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 .
Treatment of mastalgia with bromocriptine: a double-blind cross-over study.
Severe mastalgia was the dominant feature in 10 women with diffuse fibrocystic disease of the breast as judged by palpation and mammography and verified histologically . One patient ( case 1 ) had galactorrhoea . None had prominent characteristics of the premenstrual syndrome . Mastalgia had been present for from six months to several years . In a double-blind crossover trial patients were allocated at r and om to receive either bromocriptine or identical placebo capsules , each for a period of two months , in a dose of one capsule ( bromocriptine 2 - 5 mg or placebo ) daily during the first week of each period and thereafter two capsules daily . For one month before the trial and throughout the period of medication the presence and intensity of pain were recorded daily by each patient . They were seen in the outpatient clinic every four weeks . The code was broken at the end of each trial . Serum prolactin concentration was measured before the trial , on the day of crossover , and on the final day of the trial ( normal range 3 - 0 - 13 - 5 jug/l ) . During treatment with bromocriptine  pain was totally or almost totally relieved in eight patients and in two the pain was much reduced ( table ) . Placebo treatment failed to relieve mastalgia in any patient except one ( case 9 ) , in whom the relief during bromocriptine continued while taking placebo . Statistical analysis by Koch 's method ' showed that the relief obtained during bromocriptine therapy was significantly greater ( P<002 ) than that during placebo medication , while period effects as well as carry-over effects were absent ( P > 0 - 05 ) . Mastalgia reappeared as soon as active medication was stopped , with the exception of the patient in case 9 . The breasts became smaller , softer , and less tender during bromocriptine treatment . The pretrial serum prolactin concentration was slightly raised in three patients and normal in seven . During treatment with bromocriptine these concentrations were significantly lowered ( P<0 - 01 , sign test ) . There were no side effects from placebo . While taking bromocriptine five patients had slight , transitory nausea and dizziness , which is a recognised side effect . Three others had persistent and more pronounced nausea , dizziness , and general malaise
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 .