones because I really didn’t have much in the way of problems associated with my menopause. But in the last year I started to have trouble sleeping and intercourse became painful. I started taking estrogen 3 weeks ago and now my breasts are sore. Should I be worried?

Reply:

It’s perfectly normal to have breast soreness a few weeks after beginning estrogen if you have had low estrogen levels for a while as would be implied by your insomnia and vaginal dryness. The breast and the vagina contain hormonally dependent tissues. Low estrogen levels can result in involution of breast tissue and when the breast tissue is stimulated by estrogen replacement the breasts can be sore and tender for a few months while they return to their previous state. Often, women who are estrogen deficient will notice a significant reduction in breast size and then notice a return to their pre-deficient state after taking hormones.

If a woman isn’t told that this breast soreness may occur and may even be expected if she has been hormonally deficient for a while prior to beginning HRT the resultant tenderness can be frightening and is a frequent reason for discontinuing HRT in the first few months when the reasons for the tenderness and appropriate reassurance are not provided.

If breast tenderness is not associated with beginning HRT or persists for longer than a few months or lumpiness or nipple discharge is noted, a visit to your physician is indicated without fail.

Dr. N