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 double-blind randomized controlled trial of toremifen therapy for mastalgia.
HYPOTHESIS Toremifen is effective in reducing  breast pain  and does not increase the incidence of adverse events as a therapy for moderate to severe mastalgia . DESIGN AND PATIENTS In a double-blind r and omized controlled trial , patients with moderate to severe mastalgia received toremifen citrate , 30 mg daily , or a placebo tablet for 3 menstrual cycles and were followed up for breast pain score and adverse events . The serum levels of estradiol , progesterone , and prolactin were examined before treatment and correlated with the response rate to toremifen treatment . RESULTS Seventy-two ( 69.2 % ) of 104 patients receiving toremifen  and 29 ( 31.9 % ) of 91 receiving placebo  responded to the treatment , with reduction in breast pain score of more than 50 % ( P<.001 ) . Among the patients with cyclical mastalgia , the response rate for toremifen was 76.7 % ( 59/77 ) , whereas the response rate for placebo was 34.8 % ( 23/66 ; P<.001 ) . In contrast , the response rate of patients with noncyclical mastalgia was 48.1 % ( 13/27 ) for toremifen and 24.0 % ( 6/25 ) for placebo ( P = .09 ) . Adverse events were observed in 44 ( 42.9 % ) of 104 patients receiving placebo and 46 ( 50.5 % ) of 91 patients receiving toremifen ( P = .45 ) . A positive correlation between baseline breast pain score and serum estradiol level was observed in patients with cyclical mastalgia ( r = 0.35 , P = .003 ) . CONCLUSIONS Toremifen effectively relieves moderate and severe cyclical mastalgia and tends to exert a positive therapeutic effect on noncyclical mastalgia . In addition , toremifen therapy does not increase the incidence of intolerable adverse event . Therefore , it is a feasible therapy for mastalgia , especially cyclical mastalgia
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 .