Figure 25.2
Figure 25.2 is a flowchart outlining the treatment options for cyclical breast pain. Cyclical breast pain may be the only problem or it may be just one of several PMS symptoms. Some treatments are beneficial for cyclical mastalgia. These include:
- pyridoxine (vitamin B6).).
bromocriptine (Parlodel).
Prolactin is the hormone particularly responsible for milk production after childbirth. Galactorrhoea (hyperprolactinaemia) tends to occur when prolactin levels are inappropriately elevated (hyperprolactinaemia Q6.10). For more than twenty years, bromocriptine (Parlodel - Novartis) has been the specific antidote for hyperprolactinaemia. It generally proves effective when other measures fail in the relief of cyclical mastalgia even in the absence of hyperprolactinaemia. Newer agents such as cabergoline (Dostinex Pharmacia and Upjohn) are more expensive. They may cause less side effects in some patients.
- Oil of evening primrose will often prove effective and is readily available without prescription.
- Danazol at a relatively low dose danazol (200mg daily) during the premenstrual phase of the cycle may improve cyclical breast pain but not other PMS symptoms.
- GnRH to down-regulate the cyclical hormones may be helpful in severe situations which do not respond to these treatments. Add-back HRT may be required should menopausal symptoms occur (HRT-Add-Back).
- Fluoxetine (Prozac Lilly) 20mg daily provides a new option for women with severe cyclical mastalgia. There is accumulating evidence that cyclical symptoms, including premenstrual mastalgia, may be related to abnormality in the release of serotonin which is an important neurotransmitter (a chemical released by brain cells to activate other brain cells).
A thirty-four year old lady presented with severe breast pain which had been slowly increasing. She had two children aged six and eight. She was taking no regular medication. A diuretic (encourages increased urine output) provided by her general practitioner had provided only temporary relief. On examination, her breasts were reminiscent of the engorgement encountered by women two or three days after childbirth. Investigations, including prolactin estimations demonstrated no abnormality. Over several years, a variety of treatments including Efamast, diuretics, Parlodel, Danazol, progestogens, and cabergoline individually and in combination have provided at best temporary relief. Down regulation with GnRH analogues and add-back HRT have proven to be effective.
Related Medical Abstracts - Click on the paper title:-
- Topical nonsteroidal anti-inflammatory drugs versus oil of evening primrose in the treatment of mastalgia. (2005-01)
- Mastalgia: a review of management. (2005-02)
- Symptomatic treatment of premenstrual mastalgia in premenopausal women with lisuride maleate: A double-blind placebo-controlled randomized study (2001)?
- Management of cyclical mastalgia in oriental women: Pioneer experience of using gamolenic acid (Efamast(TM)) in Asia. (1999)
- Drug treatments for mastalgia: 17 years experience in the Cardiff Mastalgia Clinic. (1992-01)
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Please click on the required question.
- Premenstrual Syndrome - PMS What is The Premenstrual Syndrome (PMS)
- 2 How prevalent is PMS?
- 3 How can we tell if I have PMS?
- 4 How can my PMS be evaluated?
- 5 How can cyclical breast pain (mastalgia) be treated?
- 6 How can my PMS be treated?
- 7 What is the place of progestogens and progesterone in the management of PMS?
- 8 Could suppressing my menstrual cycle reduce my PMS problems?
- 9 Could a diuretic help my PMS?
- 10 Is there a place for anti-depressants or anxiolytic drugs in the management of PMS?
- 11 Is there a place for removing my ovaries in the management of PMS?
- 12 What can be done about my decreased libido (sex drive)
- 12A What is the place of Viagra (sildenafil citrate) in sexual dysfunction in women?
- 13 How is PMS treatment monitored?
- 14 How long should PMS treatment be taken?
- 15 What is the chronic fatigue syndrome?
- 16 What is seasonal affective disorder (SAD)
- 17 Where can I obtain more information?
- 18 Support Groups.
Please click on the required question.
- Premenstrual Syndrome - PMS What is The Premenstrual Syndrome (PMS)
- 2 How prevalent is PMS?
- 3 How can we tell if I have PMS?
- 4 How can my PMS be evaluated?
- 5 How can cyclical breast pain (mastalgia) be treated?
- 6 How can my PMS be treated?
- 7 What is the place of progestogens and progesterone in the management of PMS?
- 8 Could suppressing my menstrual cycle reduce my PMS problems?
- 9 Could a diuretic help my PMS?
- 10 Is there a place for anti-depressants or anxiolytic drugs in the management of PMS?
- 11 Is there a place for removing my ovaries in the management of PMS?
- 12 What can be done about my decreased libido (sex drive)
- 12A What is the place of Viagra (sildenafil citrate) in sexual dysfunction in women?
- 13 How is PMS treatment monitored?
- 14 How long should PMS treatment be taken?
- 15 What is the chronic fatigue syndrome?
- 16 What is seasonal affective disorder (SAD)
- 17 Where can I obtain more information?
- 18 Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
