Chest pain and your periods

by Carolyn Thomas   ♥   @HeartSisters  

It may come as a surprise, but chest pain doesn’t always mean HEART ATTACK. A researcher in Atlanta has a reminder for us of a common symptom that can be mistaken for heart-related pain. It’s called mastalgia.           .     

Dr. Laurie Ray is a nurse practitioner who teaches at Emory University, where her particular research focus is patient-centered sexual and reproductive health care. As she explained in her Clue column:

“Cyclical breast/chest pain (also called mastalgia) is a common pre-menstrual symptom that occurs in a predictable pattern related to the menstrual cycle.

“It usually happens during the luteal phase (after ovulation and before the period) and resolves once the period starts.

“People taking hormones for birth control, fertility treatments, management of abnormal bleeding, menopause or gender-affirming hormone therapy may also experience breast/chest pain related to the changes in hormone levels in those treatments.”

Women know that hormone fluctuations can cause all kinds of weird symptoms every month ranging from bloating and cramps to vivid dreams, fatigue, acne breakouts, food cravings or irritability. (That word ‘irritability’ , by the way, is gentle med-speak to describe the act of threatening spouses with severe consequences if they leave that freakin’ toilet seat up one more time).

It turns out that the hormones surging through our bodies during menstrual cycles can worsen the symptoms of a number of different pre-existing health conditions.

Although the precise cause of worsening symptoms in various body parts isn’t yet clear, researchers point to complex interactions between our immune system and our neuro-endocrine system.

The human body is indeed complex. The impact of a woman’s menstrual cycle on the severity of chronic symptoms is well documented, including, for example, those of migraine headaches(1),  asthma(2) or cardiac arrhythmias.(3)  And about half of women with Crohn’s disease (a chronic inflammatory disease of the intestines) report that their bowel symptoms feel far worse just before and during their periods(4).  Menstrual cycles have also been identified as a trigger for worsening bouts of depression(5).

And in one Japanese study on women diagnosed with a coronary spasm disorder, researchers found that chest pain caused by the non-obstructive coronary artery disease called Prinzmetal’s Variant Angina was significantly affected by menstrual cycles.(6)  This study suggested that painful angina spasms were most frequent (3.9 episodes per day) early in the menstrual phase, and least frequent (0.3 episodes per day for the rest of the month.

While chest symptoms starting before our periods may turn out to be related to mastalgia and not to our hearts, keep in mind that it’s still important for women to not automatically dismiss these symptoms as being non-cardiac – particularly if the chest pain feels very new or very unlike any other previous monthly symptoms.

For a number of years, there’s also been a growing awareness among cardiac researchers of a disturbing trend: we’re seeing increased rates of heart disease in younger women (“younger” in the wonderful world of cardiology means women under age 55, many of whom are still having their periods) along with worse cardiac outcomes compared to men of the same age.(7)   This is seen in women diagnosed with conditions like Spontaneous Coronary Artery Dissection (SCAD) for example – who tend to be younger, healthier and with fewer – if any – cardiac risk factors.

Our menopausal transitions most often begin between age 45 and 55.

My own, coincidentally, was right in the middle of that range, when I turned 50.

I know precisely when menopause started for me because I was heading to my farewell luncheon on that memorable April day, before leaving my wonderful Salvation Army colleagues to move to my new public relations job with the Victoria Hospice & Palliative Care Society. Running late (because I’d been madly trying to clear out my Sally Ann office that morning), I rushed into the big Golden City Chinese restaurant downtown, packed with hungry people who had been waiting for the guest of honour to finally arrive. After hugs all around, I collapsed onto my chair and started to sweat.

But this was no ordinary sweating. It was like projectile sweating! My blouse was soon soaked through, and within minutes, as people gathered around me to chat and take photos with me, sweat was dripping off my face and hair, while I tried desperately to discreetly mop myself up with the Golden City Restaurant cloth napkins!  Welcome to menopause hormones!

But I digress. . .

According to a Yale study published in the Journal of the American College of Cardiology, for example, it seems that we’ve made little progress in reducing heart attacks among younger women – despite expensive national campaigns designed to increase heart disease awareness and prevention.(8)

Additionally, compared to men, female heart patients under 55:

• had longer hospital stays
• had higher risk of death during hospital stays
• were more likely to have other health conditions like diabetes and high blood pressure

Meanwhile, if you are one of the many women experiencing the chest pain called mastalgia that happens monthly after ovulation and before the period), Dr. Ray has these reminders for you:

• Breast/chest pain is a common premenstrual symptom, typically occurring in the 5–10 days before the start of your period

• Cyclical breast/chest pain is a normal part of the menstrual cycle and usually not a cause for concern

• For relief, try supportive bras, warm or cold compresses, massage, medications, diet changes, and/or meditation

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1. MacGregor EA, Chia H, Vohrah RC, et al. “Migraine and menstruation: a pilot study”; Cephalalgia, 1990.10:305-310.

2. Skobeloff EM, Spivey WH, Silverman R, et al. “The effect of the menstrual cycle on asthma presentations in the emergency department”; Archives of Internal Medicine, 156:1996.1837–1840.

3. Rosano G, Leonardo F, Sarrel P et al. “Cyclical variation in paroxysmal supraventricular tachycardia in women”. Lancet, 1996.347:786–788.

4. Bernstein MT, Graff LA, Targownik LE, et al. “Gastrointestinal symptoms before and during menses in women with IBD.” Alimentary Pharmacology & Therapeutics, 2012;36:135-144.

5. Pinkerton JV, Guico-Pabia CJ, Taylor HS. “Menstrual cycle-related exacerbation of disease.” American Journal of Obstetrics and Gynecology. 2010;202(3):221-231.

6. Kawano H et al. Menstrual cyclic variation of myocardial ischemia in premenopausal women with variant angina. Annals of Internal Medicine, 2001Dec 4;135:977-81.

7. Izadnegahdar M, Humphries KH et al.  “Do younger women fare worse? Sex differences in acute myocardial infarction hospitalization and early mortality rates over ten years.” Journal of Women’s Health 2014 January;23(1):10-7.

8. Aakriti Gupta, Harlan M. Krumholz et al. Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010. July 2014.  J Am Coll Cardiol. 2014; 64(4):337-345. 

Image: Pete Linforth, Pixabay

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NOTE FROM CAROLYN:   I wrote much more about women’s chest pain (both cardiac and non-cardiac) in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local bookshop (please support your independent neighbourhood bookseller!)  or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

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Q:  Have you ever experienced distressing chest pain that was related to your period?