Rutgers Cancer Institute of New Jersey
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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.
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.
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 And another randomized trial involving 85 women also failed to find evening primose (alone or with vitamin E) to be helpful in reducing breast pain.27 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.
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
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
1. Horrobin DF, Manku MS, Brush M, et al. Abnormalities in plasma essential fatty acid levels in women with premenstrual syndrome and with nonmalignant breast disease. J Nutr Med. 1991;2:259-264.
2. Ghent WR, Eskin BA, Low DA, et al. Iodine replacement in fibrocystic disease of the breast. Can J Surg. 1993;36:453-460.
3. Pashby NL, Mansel RE, Hughes LE, et al. A clinical trial of evening primrose oil in mastalgia [abstract]. Br J Surg. 1981;68:801.
4. Mansel RE, Gateley CA, Harrison BJ, et al. Effects and tolerability of n -6 essential fatty acid supplementation in patients with recurrent breast cysts—a randomized double-blind placebo-controlled trial. J Nutr Med. 1990;1:195-200.
5. Mansel RE, Harrison BJ, Melhuish J, et al. A randomized trial of dietary intervention with essential fatty acids in patients with categorized cysts. Ann N Y Acad Sci. 1990;586:288-294.
7. Dittmar FW, Bohnert KJ, Peeters M, et al. Premenstrual syndrome: treatment with a phytopharmaceutical [translated from German]. Therapie Woche Gynakol. 1992;5:60-68.
8. Peters-Welte C, Albrecht M. Menstrual abnormalities and PMS: Vitex agnus - castus [translated from German]. Therapie Woche Gynakol. 1994;7:49-52.
9. Coeugniet E, Elek E, Kuhnast R. Premenstrual syndrome (PMS) and its treatment [translated from German]. Arztezeitschr Naturheilverf. 1986;27:619-622.
10. Halaska M, Beles P, Gorkow C, et al. Treatment of cyclical mastalgia with a solution containing a Vitex agnuscastu s extract: results of a placebo-controlled double-blind study. Breast. 1999;8:175-181.
11. Wuttke W, Splitt G, Gorkow C, et al. Treatment of cyclical mastalgia: results of a randomised, placebo-controlled, double-blind study [translated from German]. Geburtsh Frauenheilk. 1997;57:569-574.
12. Kubista E, Muller G, Spona J. Treatment of mastopathy associated with cyclic mastodynia: clinical results and hormone profiles [translated from German]. Gynakol Rundsch. 1986;26:65-79.
13. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. 2001;322:134-137.
16. Tamborini A, Taurell R. Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome [translated from French]. Rev Fr Gynecol Obstet. 1993;88:447-457.
17. Ingram DM, Hickling C , West L, et al. A double-blind randomized controlled trial of isoflavones in the treatment of cyclical mastalgia. The Breast. 2002;11:170-174.
18. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer-Verlag; 1998:240
19. Mansel RE, Pye KJ, Hughes LE. A controlled trial of evening primrose oil (Efamol) in cyclic premenstrual matalgia. Abstract 47. Proceedings of the 2nd International Symposium on Premenstrual, Postpartum, and Meonopausal Mood Disorders; 1987; Kiawah Island, SC.
20. Preece PE, Hanslip JI, Gilbert L. Evening primrose oil (Efamol) for mastalgia. In: Horrobin DF, ed. Clinical Uses of Essential Fatty Acids. Montreal, Quebec: Eden; 1982: 147-154.
21. Blommers J, De Lange-De Klerk ES, Kuik DJ, et al. Evening primrose oil and fish oil for severe chronic mastalgia: a randomized, double-blind, controlled trial. Am J Obstet Gynecol. 2002;187:1389-1394.
22. Kollias J, Macmillan RD, Sibbering DM, et al. Effect of evening primrose oil on clinically diagnosed fibroadenomas. Breast. 2000;9:35-36.
23. Horner NK, Lampe JW. Potential mechanisms of diet therapy for fibrocystic breast conditions show inadequate evidence of effectiveness. J Am Diet Assoc. 2000;100:1368-1380.
24. Goyal A, Mansel RE. A randomized multicenter study of gamolenic acid (Efamast) with and without antioxidant vitamins and minerals in the management of mastalgia. Breast J. 2005;11:41-47.
25. McFadyen IJ, Chetty U, Setchell KD, et al. A randomized double blind-cross over trial of soya protein for the treatment of cyclical breast pain. Breast. 2000;9:271-276.
26. Zeligs MA, Brownstone PK, Sharp ME, et al. Managing cyclical mastalgia with absorbable diindolylmethane: A randomized, placebo-controlled J Amer Nutr Assn. 2005;8:10-20.
27. Pruthi S, Wahner-Roedler DL, Torkelson CJ, et al. Vitamin E and evening primrose oil for management of cyclical mastalgia: a randomized pilot study. Altern Med Rev. 2010;15(1):59-67.
Last reviewed December 2015 by EBSCO CAM Review Board Last Updated: 12/15/2015