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The pill and boobs

by Mary Hargreaves · June 16, 2022

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Reviewed by Dr Melanie Davis-Hall on June 16, 2022

The pill and boobs | The Lowdown
One of the most common side effects The Lowdown users report for all contraception methods are tender and/or enlarged breasts. Get the lowdown on what the evidence says about boobs their relationship to hormonal contraception

What’s the lowdown?

  • Two of The Lowdown’s most commonly reported side effects across all contraceptives are tender breasts and enlarged breasts
  • Hormonal contraception can cause temporary changes to your body which should pass with time, such as water retention, weight gain or breast tissue changes, which could be responsible for discomfort and enlargement.
  • There is evidence that hormonal contraception could protect against non-cancerous tumours called fibroadenomas
  • There is contradicting evidence about the effects of hormonal contraception on risk of developing benign fibrocystic breast disease, a common condition which makes boobs feel lumpy
  • Hormonal contraception can alleviate breast pain in women who experience sore boobs before their period
  • Over the counter painkillers and evening primrose oil may help if you experience breast pain
  • Be sure to see your doctor immediately if you notice a new lump of any kind so they can tell you what it is and whether any further investigation is needed. 

Our boobs are weird, wonderful, ever-changing things. They can grow and shrink, change in texture and require near-constant support (why are bras so expensive? Has anyone figured that out yet?)

One of the most common side effects The Lowdown users report for all contraception methods are tender breasts and enlarged breasts. There are lots of boob-y changes that can occur throughout our monthly cycle, and as our breasts are accessories to our reproductive system, it makes sense that they’d be affected by our hormones. Whether that’s naturally occurring hormones during the menstrual cycle or the artificial ones in hormonal contraception. 

Here, we’ll talk about common breast problems and what the evidence says about their relationship to hormonal contraception. We won’t be talking about breast cancer here – but we’ll cover practically everything else, from size changes to cysts.

Breast Size Changes

Some women may experience an increase in the size of their boobs when they begin taking hormonal contraception. This is quite common, but usually not permanent. The hormones in your contraception can cause fluid retention, changes to breast tissue or weight gain, all of which usually pass within a few months of starting to take the pill. 

If you carry on taking the pill, or stop taking it altogether, your boobs should go back to their normal size. 

How can you tell if you’re experiencing breast size changes?

If you’ve just started the pill and your bra feels tighter, or your boobs are sore or tender, you might be experiencing breast size changes. 

If your breasts are larger because you’re experiencing water retention, you might notice that they return to normal during your pill-free week (if you have one). Keeping a diary for a couple of months may help with this. 

Does the pill make your breasts bigger?

Oestrogen is known to cause fluid retention, while progestogen is thought to have the opposite effect. It stands to reason, then, that combined oral contraception (the pill that contains both oestrogen and progestogen) is more likely to cause water retention than the progestogen-only pill. 

If you experience unwanted changes in your breast size whilst using combined hormonal contraception, a pill with a lower dose of oestrogen or a different type of progestogen, or a progestogen-only method might be better options. Do remember, though, that water retention, weight gain and breast tenderness caused by the hormones in your birth control usually pass within a few months. 

Are changes in breast size associated with how you take your contraception?

People who take combined hormonal contraception (i.e the combined pill, patch or ring) will usually have a hormone-free week (although this isn’t necessary, as you can use these methods continuously). During this hormone-free week, any water retention that might be causing your boobs to swell should lessen. 

Lifestyle measures that can help with changes in breast size

There isn’t much that can be done about the temporary hormonal changes you might experience in the first few months of taking the pill. It’s always important to wear a bra that fits properly to reduce any discomfort you feel, and while it might seem wasteful to buy new underwear for something which will probably pass, it’s likely to be worth the investment.

If you’re experiencing water retention, there are a few things you can do. Keep well hydrated, cut back on salt and exercise frequently to reduce fluid build up. However if your breasts feel uncomfortable and this persists after a few months of starting contraception, speak to your doctor or nurse about your options.

