A 30-year-old nulliparous woman with bilateral rubbery mobile breast masses that are tender around the menstrual period asks how to proceed.

A 30-year-old nulliparous woman with bilateral rubbery mobile breast masses that are tender around the menstrual period asks how to proceed.

• A. Prescribe antibiotics
• B. Order a mammogram now
• C. Advise to return 1 week after period for recheck
• D. Refer for biopsy

Answer: (C)

Cyclic breast symptoms in a premenopausal woman with bilateral, mobile, rubbery masses that are tender around the menstrual period point to fibrocystic changes rather than infection or cancer. This pattern—worsening before menses and improving after—is typical of hormonally influenced benign changes. The best next step is conservative management with observation and a recheck after the period to see if the masses and tenderness have changed. Antibiotics aren’t indicated because there are no signs of infection. A mammogram isn’t routinely required at this age for bilateral benign-appearing findings, and a biopsy is reserved for features that are suspicious or for persistent masses after re-evaluation. So, advising a return for recheck one to a few weeks after the period aligns with the expected course of fibrocystic changes and helps determine if further workup is needed.

Cyclic breast symptoms in a premenopausal woman with bilateral, mobile, rubbery masses that are tender around the menstrual period point to fibrocystic changes rather than infection or cancer. This pattern—worsening before menses and improving after—is typical of hormonally influenced benign changes. The best next step is conservative management with observation and a recheck after the period to see if the masses and tenderness have changed. Antibiotics aren’t indicated because there are no signs of infection. A mammogram isn’t routinely required at this age for bilateral benign-appearing findings, and a biopsy is reserved for features that are suspicious or for persistent masses after re-evaluation. So, advising a return for recheck one to a few weeks after the period aligns with the expected course of fibrocystic changes and helps determine if further workup is needed.