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. 2025 Jul;35(7):e70101.
doi: 10.1111/sms.70101.

How Do Fluctuations in Endogenous Sex Hormones Affect Breast Pain in Female Athletes?

Brooke R Brisbine  1 , Jocelyn K Mara  1 , Alannah K A McKay  2 , Louise M Burke  2 , Rachel McCormick  2 , Rachel Harris  3   4 , Clare Minahan  3   5 , Kathryn E Ackerman  6 , Celeste E Coltman  1
Affiliations

How Do Fluctuations in Endogenous Sex Hormones Affect Breast Pain in Female Athletes?

Brooke R Brisbine et al. Scand J Med Sci Sports. 2025 Jul.

Abstract

Cyclic breast pain (mastalgia) is speculatively associated with hormonal fluctuations during the menstrual cycle. No research to date has quantified this effect through circulating concentrations of estradiol and progesterone in a sample of female athletes. Such data are essential for understanding how hormonal changes contribute to the incidence and severity of cyclic breast pain, with implications for enhancing breast pain management and athletic performance in women's sport. Twenty-four female Australian First Nation athletes from the National Rugby League Indigenous Women's Academy pathways program participated in a Female Athlete Research Camp. Over 5 weeks, participants completed a daily survey about their experience of breast pain and, at three approximate phases of the menstrual cycle (Phases 1, 2, and 4), presented to the laboratory for venous blood samples to track circulating estradiol and progesterone concentrations. Average mastalgia ratings spiked during the commencement of the menstrual period and 14-26 h prior to ovulation. Higher levels of estradiol and progesterone were associated with a decreased likelihood of experiencing mastalgia; elevated progesterone levels were also linked to a reduction in mastalgia severity. These effects were highly interdependent, such that the effect that progesterone had on mastalgia was dependent on the value of estradiol, and vice versa. This study provides the first quantitative evidence that circulating estradiol and progesterone levels influence the occurrence and severity of cyclic breast pain in female athletes. These findings support the development of targeted strategies for managing mastalgia, ultimately promoting well-being and enhancing performance for women in sport.

Keywords: estradiol; mastalgia; menstrual cycle; progesterone; women.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The distribution of (A) daily mastalgia values across the menstrual cycle and (B) the 5‐day weighted moving average (WMA) for mastalgia at Phases 1, 2, and 4. The bars show the number of observations between a given range of values. The dashes below the bars show the individual data points. The lighter colored bars for both (A) and (B) show the number of observations that were 0, and the darker colored bars show the number of observations that were > 0.
FIGURE 2
FIGURE 2
Estradiol (A) and progesterone (B) at Phases 1, 2, and 4. The bars show the number of observations between a given range of values. The dashes below the bars show the individual data points.
FIGURE 3
FIGURE 3
Daily mastalgia (WMA) across the menstrual cycle, and estradiol and progesterone at the three data capture points (Phases 1, 2, and 4) for participants who were (A) naturally cycling and not using hormonal contraception and (B) who were using hormonal contraception. Each Figure (A–M) shows the data for an individual participant. Mastalgia (WMA), estradiol and progesterone have been scaled using a min–max transformation to represent each of these variables on a scale of 0–100 for the purpose of visualization.
FIGURE 4
FIGURE 4
(A) Predicted mastalgia for continuous values of estradiol and Q1, median and Q3 values for progesterone, and (B) predicted mastalgia for continuous values of progesterone and Q1, median and Q3 values for estradiol. For both A and B, mastalgia has been predicted for the mean values of breast volume (361.5) and age (21.6) The black lines represent the median expectation of the posterior predictive distribution, and the varying shaded ribbons represent the 50%, 80% and 95% quantile intervals.
FIGURE 5
FIGURE 5
(A) The marginal effect of progesterone at the Q1, median, and Q3 values of estradiol, and (B) the marginal effect of estradiol at the Q1, median, and Q3 values of progesterone. Marginal effects are presented as the percent change in predicted mastalgia for a 1% increase in progesterone (A) or estradiol (B). Density is calculated using a kernel density estimator.
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