RESULTS Reassurance plus bra-fitting advice provides relief for most women .
There is some benefit in reducing dietary coffee and fat intake .
Dopamine agonists are useful , but less effective than endocrine treatments such as Danazol or Tamoxifen .
Of the Selective Oestrogen Receptor Modulator drugs , Ormeloxifene appears most effective , but is not licenced in the United Kingdom .
Relaxation therapy , acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness .
Subsequent drug therapy should be balanced against its side-effects ; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects .
INTRODUCTION Idiopathic mastalgia ( benign breast pain of unknown origin ) is often poorly managed because of its subjective nature and unclear aetiology .
Mastalgia is a reason for up to 50 % of breast outpatient referrals .
Existing systematic review s discuss date d treatment options that provide limited symptomatic relief .
A randomized double blind-cross over trial of soya protein for the treatment of cyclical breast pain.
Twenty patients with cyclical breast pain were enrolled in a double-blind cross-over trial in which either a soy protein drink or a flavoured cow 's milk was taken orally each day for 3 months before crossing over to the alternate drink for a further 3 months . Records of pain scores were taken throughout the study . Blood was also taken before and after 3 and 6 months for the measurement of phytoestrogents to assess compliance . Two women withdrew from the study at the outset leaving 18 evaluable patients who completed the study . Of these 10 ( 56 % ) felt that soy protein improved breast pain ( two of whom received soy as first treatment ) and two ( 11 % ) felt that cow 's milk alleviated symptoms ( one receiving this as first preparation ) and the remaining six ( 33 % ) experienced no relief of pain with either dietary preparation . Blood levels of diadzein and genistein were elevated after the ingestion of soy protein in only 13 patients ( seven of whom felt that soy improved their breast pain ) ; in the remaining five patients ( three of whom suggested that soy protein improved breast pain ) phytoestrogen levels were no higher than pretreatment values . Although the ingestion of soy protein may be associated with relief of breast pain , these results illustrate the problem of non-specific effects in studies of mastalgia in that 1 ) cow 's milk also relieved breast pain in some patients and 2 ) that the benefits of soy protein were not always associated with evidence of elevated circulating levels of phyto-estrogens , indicating the difficulty of compliance in dietary intervention studies using soy foods
RESULTS Reassurance plus bra-fitting advice provides relief for most women .
There is some benefit in reducing dietary coffee and fat intake .
Dopamine agonists are useful , but less effective than endocrine treatments such as Danazol or Tamoxifen .
Of the Selective Oestrogen Receptor Modulator drugs , Ormeloxifene appears most effective , but is not licenced in the United Kingdom .
Relaxation therapy , acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness .
Subsequent drug therapy should be balanced against its side-effects ; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects .
INTRODUCTION Idiopathic mastalgia ( benign breast pain of unknown origin ) is often poorly managed because of its subjective nature and unclear aetiology .
Mastalgia is a reason for up to 50 % of breast outpatient referrals .
Existing systematic review s discuss date d treatment options that provide limited symptomatic relief .