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 cyclic mastitis and is often associated with premenstrual syndrome (PMS). When the lumps become significant enough to be called cysts, the condition is 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 some evidence hints that women with fibrocystic breast disease may also have a greater tendency toward breast cancer.

The cause of cyclic breast pain is unclear. One theory, popular in Europe, suggests that higher than normal levels of the hormone prolactin may be involved. ]]>18]]> Another theory attributes the condition to an imbalance of essential fatty acids. ]]>1]]>

Conventional treatment for cyclic mastalgia involves anti-inflammatory medications and, sometimes, hormonal treatments.


Principal Proposed Natural Treatments

Cyclic mastalgia often occurs in connection with PMS]]> .


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. ]]>7-9]]>

Some evidence suggests that it is, in fact, effective for this purpose. For example, a ]]>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.

Another double-blind, ]]>placebo-controlled]]> study, enrolling 178 women, evaluated chasteberry for PMS in general. ]]>13]]> The results over three menstrual cycles indicated that chasteberry reduced breast tenderness and other PMS symptoms. Benefits were also seen in two other double-blind trials enrolling a total of more than 250 women. ]]>10,12]]>

For more information, including dosage and safety issues, see the full ]]>Chasteberry]]> article.


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 Natural Treatments

Evening primrose oil contains relatively high concentrations of the essential omega-6 fatty acid named gamma-linolenic acid]]> (GLA). On the theory that essential fatty acid imbalances play a role in cyclic mastalgia, evening primrose oil became a popular treatment for this condition. However, despite numerous positive anecdotes, there are considerable doubts regarding whether it is actually effective. The main supporting evidence for GLA comes from three small double-blind studies. ]]>3,19,20]]>

Unfortunately, all of these suffered from significant limitations in study design and reporting. A very large (555-participant) and well-designed study failed to find GLA, with or without antioxidants, any more effective than placebo. ]]>24]]> (The placebo by itself, however, was found to be quite effective, possibly explaining why so many doctors and patients believe that evening primrose oil is helpful!) Another well-designed study found that evening primrose oil, by itself or with ]]>fish oil]]> , is not more effective than placebo for cyclic breast pain. ]]>21]]> Other studies found evening primrose oil ineffective for established breast cysts. ]]>4,5,22]]>

Fish oil taken alone has, thus far, failed to prove effective for cyclic breast pain.

According to one small double-blind trial, the substance ]]>diindolylmethane]]> (DIM) might be helpful for cyclic mastalgia. ]]>26]]>

A small and poorly reported double-blind, placebo-controlled trial provides weak evidence that ]]>red clover isoflavones]]> might reduce symptoms of cyclic mastalgia. ]]>17]]> Another small study suggests possible benefit with ]]>soy]]> protein. ]]>25]]>

Very weak evidence suggests the supplement ]]>iodine]]> may also be helpful for cyclic mastalgia. ]]>23]]>

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.

Finally, many conventional and alternative practitioners suggest avoiding caffeine. However, despite the popularity of this intervention, there is no consistent evidence that caffeine really causes a problem. ]]>23]]>