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Breast Pain
Health Guide
Breast pain is one of the commonest reasons why women see their doctors. It can vary from trivial premenstrual discomfort to severe and debilitating pain persisting throughout the menstrual cycle.

In the past, mastalgia has been labelled as a manifestation of a variety of psychiatric and emotional problems! Mastalgia is now generally recognised as an abnormal response by the breast tissue to the hormones produced by the ovaries and pituitary gland. The term "hormone imbalance" is often used in a loose way but it is virtually impossible to obtain objective evidence such as blood tests to check this. It seems likely that for most women the problem is one of the increased sensitivity of breast cells lining the milk glands to "normal" levels of hormones that the body produces.

Mastalgia seldom occurs at puberty but may be a significant problem in later teenage years. The peak incidence of mastalgia occurs in the 35 - 45 year age group. Breast pain becomes rare after the menopause but use of hormone replacement therapy may account for women in this age group who present with this problem.

Mastalgia can present in a variety of ways. It may involve one or both breasts, be diffuse or localised, and present throughout the whole cycle or part of it.

There are different ways mastalgia can be treated beginning with dietary changes through to hormonal medications. One golden rule must be to avoid replacing a mild - moderate symptom with a severe drug side-effect! At St Marks Breast Centre, we will formulate a plan of action that will suit each individual.

Treatment options

  • Reassurance only (exclude breast cancer as a cause of breast pain)
  • Dietary - reduction of caffeine, alcohol, fat
  • Lifestyle - stress, cigarettes
  • Herbal - EPO / Starflower Oil (50 - 75% response)
  • Hormonal - Tamoxifen, Danazol, Bromocryptine (70 -90% response)How does Evening Primrose Oil work?

    Vitamin B6 and Evening Primrose Oil or E.P.O. have important actions in the production of prostaglandin. Prostaglandins are substances which regulate the action of other hormones and, in the case of the breasts, hormones which can cause pain. Vitamin B6 acts as a catalyst early on in this pathway and Evening Primrose Oil occurs later on in the pathway and contains gamma linoleic acid which is an essential precursor of the prostaglandin. The synthesis of prostaglandins can be blocked by saturated fatty acids and therefore the theory that reducing fat intake may help breast pain has been suggested. Other potential blocks to this pathway may be through stress, alcohol, cigarette smoking and caffeine.

    Where do I get EPO?

    EPO is sold in supermarkets, health food stores and pharmacies. All the brands are similar in effectiveness. EPO comes in different strength capsules, 500 mg, 1000 mg and 1500 mg.

    What dose of EPO should I take?

    In our experience, dose of 3,000 mg of Evening Primrose Oil ( EPO ) per day are needed to be taken initially. We have found that up to 75% of women will get either full or partial relief of breast pain in the second month of treatment. Once the pain resolves the dose can be reduced down t two thirds or half and continued for 12 weeks. If the pain returns on the lower dose, the EPO should be increased back to 3000 mg per day. Alternatively, if there is no improvement after taking EPO 3000 mg each day for six weeks we would recommend stopping.

    The manufacturers recommend that EPO is taken in divided doses with meals. This is because if the EPO capsules are taken on a empty stomach, when the capsule dissolves, the oil may cause nausea or abdominal upset. If this does not occur with you, the EPO can be taken as a single dose with or without a meal.

    What is Starflower Oil?

    Starflower oil is a more concentrated form of EPO with the equivalent dose of EPO 3000 mg per day being 1 & 1/2capsules of Starflower Oil. This means you can either go to a higher end of the range and take 2 capsules per day or alternate 2 capsules on one day and one capsule the other. Taking only one capsule per day runs the risk of not responding to this lower dose.Link to St Marks Breast Centre Online

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