Evening Primrose oil (EPO):
We have had patients who have reported dramatic benefits with EPO, and others who had no benefit. EPO comes in a capsule that is taken by mouth, and is available in most health food stores. We recommend that a patient start with 1500 mg twice a day for at least two weeks. If there is improvement in pain, this dosing is continued for at least 3 months to assess its effect over successive menstrual cycles, and can be continued as needed for symptomatic relief. If no benefit is obtained, dosing can be discontinued.
Vitamin E and other “anti oxidants”
Vitamin E, as well as many of the B vitamins, have been credited with providing relief for breast pain, but the data to support the effectiveness of their use in women with breast pain is limited.
Estrogen and Breast Pain:
One of the most common side effects of estrogen is breast pain, and one of the most common causes of breast pain in post-menopausal women is the estrogen component in hormone replacement therapy. We recommend that all post-menopausal women on estrogen take the lowest dose that will control menopausal symptoms. Breast pain secondary to estrogen intake is just one more good reason to keep estrogen doses as low as tolerable.
Fortunately, birth control pills are not typically associated with breast pain, and sometime breast pain is reduced with the use of oral contraceptives.
Diet and Breast Pain:
There is limited evidence that a low-fat diet may have some benefit on breast pain. We still recommend a low-fat diet, since it may help in lowering breast cancer risks, and is definitely of value in lowering cardiac risks and the risk of other types of cancer (i.e. colon).
A well-fitted bra is often of value in reducing breast pain. It is of important to get a good fit, and every woman seems to have her own favorite type of fit. There are professional fitters who can be of assistance. In some cases, extra support can be obtained with an additional external wrap, such as with a circumferentially wrapped ace-bandage.
Bromocriptine (a medication which blocks the pituitary secretion of prolactin) and danazol (which blocks luteinizing and follicle-stimulating hormones) are often mentioned as agents that can be used for severe breast pain. The side-effects of both drugs are significant, and it our experience that when these side effects are discussed with patients, they have all elected not to take the drugs.
Diuretics have also been advised in the past, but we do not recommend them for breast pain.
Over-the-counter analgesics such as Tylenol, aspirin, and non-steroidal anti-inflammatories (i.e. Advil, Motrin) are often quite effective for short-term pain relief.
In the past, subcutaneous mastectomy was used as a treatment for extreme breast pain that was not responsive to standard treatments. We believe that patients with breast pain can be handled with less invasive forms of treatment.