Cyclic Mastalgia (Breast Pain)
Ever wonder why you experience breast pain every month? As women, our hormones play a powerful role in the body, including some not so desired effects. Dr. Anna answers the question of what is cyclic mastalgia, why it occurs and what you can do about it naturally. Listen below and subscribe to the Health is PowHer podcast on iTunes, Spotify or Stitcher!
What is cyclic mastalgia?
In non-medical terms, cyclic mastalgia means breast pain that starts 1-2 weeks prior to menses and goes away at the start of the menstrual period. Cyclic mastalgia is usually more common for women ages 30-40 years old. Approximately 60-70% of women suffer from typical breast pain and about 10-20% of women have a more severe form.
Causes of cyclic mastalgia
Increased estrogen secretion compared to progesterone may cause cyclic mastalgia, and in some cases progesterone may actually be deficient. Elevated prolactin levels may also contribute to symptoms.
Other possible causes of breast pain may be due to cancer, pregnancy, breast cysts, breast abscesses, mastitis, diabetic breast tumors, and referred pain other from organs including the heart, lungs, diaphragm, ribs, muscles such as the pectoralis, or the upper gastrointestinal tract.
Risk factors include:
Stress
Caffeine (however there is conflicting evidence and this may be related to an individual’s ability to metabolize caffeine)
Smoking
Lactation frequency (pain may increase with more frequent breastfeedings)
Increased breast density, cysts, and fibroadenomas
Treatments for cyclic mastalgia
One key takeaway we want for you to know is that lifestyle change is the best treatment for cyclic mastalgia according to research. These changes include:
Relaxation therapy
Limiting caffeine intake
Exercise
Wearing a well-fitting sports bra (this provided breast pain relief in 85% of patients after wearing for 3 months)
Conventional treatments for cyclic mastalgia is through pharmaceuticals.
Medications commonly prescribed include danazol, bromocriptine, and tamoxifen.
Danazol is a synthetic testosterone that has shown good results by improving pain by 70%. However, side effects may include masculinizing changes in the woman’s body, depression and it is contraindicated during pregnancy due to potential harm to the developing fetus.
Bromocriptine is a dopamine agonist which inhibits release of prolactin from the anterior pituitary. We know that prolactin can be high in women with cyclic breast pain, so this helps counteract that imbalance. Side effects may include headaches and dizziness. Also, this medication has not been shown to be as effective as Danazol in terms of symptom improvement.
Tamoxifen is a drug that blocks the effects of estrogen in breast tissue and has also been used in certain breast cancers. It has a 90% success rate at resolving cyclic mastalgia, but unfortunately about 50% of patients have relapses of pain after 3 months of treatment. Side effects can include irregular periods, hot flashes, hormonal changes, and there is potential for it causing endometrial cancer for certain individuals.
Integrative treatments for cyclic mastalgia unfortunately have very little evidence. Therefore, lifestyle change is truly the strongest treatment in terms of supportive research.
However, we will discuss a few of the integrative treatments which have been studied. A few supplements and botanicals for cyclic mastalgia are flaxseed meal, vitamin E, vitamin B6 and Vitex (chaste tree berry).
Flaxseed meal is generally the first line integrative treatment that can decrease pain. It may be more beneficial than the anti-inflammatory Omega-3’s in fish oil. Flaxseed meal contains lignans which are phytoestrogens and have estrogen adaptogenic properties in high doses of 25 grams per day.
Vitamin E may show benefit in reducing breast pain severity as shown in 2 different studies. Doses ranged from 200 IU to 1200 IU daily in these studies.
Vitamin B-6 at 40 mg daily in one study showed benefits for women with cyclic mastalgia by reducing breast pain.
Vitex (chaste tree berry) at 40mg to 440mg daily may reduce breast pain by regulating the high prolactin levels.
There are a few other second-tier treatments. Supplementation of inositol, betaine, and boswellia decreased breast pain in one study. Another study found that topical nigella sativa seed oil at 600mg daily compared to topical diclofenac (an anti-inflammatory medication) was more effective than placebo. Evening primrose oil (GLA) used at 3000mg daily decreased breast pain severity.
Beyond supplements and botanicals, there has been some research for acupuncture and mind-body therapies.
Acupuncture has anecdotal evidence that one point called HT7 works “magic” for breast pain. Another study shows that low level laser acupuncture therapy is possibly equal to treatment with bromocriptine. Mind-body therapies including relaxation and mitigating stress may be of good benefit as stress is one of the largest contributing factors to hormonal disruption and cyclic breast pain.