Rating	Nutritional Supplements	Herbs
	Evening primrose oil	Vitex
	Iodine Vitamin B6 Vitamin E
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of fibrocystic breast disease? Both breasts become tender or painful and lumpy, and these symptoms vary at different times in the menstrual cycle. Despite the fact that signs and symptoms of FBD appear to be quite distinct from textbook signs and symptoms of breast cancer, any lump in the breast should be diagnosed by a doctor to rule out the possibility of cancer.

How is it treated? All women, including those with FBD, are encouraged to examine their breasts monthly and have regular medical evaluations, including mammograms after the age of 50. Symptomatic treatment with oral contraceptives (birth control pills) and pain relievers, such as aspirin (e.g., Bayer®), acetaminophen (Tylenol®), and ibuprofen (e.g., Advil®), may be recommended.

Dietary changes that may be helpful: Some,¹ ² but not all³ ⁴ studies have found that women with FBD drink more coffee than women without the disease. Eliminating caffeine for less than six months does not appear to be effective at reducing symptoms of FBD.⁵ ⁶ However, long-term and complete avoidance of caffeine does reduce symptoms of FBD.⁷ ⁸ Some women are more sensitive to effects of caffeine than others, so benefits of restricting caffeine are likely to vary from woman to woman. Caffeine is found in coffee, black tea, green tea, cola drinks, chocolate, and many over-the-counter drugs. A decrease in breast tenderness can take six months or more to occur after caffeine is eliminated. Breast lumpiness may not go away, but the pain often decreases.

FBD has been linked to excess estrogen. When women with FBD were put on a low-fat diet, their estrogen levels decreased.⁹ ¹⁰ After three to six months, the pain and lumpiness also decreased.¹¹ ¹² The link between dietary fat and symptoms appears to be most strongly related to saturated fat.¹³ Foods high in saturated fat include meat and dairy products. Fish, nonfat dairy, and tofu are possible replacements.

Lifestyle changes that may be helpful: Exercise may decrease breast tenderness. In one study, women who ran 45 miles per menstrual cycle reported less breast tenderness as well as improvement in other symptoms, such as anxiety.¹⁴

Nutritional supplements that may be helpful: In double-blind research, evening primrose oil (EPO) has reduced symptoms of FBD,¹⁵ ¹⁶ though only slightly.¹⁷ One group of researchers reported that EPO normalizes blood levels of fatty acids in women with FBD.¹⁸ However, even these scientists had difficulty linking the improvement in lab tests with an actual reduction in symptoms. Nonetheless, most reports continue to show at least some reduction in symptoms resulting from EPO supplementation.¹⁹ ²⁰ Based on this research, many doctors recommend a trial of 3 grams per day of EPO for at least six months to alleviate symptoms of FBD.

While several studies report that 200–600 IU of vitamin E per day, taken for several months, reduces symptoms of FBD,²¹ ²² most double-blind trials have found that vitamin E does not relieve FBD symptoms.²³ ²⁴ Nonetheless, many women take 400 IU of vitamin E for three months to see if it helps.

As with vitamin E, the effectiveness of vitamin B6 remains uncertain. Some,²⁵ but not all,²⁶ studies find that B6 supplementation reduces symptoms. Since vitamin B6 supplementation is effective for relieving the symptoms of premenstrual syndrome (PMS), in addition to breast tenderness, women should discuss the use of vitamin B6 with their healthcare provider.

Some doctors use iodine to treat FBD symptoms. In animals, iodine deficiency can cause the equivalent of FBD.²⁷ What appears to be the most effective form—diatomic iodine²⁸ —is not readily available, however. Some people are sensitive to iodine and high amounts can interfere with thyroid function. Therefore, supplemental iodine should only be taken with the guidance of a healthcare practitioner.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Since many women with FBD and cyclical breast tenderness also suffer from PMS, there is often an overlap in herbal recommendations for these two conditions despite a lack of research dealing directly with FBD.

In one double-blind trial, a liquid preparation containing 32.4 mg of vitex and homeopathic ingredients was found to successfully reduce breast tenderness associated with the menstrual cycle (e.g. cyclic mastalgia).²⁹ Vitex is thought to reduce breast tenderness at menses because of its ability to reduce elevated levels of the hormone, prolactin.³⁰

Doctors typically suggest 40 drops of a liquid, concentrated vitex extract or 35–40 mg of the equivalent dried, powdered extract to be taken once per day in the morning with some liquid. Vitex should be taken for at least three menstrual cycles to determine efficacy.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Marshall JM, Graham S, Swanson M. Caffeine consumption and benign breast disease: a case-control comparison. Am J Publ Health 1982;72(6):610–2.

2. Lubin F, Ron E, Wax Y, et al. A case-control study of caffeine and methylxanthines in benign breast disease. JAMA 1985;253(16):2388–92.

3. Boyle CA, Berkowitz GS, LiVoisi VA, et al. Caffeine consumption and fibrocystic breast disease: a case-control epidemiologic study. J Natl Cancer Inst 1984;72:1015–9.

