Simple measures are usually attempted first, including the use of a well-fitting brassiere, a low-fat diet, Evening Primrose Oil, regular exercise and/or Neurofen (tablet or local gel as required). If these fail to improve the symptoms, then the patient is advised to stop taking any oral contraceptives.
If the pain is severe and persistent, then stronger drugs can be used, such as bromocriptine, danazole and tamoxifen. However, these drugs can have significant side-effects such as weight gain, the growth of facial hair, and hot flushes. Tamoxifen (10 mg daily) is the most effective but should not be used for more than 6 months. Cyclical mastalgia usually improves with age.
Non-cyclical Mastalgia
This refers to pain in the breast area that is unrelated to the menstrual cycle. Non-cyclical mastalgia may arise from the breast tissue itself, the underlying ribs, or from conditions such as hiatus hernia and angina. Although non-cyclical breast pain is not usually a symptom of cancer, occasionally, cancer has been detected in women with breast pain, especially if they are over 40 years old. Consequently, if you have non-cyclical mastalgia, it is important to consult your doctor.
Women with non-cyclical breast pain affecting one breast will require breast examination and they should also have a mammogram if they are over 35 years old. Treatment will depend upon the cause of the pain. Inflammation in the ribs can be treated with simple painkillers, such as ibuprofen (tablet or gel), whereas other conditions, such as angina or hiatus hernia, will require specialist treatment.
The general treatment for non-cyclical mastalgia is listed below:
- Wear a well-fitting firm brassiere.
- Optimise body weight and undertake regular exercise.
- Increase the amounts of fresh fruit and vegetables and reduce animal fat in your diet.
- Try Evening Primrose Oil.
- Try Ibuprofen tablets or cream/gel.
- If there is a 'trigger spot' in the breast, then an injection of local anaesthetic and steroid will relieve symptoms in most cases.
- Discontinuing HRT may relieve severe mastalgia in some post-menopausal women.
- If the above measures fail and the breast pain is severe then it is worth trying tamoxifen (10 mg daily), bromocriptine or cabergoline (0.5 mg once weekly) under medical guidance and supervision.