Conditions:
Cyclic Mastalgia
Related Terms
•
Cyclic Mastitis, Fibrocystic Breast Disease
Principal Proposed Treatments
•
Chasteberry, Evening Primrose Oil (GLA), Ginkgo
Other Proposed Treatments
•
Red Clover Isoflavones, Iodine
Some women's breasts are unusually tender and lumpy, with symptoms of pain and dull heaviness that vary with the menstrual cycle. This condition is called cyclic mastalgia or mastitis and is often associated with premenstrual stress syndrome (PMS). When the lumps become significant enough to be called cysts, this condition is sometimes called fibrocystic breast disease.
Besides discomfort, perhaps the worst problem of this condition is that it can mimic the appearance of breast cancer on mammograms, leading to false alarms. To make matters worse, fibrocystic changes can also hide true cancers, and women with fibrocystic breast disease may also have a greater tendency toward breast cancer (although this is controversial).
Conventional treatment of cyclic mastalgia has incorporated many staples of alternative medicine. After screening carefully for breast cancer, physicians typically recommend reducing animal fats, avoiding chocolate and caffeine, and supplementing with vitamin E (400 IU daily) and vitamin B6 (50 mg daily). Some physicians have begun to use evening primrose oil as well. These treatments are more likely to be successful in cases that involve pain but no cysts. Even so, the response to therapy is slow, often requiring over 6 months for full results.
If these natural methods don't work, physicians may prescribe various hormone or hormone-like medications.
Principal Proposed Treatments for Cyclic Mastalgia
Cyclic mastalgia often occurs in connection with PMS. (See the article on PMS for information on related treatments.)
Chasteberry
In Germany, the herb chasteberry is frequently used to treat cyclic mastalgia and other symptoms of PMS because of its effect on the pituitary gland to suppress the release of prolactin.7,8,9
What Is the Scientific Evidence for Chasteberry
A double-blind placebo-controlled trial of 97 women with symptoms of cyclic mastalgia found that treatment with chasteberry extract significantly reduced pain intensity by the end of one menstrual cycle.10 The reduction continued to increase throughout the second menstrual cycle, and at the end of both the first and second cycle, women in the treated group were doing better than those receiving placebo.
However, something interesting happened in the third cycle. The benefits of chasteberry treatment reached a plateau, while the placebo group continued to improve. At the end of the third cycle, those receiving chasteberry were still doing better, but the difference was no longer statistically significant.
Another double-blind trial of 104 women compared placebo against two forms of chasteberry (liquid and tablet) for at least three menstrual cycles.11 The results showed statistically significant and comparable improvements in the treated groups as compared to placebo.
Benefits were also seen in a double-blind trial that enrolled 160 women with cyclic breast pain. The women were given either chasteberry, a drug related to progesterone, or placebo, and were followed for at least four menstrual cycles.12 Although there were many dropouts, the results again suggest that chasteberry is superior to placebo.
Finally, a double-blind placebo-controlled study of 178 women found that treatment with chasteberry over three menstrual cycles significantly reduced PMS symptoms, including breast tenderness.13
For more information, including dosage and safety issues, see the full chasteberry article.
Evening Primrose Oil (Source of GLA)
European physicians commonly use evening primrose oil to treat cyclic mastalgia, and the practice has come to be popular among some physicians in the United States as well. Evening primrose contains relatively high concentrations of the essential fatty acid gamma-linolenic acid (GLA). Fatty acid metabolism is known to be disturbed in women with cyclic mastalgia, and abnormalities in essential fatty acid levels have been found in women with PMS and with nonmalignant breast disease.1 It appears that supplementation with evening primrose oil may be able to correct this imbalance.
What Is the Scientific Evidence for Evening Primrose Oil?
In uncontrolled studies, evening primrose oil has been found to produce significant benefits in about 44% of women with cyclic mastalgia.2
Improvement was also seen in a double-blind placebo-controlled study of 73 women suffering from cyclic breast pain.3 Discomfort was significantly reduced in the group taking evening primrose oil, whereas no significant improvement was seen in the placebo group.
However, evening primrose oil does not seem to be helpful when there are breast cysts rather than just pain. In a 1-year, double-blind study of 200 women with breast cysts, evening primrose oil did not prove effective.4,5
For more information, including dosage and safety issues, see the full GLA article.
Ginkgo
Although the herb ginkgo is primarily used to enhance memory and mental function (see the article on Alzheimer's disease), it may be helpful for breast tenderness as well. A double-blind placebo-controlled study evaluated 143 women with PMS symptoms, 18 to 45 years of age, and followed them for two menstrual cycles.16 Each woman received either the ginkgo extract (80 mg twice daily) or placebo on day 16 of the first cycle. Treatment was continued until day 5 of the next cycle, and resumed again on day 16 of that cycle.
As compared to placebo, ginkgo significantly relieved major symptoms of PMS, especially breast pain.
For more information, including dosage and safety issues, see the full ginkgo article.
Other Proposed Treatments for Cyclic Mastalgia
A small and poorly reported double-blind placebo-controlled trial provides weak evidence that red clover isoflavones might reduce symptoms of cyclic mastalgia.17
Very weak evidence suggests the supplement iodine may also be helpful for cyclic mastalgia.
Like chasteberry, the herb bugleweed appears to reduce prolactin levels, and for this reason has also been tried for the treatment of cyclic mastalgia. However, this herb affects the thyroid gland, and we do not recommend it.
View References
Last reviewed July 2002 by Medical Review Board
