Part Two

Treatment

Cyclical Mastalgia

A full range of treatments are available but it is imperative that the woman herself chooses which to take as the side effects can be worse than the pain and the woman is the only one who can decide as she is the one with the pain!

Simple advice like reducing caffeine intake, wearing appropriate bra sizes (including perhaps a larger comfortable bra at the end of the cycle), a healthy diet and reducing external stress etc. would not be unreasonable as a starting point.

There is some evidence that iodine can help so I normally advise some vitamin and mineral supplement.

The evidence around gamma linoleic acid (GLA) and mastalgia is controversial.  However I believe it is reasonable to try either Evening Primrose Oil or Star Flower Oil (this contains more GLA so you don’t have to take so many tablets) to give a dose of arounf 320mg of GLA a day.  As it is a food supplement it can take a couple of months to work so in the mean time unless it is contra-indicated some ibuprofen or voltarol gel massaged into the painful areas of the breast twice a day may help.  The massage may help reduce the congestion in addition to the pain relief in the gel.  Those wishing to use more natural approach can try a Savoy cabbage leaf placed  in a comfortable bra at night – there is evidence that this is as effective as the gels.

If these measures do not work then the woman must decided on whether she wishes to explore more radical hormonal manipulation.  If on a hormonal contraceptive it may be worth changing this first and if perimenopausal and not on the pill it may be worth actually starting a low dose pill to regulate the hormonal situation as long as the risks are explained and the woman can make an informed choice.

Other options include the use of drugs such as Danazol. This acts like a male hormone and around 25% of women suffer side effects such as male pattern hair growth, weight gain, voice changes, aggression and increased libido.

If this is unsuccessful then some women will choose a trial of Tamoxifen. This anti-oestrogen is not licensed for the treatment of mastalgia and although effective it has significant potential side effects which can be fatal and therefore should be fully explained.

In the premenopausal woman with resistant mastalgia a trial of Zoladex injections could be used to stop her periods altogether and render her temporarily post-menopausal. Clearly this decision must be made in partnership with the patient.

Surgery is very rarely indicated and not always successful. If as a last resort it is being considered a second opinion should always be sort and also psychological counselling is mandatory.

Non – Cyclical Mastalgia

This type of mastalgia is much more difficult to treat as hormonal manipulation is less likely to work, especially in the postmenopausal woman – unless she is taking HRT.  The basic advice remains the same and the clinician will pay particular attention to any signs of sites for referred pain or general rheumatological conditions such as fibromyagia.

Summary

Mastlagia effects 85% of women during their lifetime. It is rarely associated with breast cancer.  Cyclical mastalgia is the commonest type.  It is generally self limiting and resolves without treatment.  However, treatment is available although it is imperative that the woman herself decides on how far she wishes to go.