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 .
Cyclical mastalgia: prevalence and associated health and behavioral factors
Perimenstrual breast pain ( cyclical mastalgia ) is a common problem that can be sufficiently severe to interfere with usual activities , and has been associated with elevated  mammography usage in young women . This study was undertaken to replicate clinic-based research on cyclical mastalgia , and to examine the association between this disorder and health-related behaviors and perceived stress . Using r and om digit dialing throughout Virginia , 874 women aged 18 - 44 were interviewed . Sixty-eight per cent of women experienced cyclical breast symptoms ; 22 % experienced moderate to extreme discomfort ( classified as cyclical mastalgia ) . Hormonal contraceptive usage was associated with significantly less mastalgia and premenstrual syndrome ( PMS ) . Smoking , caffeine consumption and perceived stress were associated with mastalgia ( odds ratios = 1.52 , 1.53 and 1.7 , respectively ) . Young women ( under 35 years ) with mastalgia were more likely to have had a mammogram ( 20.2 % ) than those without mastalgia ( 9.9 % ) . Most women with this disorder ( 77.5 % ) did not have PMS . The prevalence of cyclical mastalgia and its association with mammography replicate clinic-based findings . Associations with smoking and stress had not previously been reported . Prospect i ve research is needed to determine the biopsychosocial factors contributing to this disorder
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 .