4. Vecchia C, Franceschi S, Parazzini F, et al. Benign breast disease and consumption of beverages containing methylxanthines. J Natl Cancer Inst 1985;74:995–1000.

5. Ernster VL, Mason L, Goodson WH, et al. Effects of a caffeine-free diet on benign breast disease: a randomized trial. Surgery 1982;91:263.

6. Allen S, Froberg DG. The effect of decreased caffeine consumption on benign proliferative breast disease: a randomized clinical trial. Surgery 1987;101:720–30.

7. Minton JP, Foecking MK, Webster DJT, Matthew RH. Caffeine, cyclic nucleotides, and breast disease. Surgery 1979;86:105–8.

8. Minton JP, Abou-Issa H, Reiches N, et al. Clinical and biochemical studies on methylxanthine-related fibrocystic breast disease. Surgery 1981;90:299–304.

9. Rose DP, Boyar AP, Cohen C, Strong LE. Effect of a low-fat diet on hormone levels in women with cystic breast disease. I. Serum steroids and gonadotropins. J Natl Cancer Inst 1987;78:623–6.

10. Woods MN, Gorbach S, Longcope C, et al. Low-fat, high-fiber diet and serum estrone sulfate in premenopausal women. Am J Clin Nutr 1989;49:1179–83.

11. Rose DP, Boyar A, Haley N, et al. Low fat diet in fibrocystic disease of the breast with cyclic mastalgia: a feasibility study. Am J Clin Nutr 1985;41(4):856 [abstract].

12. Boyd NF, McGuire V, Shannon P, et al. Effect of a low-fat high-carbohydrate diet on symptoms of cyclical mastopathy. Lancet 1988;ii:128–32.

13. Lubin F, Wax Y, Ron E, et al. Nutritional factors associated with benign breast disease etiology: a case-control study. Am J Clin Nutr 1989;50:551–6.

14. Prior JC, Vigna Y, Sciarretta D, et al. Conditioning exercise decreases premenstrual symptoms: a prospective, controlled 6-month trial. Fertil Steril 1987;47(3):402–8.

15. Mansel RE, Pye JK, Hughes LE. Effects of Essential fatty acids on cyclical mastalgia and noncyclical breast disorders. In Omega-6 essential fatty acids: Pathophysiology and roles in clinical medicine. New York: Alan R Liss, 1990, 557–66.

16. Preece PE, Hanslip JI, Gilbert L, et al. Evening primrose oil (EFAMOL) for mastalgia. In: Clinical Uses of Essential Fatty Acids, ed. DF Horrobin, Montreal: Eden Press, 1982, 147–54.

17. Mansel RE, Harrison BJ, Melhuish J, et al. A randomized trial of dietary intervention with essential fatty acids in patients with categorized cysts. Ann NY Acad Sci 1990;586:288–94.

18. Gateley CA, Maddox PR, Pritchard GA, et al. Plasma fatty acid profiles in benign breast disorders. Br J Surg 1992;79:407–9.

19. Harding C, Harvey J, Kirkman R, Bundred N. Hormone replacement therapy-induced mastalgia responds to evening primrose oil. Br J Surg 1996;83(Suppl 1):24 [abstract # Breast 012].

20. Pye JK, Mansel RE, Hughes LE. Clinical experience of drug treatments for mastalgia. Lancet 1985;ii:373–7.

21. Abrams AA. Use of vitamin E in chronic cystic mastitis. N Engl J Med 1965;272(20):1080–1.

22. London RS, Sundaram GS, Schultz M, et al. Endocrine parameters and alpha-tocopherol therapy of patients with mammary dysplasia. Cancer Res 1981;41:3811–3.

23. Ernster VL, Goodson WH, Hunt TK, et al. Vitamin E and benign breast “disease”: a double-blind, randomized clinical trial. Surgery 1985;97:490–4.

24. London RS, Sundaram GS, Murphy L, et al. The effect of vitamin E on mammary dysplasia: a double-blind study. Obstet Gynecol 1985;65:104–6.

25. Brush MG, Perry M. Pyridoxine and the premenstrual syndrome. Lancet 1985;i:1399.

26. Smallwood J, Ah-Kye D, Taylor I. Vitamin B6 in the treatment of pre-menstrual mastalgia. Br J Clin Pract 1986;40:532–3.

27. Krouse TB, Eskin BA, Mobini J. Age-related changes resembling fibrocystic disease in iodine-blocked rat breasts. Arch Pathol Lab Med 1979;103:631–4.

28. Ghent WR, Eskin BA, Low DA, Hill L. Iodine replacement in fibrocystic disease of the breast. Can J Surg 1993;36:453–60.

29. Halaška M, Beles P, Gorkow C, Sieder C. Treatment of cyclical mastalgia with a solution containing Vitex agnus extract: results of a placebo-controlled double-blind study. The Breast 1999;8:175–81.

30. Böhnert KJ. The use of Vitex agnus castus for hyperprolactinemia. Quart Rev Nat Med 1997;Spring:19–21.

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