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 .
Multicentre study of gestrinone in cyclical breast pain FRIEDOLF PETERS
Although the aetiology of cyclical mastalgia is poorly understood , the consistent finding of an increased prolactin stimulation response probably due to oestrogen dominance has led to the use of treatment with prolactin-lowering drugs and antioestrogens . The efficacy and safety in cyclical mastalgia of gestrinone , which has and rogenic , anti-oestrogenic , and antiprogestagenic properties , were investigated in a multicentre study . In a double-blind r and omisation procedure , 72 patients were allocated placebo and 73 treatment with gestrinone  ( 2.5 mg twice a week ) for 3 months . The patients recorded the severity of breast pain on a visual analogue scale before and during treatment and scored other breast symptoms as not present ( 0 ) , mild ( 1 ) , moderate ( 2 ) , or severe ( 3 ) . The gestrinone group had significantly greater reductions than the placebo group in breast pain score at months 1 , 2 , and 3 of treatment ( mean reduction 59.5 [ SD 22.6 ] to 11.7 [ 17.0 ] vs 58.2 [ 17.6 ] to 36.7 [ 23.0 ] at month 3 ; p less than 0.0001 ) . All six breast symptoms had lower scores in the gestrinone than in the placebo group by the end of treatment . In a subset of 30 participants ( 15 from each group ) , serum concentrations of oestradiol , progesterone , and tri-iodothyronine were significantly lower than baseline after 3 months of gestrinone , but concentrations of luteinising hormone , follicle-stimulating hormone , prolactin , thyroid-stimulating hormone , and thyroxine did not change . 41 % of gestrinone-treated and 14 % of placebo-treated patients reported at least one side-effect ; most of these were and rogen-mediated . 11 placebo-treated patients and 4 on gestrinone discontinued treatment . Thus , gestrinone was very effective in the treatment of cyclical mastalgia  and was well tolerated
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 .