Get your contraception prescription ordered through us | The Lowdown 

Fibroadenoma

A fibroadenoma is a non-cancerous tumour found in the breast tissue. You can get fibroadenomas at any age, but they’re more common during your 20s and 30s. They’re usually totally harmless, and are generally pain-free, but might cause you discomfort or feel tender just before your period. A fibroadenoma will feel like a marble under the skin, and should be smooth to touch.

We don’t really know what causes fibroadenomas, but there is some research that suggests that taking oral contraceptives before the age of 20 could increase your risk of developing one. 

How can you tell you’re experiencing fibroadenoma?

A fibroadenoma will feel like a smooth lump just under the skin of your breast. It should move easily when you push it. Of course, it goes without saying that any lump in your breast should be checked out by your doctor – they’ll be able to confirm exactly what it is, and will be able to put your mind at rest. 

The Breast Cancer Now charity website has a wealth of information about fibroadenoma.

Can the pill cause fibroadenoma?

Fibroadenomas could be caused by a portion of your breast’s glandular tissue being oversensitive to oestrogen. So you’d have thought that contraceptive pills containing oestrogen would increase the risk or size of a fibroadenoma – but interestingly, there isn’t evidence to support this. 

There is evidence, though, that combined oral contraceptives (those containing both oestrogen and progestogen) could reduce hospital referral rates for fibroadenoma. Some studies have found that oral contraceptive use in general can reduce incidences of fibroadenoma by 30-50%. This effect is mainly seen in women who are currently using oral contraceptives, and have been for a long time, or women who have recently stopped taking oral contraceptives after long-term use. 

Some oral contraceptives may protect against fibroadenoma by inhibiting ovulation and preventing changes in breast cells that take place in the first half of the menstrual cycle. 

Is fibroadenoma associated with how you take your contraception?

There doesn’t appear to be any evidence currently that taking the pill continuously or with a break has an impact on your risk of developing fibroadenoma. 

Lifestyle measures that can help with fibroadenoma

Fibroadenomas sometimes go away on their own. If you are experiencing pain and discomfort because of a fibroadenoma which has been confirmed and diagnosed by a doctor, you can try paracetamol or ibuprofen gel, or taking evening primrose oil, which has been shown to reduce breast pain. You will soon be able to buy evening primrose oil at The Lowdown… so watch this space for updates.

Benign Fibrocystic Breast Disease

Benign fibrocystic breast disease is a condition whereby the breasts feel lumpy. It’s really common, and doesn’t pose any risk to your health. It’s estimated that more than half of all women will experience fibrocystic breast disease at some point in their lives, and there’s actually a recent push to stop calling it a disease at all. In fact, it’s totally normal for your breasts to fluctuate in texture throughout your menstrual cycle. 

How can you tell you’re experiencing benign fibrocystic breast disease?

You may experience breast lumps that change throughout your menstrual cycle. For some women, these lumps may cause general pain in the breast, and green or dark brown discharge from the nipples. Some women may find that the lumps in their breasts, and any pain associated with them, increase during the time between ovulation and the start of their period.

If you feel a lump in your breast, or discharge from your nipples, never self-diagnose. Pay a visit to your doctor, who will be able to determine whether it is benign fibrocystic breast disease or not. 

Is benign fibrocystic breast disease associated with any particular contraceptives?

Some research suggests that the use of oral contraceptives may actually reduce your risk of benign fibrocystic breast disease, and this protective effect is thought to be greater the longer you have been taking oral contraception. There is opposing evidence, however, that oral contraceptive use has no effect on the development of fibrocystic breast disease, either in long-term or recent users. This research also found that previous oral contraceptive use made post-menopausal women more likely to develop fibrocystic breast disease.

Is benign fibrocystic breast disease associated with how you take your contraception?

There isn’t any concrete evidence that any specific oral contraception regimen has an effect on fibrocystic breast disease risk. However, some people find that their contraception helps to relieve any breast pain they might have previously experienced just before their period, so the pill may help in tackling this aspect.

