Cyclic Mastalgia: Treatment Options For Premenstrual Breast Pain

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Do your breasts get very painful and swollen every month before your period? If you experience these symptoms you may be suffering from a condition called cyclic mastalgia.

What is Cyclic Mastalgia?

The exact cause of the breast pain and swelling is not known but it is likely related to the normal hormonal changes of your menstrual cycle. In some women, these normal hormonal fluctuations likely trigger additional hormone changes or imbalances that result in the swelling and pain of the breast tissue.

The symptoms will begin in the luteal phase of your menstrual cycle or the time between your ovulation and the first day of your period. The symptoms should go away within the first couple of days of your period. For some women, these symptoms are very severe.

Sometimes cyclic mastalgia may be a woman's only premenstrual luteal phase complaint. But for some women breast, pain and swelling are only one of several premenstrual symptoms. In fact, cyclic mastalgia is one of the criteria used to make the diagnosis of Premenstrual Dysphoria Disorder (PMDD).

Understandably, one of the biggest concerns you may have, if you experience painful and swollen breasts, is the possibility that you may have breast cancer. It is very important to understand that pain and or swelling in both of your breasts that come and goes with your menstrual cycle is very unlikely to be a sign of breast cancer. In fact, breast pain, in general, is very rarely a sign of breast cancer.

That being said, it is important to discuss your symptoms with your healthcare provider. A breast exam is important and your doctor may recommend additional testing if you have a palpable mass that is concerning or if you are due for recommended breast cancer screening based on your age and family history.

Treatment Options For Cyclic Premenstrual Breast Pain

  1. Wear a different bra. This may seem like a simple suggestion but it is a great place to start. If the volume of your breasts has increased due to swelling your usual bra may be too tight and the underwire may be quite uncomfortable. You may want to choose a very supportive soft cup option. There is no reason to increase your discomfort by forcing your temporarily larger breasts into your usual bra.
  2. Limit your caffeine intake. This is a common recommendation given to women complaining of cyclic mastalgia. In general, it is recommended that a healthy adult limit their caffeine intake to 400 mg a day. There is conflicting evidence on how much changing your caffeine intake will reduce your cyclic breast pain and swelling. But since it is a relatively easy option it is probably worth a try.
  3. Add flaxseed to your diet. There is some evidence to suggest that dietary supplementation with 25 mg of ground flaxseed daily can help to reduce cyclic breast pain. 
  1. Chasteberry (Vitex agnus castus) supplementation. There is some evidence to suggest that chaste berry supplementation may help to reduce the symptoms of cyclic mastalgia. The typical dose of chaste berry used in studies is 20-40 mg daily. 
  2. Vitamin E supplementation. The effectiveness of Vitamin E supplementation is controversial.  There is some limited evidence that 400 mg of Vitamin E daily may have some benefit. Although one clinical guideline goes as far as to say it should not be recommended because it has not been adequately shown to be effective.
  3. Evening Primrose Oil. Similar to Vitamin E the evidence for the benefit of EPO is insufficient. In the studies that have suggested some improvement, a dose of 3,000 mg of EPO was used. 

If these first line interventions are not helpful your may suggest these additional medications.

  • Topical NonSteroidal Anti-inflammatory Drugs (NSAIDs)
  • Hormonal Medications
    • Danazol
    • Tamoxifen
    • Bromocriptine

If your symptoms do not respond to any of these treatment options you may need to consider surgical management although this is, of course, your very last treatment option.

Also, be sure to discuss the use of any herbal supplement with your health care provider BEFORE you start one as serious interactions with medication or worsening of health problems can occur.

Rosolwich V.et al Mastalgia. Journal Obstetrics and Gynecology Canada 2006 Jan;28(1)49-71

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