Breast Tenderness in Very Early Pregnancy: Timing and Differential
Timing
Breast changes from pregnancy typically begin 6–10 days after ovulation (around expected period), not "a few days after conception."
Mechanism
- hCG → corpus luteum → progesterone + estrogen → ductal/glandular proliferation, stromal edema.
- Sensitivity peaks in first trimester.
Differential
- Premenstrual mastalgia (cyclic, bilateral).
- Medication effect (hormonal contraceptives, antidepressants).
- Caffeine, fibrocystic changes.
Action
If unprotected intercourse occurred, test on day of missed period. Clinical breast exam if unilateral, persistent, or associated with mass/nipple discharge.
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