Modern medicine calls premenstrual mastalgia cyclic mastalgia and explains that it is closely related to hormonal changes during the menstrual cycle. Pain is triggered when breast tissue reacts sensitively during the luteal phase, especially when the balance between estrogen and progesterone is disrupted or when estrogen levels become relatively elevated. Estrogen tends to stimulate the proliferation of mammary gland tissue and increase water retention, which causes the breasts to swell, become firm, and feel painful during this phase. Furthermore, an increase in prostaglandins, which are inflammatory substances, a microinflammatory response in mammary gland tissue, and hypersensitivity of nerve fibers within the breast are also seen as contributing to the pain. It is not solely a hormone issue; changes in neurotransmitter levels in our brain, particularly serotonin, also exert a significant influence. Before menstruation, serotonin levels temporarily drop, which can be accompanied by psychological symptoms such as mood swings, irritability, anxiety, and depressive feelings. When these symptoms combine with physical pain, they manifest as premenstrual syndrome. If these symptoms are severe enough to cause serious disruption to daily life, premenstrual dysphoric disorder may be diagnosed. PMDD involves far more extreme mood swings, depression, anxiety, and anger than PMS, appearing intensively before menstruation and characteristically vanishing as if by magic once menstruation begins. The liver qi stagnation mentioned in Donguibogam can be understood modernly as our body’s response to stress, namely autonomic nervous system imbalance and changes in neurotransmitters. When stress persists, the brain’s hypothalamic-pituitary-adrenal axis undergoes hyperactivation, which further exacerbates hormonal imbalance and the inflammatory response, worsening breast pain. Ultimately, physical and psychological symptoms act together in a complex manner to distress us every month. You should view this as a small SOS signal sent by your body and never take it lightly.
