Mastaglia

Treatment options are varied. Reassurance of a normal exam and evaluation can reduce fears of cancer and ease the discomfort in up to 85% of patients4. Initial treatments include a well fitting bra. This is especially important with vigorous exercise. A properly fitting sport bra can reduce pain symptoms dramatically.

Dietary treatments include reducing dietary saturated fat levels. Supplementing with certain vitamins can be helpful. Although not conclusively proven in double blinded studies, Vitamin E has been shown to be effective in reducing breast discomfort in many women. 400 - 800 units per day can reduce pain significantly.5 Reducing caffeine use in the premenstrual time can also be effective for some women. Decreasing coffee, tea, and chocolate consumption is a mainstay of therapy for many women. A recent study has shown dietary flaxseed effective in reducing cyclic mastalgia. Dr. Tong Li of Princess Margaret Hospital in Toronto reported a significant reduction in symptoms after supplementing 25 grams of ground flaxseed daily during a three-month study.6 The benefit was seen within two months of treatment. The hypothetical reason for its success is the ability of flaxseed to act as an anti-estrogen on breast tissue.

Medications used to treat cyclic mastalgia include diuretics (water pills), evening primrose oil, oral contraceptives, progesterone, tamoxifen and Chaste Tree extract.

Diuretics have been commonly prescribed, but never proven effective for mastalgia.

Evening primrose oil (EPO) contains polyunsaturated fatty acids and may normalize fatty acid content in women with cyclic mastalgia. Evening primrose oil is helpful in the treatment of symptoms in 58% of women, compared to 19% of women taking placebo.7 In open studies performed at the Cardiff Mastalgia Clinic in the UK, EPO has been found to produce positive effects in 44% of women with cyclical mastalgia [Pye et al., 1985; Gately, 1990]. According to the same researchers, this was about the same benefit as seen with bromocriptine, but danazol was somewhat more effective (70% response rate). In a double-blind placebo-controlled study, 73 patients with mastalgia with or without palpable nodularity randomly received evening primrose oil 3 grams per day or placebo for 3 months. Over the course of the study, 3 patients in the treated group and 16 patients in the control group dropped out. Discomfort was significantly reduced in women with either cyclical or noncyclical mastalgia, while no significant improvement was seen in the control. Nodularity improved only in the cyclic group [Pashby et al., 1981]. However, in a double-blind study of 200 women treated for 1 year, EPO did not prove effective in the treatment of recurrent breast cysts [Mansel et al., 1990]. The most common dose of EPO is 3 grams per day for cyclic mastalgia.

Oral contraceptives can be helpful, although many women notice increasing tenderness during the first few cycles while taking the pill. This discomfort generally subsides within 3 months and any beneficial effect is seen within the first 3 - 6 months of use.

Progesterone in all forms (tablets, creams, and injections) has been studied a number of times and has not been conclusively proven effective for cyclic mastalgia, though there are a number of women who obtain pain relief with its use.

Tamoxifen is an anti-estrogen that is used to treat or prevent breast cancer. It is effective in reducing breast tenderness (71% vs 29% with placebo)8, but significant side effects preclude its use in many patients.

Vitex (Vitex agnus-castus or chaste tree)
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Vitex is a herbal preparation that can equilibrate the hormone levels in women with cyclic mastalgia and premenstrual syndrome. It has been shown to be effective when used over several months.9 Forty milligrams per day of the dried herb is common, though the dose depends upon the manufacturer.

Other medications used in the past include danazol and bromocriptine. They are not routinely used because of side effects. There is some evidence that danazol may be effectively used in the premenstrual time with limited side effects. Supporting studies may shed light on this option for therapy.

Because the exact reason for cyclic mastalgia is unknown, there are many treatments options proposed. Most women can achieve success with one or more treatments after an adequate evaluation and explanation has been performed. Individualizing treatment is important and working with your physician is critical for rapid improvement.

References:
1 - Horrobin DF: The effects of gamma-lenolenic acid on breast pain and diabetic neuropathy: Possible non-eicosanoid mechanisms. Prostaglandins, Leukotrienes and Essential Fatty Acids. 48:101-104, 1993

2 - Mansel RE: the clinical assessment of mastalgia. Br J Clin Prac 68:17-20, 1989

3 - Wilson MC, Silwood RA: Therapeutic value of a supporting brassiere in mastodynia. Br Med J 2:90, 1976

4 - Pye JK, Mansel RE, Hughes LE: Clinical experience of drug treatment for mastalgia. Lancet 2:373, 1985

5 - London RS, Sundaram GS, Schultz M, et al. Endocrine parameters and alpha-tocopherol therapy of patients
with mammary dysplasia. Cancer Res 1981;41:3811-13.

6 - Dietary Flaxseed may relieve cyclic mastalgia. pg 6: Ob/Gyn News, 1/15/01

7 - Mansel R: Benign breast disease. Practitioner 236:830-837, 1992

8 - Fentiman IS, Caleffi M, Hamed H, et al: Studies of tamoxifen in women with mastalgia. Br J Clin Prac
68:49-53, 1989

9) Dittmar FW, Böhnert KJ, et al. Pre-menstrual syndrome: Treatment with a phytopharmaceutical.
Therapiwoche Gynäkol 1992; 5:60-68.

The information provided by MenopauseRx, Inc. is not intended to replace the medical advice of your doctor or health-care provider. Please consult your health-care provider for advice about a specific medical condition.