Lifestyle measures that can help with benign fibrocystic breast disease

If you’re experiencing pain or discomfort because of benign fibrocystic breast disease, the best starting point is to check that you’ve got a good, well-fitting bra. As with fibroadenoma, you can use over the counter painkillers, evening primrose oil, a heated pad or hot water bottle to relieve your symptoms.

Cyclical Breast Pain

When your boobs are sore at certain times of the month, like just before your period, it’s referred to as cyclical breast pain. Some people experience severe pain, which can last for the full two weeks before their period. 

It is believed that cyclical breast pain occurs in those who are more sensitive to the normal hormonal changes that occur before the start of their period.

How can you tell you’re experiencing cyclical breast pain?

If you find that your boobs are sore or uncomfortable in the days or weeks leading up to your period, and this is something that occurs monthly, you may have cyclical breast pain. Some find that their cyclical breast pain comes and goes; they may have a few months with it before it disappears, and it may then reappear months or years later. 

Is cyclical breast pain associated with any particular contraceptives?

Cyclical breast pain, by definition, is a result of the hormonal fluctuations in your natural menstrual cycle. Hormonal contraception disrupts or overrides this cycle, often preventing you from ovulating and from having a regular period. Breast pain that you feel while taking hormonal contraception, then, is not due to the hormones in your menstrual cycle. Hormonal contraception may sometimes be prescribed as a treatment for cyclical breast pain, as it disrupts the natural cycle and prevents the hormone fluctuations that cause the pain each month. 

However, breast pain can also be a side effect of hormonal contraception. Some find that the hormones in the combined pill make their boobs sore, while others find that the progestogen in the mini pill causes discomfort or tenderness. Annoyingly, there’s no real way to tell whether one or the other is likely to give you breast pain until you’ve tried it.

Is cyclical breast pain associated with how you take your contraception?

Cyclical breast pain is related to your menstrual cycle. You may experience cyclical breast pain whilst using contraception if you are still having menstrual cycles, such as with non-hormonal methods like the copper coil (IUD) or fertility awareness methods (FAM), and also with some progestogen-only methods like the hormonal coil or some mini pills which do not stop you ovulating.  

There is no evidence to suggest that taking combined oral contraception continually or with a break is more likely to cause breast pain, although some individuals may notice differences. Progestogen only contraception should be taken without breaks to maintain its contraceptive effectiveness. 

Lifestyle measures that can help with cyclical breast pain

Breast pain, whether cyclical or as a result of your contraception, can be frustrating. Keeping a diary for a couple of months may help you work out if you are experiencing cyclical breast pain by looking at the pattern in relation to your menstrual cycle. You might find that a hot water bottle, cold compress, painkillers like paracetamol and ibuprofen, or evening primrose oil help to alleviate your symptoms. 

Breast Cysts

A breast cyst is a sac of fluid that develops in the glands in the breasts. Breast cysts can be large enough to feel, and are usually smooth and move easily under the skin. Breast cysts are usually not cancerous, and do not require treatment unless they are causing particular discomfort.

How can you tell you’re experiencing breast cysts?

If you have a lump in your breast that feels as though it’s full of water, like a grape or a small balloon, it may be a breast cyst. Breast cysts can also be hard. It’s really important to get any new lump checked out with your doctor to rule out other conditions. If you have one or more breast cysts, they may become bigger or more painful just before your period. You might also experience brown, yellow or clear nipple discharge.

Are breast cysts associated with any particular contraceptives?

There is no evidence that hormonal contraception increases your risk of breast cysts. 

Lifestyle measures that can help with breast cysts

If you have a breast cyst that’s causing you pain or discomfort a hot water bottle or cold compress, or over-the-counter painkillers like paracetamol, might reduce the severity of the pain. You can also try evening primrose oil to alleviate your symptoms. If you have a breast cyst that is causing you particular discomfort, your doctor may recommend that you have it drained.

Need help? Talk to our doctors about your contraception

Tags
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Mary Hargreaves is a writer and author with a passion for women’s reproductive health. She has a Masters in Clinical and Health Psychology, and has worked in scientific research across a range of disciplines.