Expert: Claes-Gustaf Nordquist, M.D. - 9/28/2007

Question
i am in my early 30s, and since i was 10 1/2 years old (began menstruating at age 11 1/2), i've had lumpy breasts that are tender and painful. one is even a little larger than the other. i've had 2 doctors in the past 3 years because i attend a clinic with rotating pa's/doctors. i've mentioned it to two of these doctors in the past 6 years (during the years that i had my children). they've always checked me through a physical examination, but they never felt the need for a mammogram. thus, i have stopped bringing it up during my visits. i vist every few months because i am now on medicine for hypertension. during my menstrual cycle, i often feel very uncomfortable when trying to sleep, and i tend to get minor chest pain. for the most part, my blood pressure has been kept at a reasonable level. i do worry, however, if these lumps on my breast could be more than just the normal lumps that some women get and could possibly have an effect on my blood pressure/heart. often, when i can't sleep,  i take tylenol pm in order to rest at night. on top of that, these symptoms have become more noticeable since i requested and received the mirena iud for birth control in 2004, which may not have anything to do with these symptoms.please tell me if you think any of this is connected, and things that i could tell my doctor.

Answer
Such "lumpy" breasts as you seem to have are indeed difficult to examine even with mammography. But breast MRI scans can check them with a very high degree of certainty. So I suggest that you ask to have your breasts checked this way. Once a year should be enough. Probably best in combination with mammography and ultrasound scans and if necessary with needle biopsies. At least this should relieve you of any worries. I am not aware of any connection with your blood pressure or heart condition or with your iud. However if your iud is "hormone loaded" there may be a connection with your breasts (and maybe with your blood pressure). Discuss that with your gynecologist and other dr. Good luck!