“3 questions about recent issues?”

Yes. You should have a mammogram when your breasts are not so tender. Limit your caffeine and avoid nicotine. Vitamin E oil may be helpful.

Yes, the achy breast can be related to the cycle. Also, the asymmetric findings can also be normal. Starting at age 40, you should be getting a mammogram yearly with an annual clinical exam and self-awareness at least once a month, preferably 1 week after your cycle. If any of the breast changes are new, you should be seen by a physician for exam.
Stay safe!

Your questions are all good ones; let’s break it down. Breast tenderness with lumps/masses or nipple discharge usually signals hormone imbalance; specifically, an Estradiol dominance. Women make both Estradiol + Progesterone during their monthly menstrual cycle. Once the decade of your 40’s begins, most women start to experience perimenopausal symptoms of ‘swinging hormones’ that includes larger and larger swings in Estradiol (E) levels and many months when ovulation doesn’t occur so there is no Progesterone (P4) production. Even if both E+P4 levels swing, they may not swing together with wilder swings in E levels and usually a drop out of P4 levels, aggravating the E dominance. E dominance will then hyperstimulate the organs that have larger numbers of E receptors: breast (fibrocystic changes), uterus (fibroids, polyps, thick and heavy lining with heavy periods), endometriosis and its cousin, adenomyosis and even ovaries (large and possibly recurrent ovarian cysts). The longer and the larger E dominance there is, the stronger the hyperstimulation to the breast which can lead to increased breast density (fibrocystic change), bad mammograms, cysts, breast biopsies, breast enlargement which may not be equal L vs R side and sometimes even underarm tenderness if there is a tail of breast tissue that you may have in your armpit or axilla. If you build a cyst in the breast (an enlargement of a duct which is usually E dominance), then the larger the cyst, the more it may change the direction of the duct that it is in and then change the direction of the nipple. Breast surveillance by self-breast exam can help determine if your breast feels more ‘cystic’ or overall more ‘lumpy-bumpy’; you may feel a generalized ‘fullness’ and not a lump if these changes are deeper in the base or inside of the breast; that’s where having your doctor do a breast exam or having a screening mammogram (X-ray or radiation) vs a thermogram (heat-distinction/no radiation) can be helpful. I also recommend closely following your female hormone levels throughout your decade of your 40’s so you are better prepared to rebalance your hormones and keep yourself in best female health. I highly encourage you to get more information about hormone balancing by checking out my book, Full Bloom: Perimenopause, Menopause, Postmenopause and Beyond. Full Bloom is available on Amazon and is written for the everyday patient to help debunk the myths and put forth the truths about this challenging time that we all need to go through and how to best help ourselves navigate the many changes that our body will go through. The hormone imbalances that occur happen to us all; some of us more gracefully than others, but knowing what your body is doing and how to keep your female health as balanced as it can be is your best approach to optimal health. Family history may not be in your favor if there is a direct family history of breast cancer in your maternal side of the family, but that may also mean that there was hormone imbalance in your maternal family members as well. Talk with your doctor; managing your female health in your early 40’s can make the decade of your 40’s more manageable and put you back in control of your physical and emotional health. There is a chapter at the back of Full Bloom that tells you how to talk to your doctor and which lab tests you should have done; use that as a guide to help you get the right blood tests done. Become a partner with your doctor in your healthcare.