Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Fibrocystic Breast Changes

Most women experience breast tenderness at some time during the menstrual cycle. For many, this can be a source of both discomfort and anxiety. This is especially true if the patient also notices a mass or lumpiness of the breast. Thankfully, the most common cause of painful swelling of the breasts is fibrocystic breast changes. Fibrocystic breast change is the most common non-cancerous condition of the breast. Typically the symptoms consist of pain and swelling in the upper and outer aspects of both breasts. In some cases even a discreet mass may be palpable. The symptoms are most common during the week prior to the onset of the menstrual period and may accompany other signs of PMS. These changes in the breast are the result of the hormonal changes that occur through the menstrual cycle. The symptoms are often worse in women who are experiencing irregular cycles because of the huge swing in hormone levels that may occur. Foods containing methylxanthines (coffee) and caffeine are thought to also increase the symptoms of fibrocystic breast changes. Ingestion of more than 500mg of caffeine (about 4 cups of coffee) is thought to increase the risk. Smoking and family history also increase the risk of fibrocystic breast changes. Treatment of fibrocystic breast changes includes reduction of ingestion of caffeine and control of the cyclic hormonal stimulation. Birth control pills can suppress symptoms in 90% of patients. Other treatments may include analgesics such as ibuprofen or acetaminophen. The data as to whether vitamin supplements may help is confusing. Some studies have shown improvement with the use of vitamins A and E. As vitamin A in large quantities (more than 25,000 IU per day) has been shown to cause birth defects, I caution the use of this vitamin in women of reproductive age. 800 IU of vitamin E per day may help to reduce symptoms and is unlikely to cause side effects at that dose. In addition to its antioxidant benefits, Vitamin E has been shown to be helpful for other symptoms of PMS. In doses greater than 800IU, vitamin E can prolong bleeding time and should be used with caution in women on blood thinning medications.

Unlike breast cancer, women with fibrocystic breast changes will have breast lumps that come and go with the hormonal changes during the menstrual cycle. Though fibrocystic changes are not thought to be a cause of breast cancer, it can make the diagnosis of breast cancer difficult. The lumpiness and tenderness can make both the physical exam and the mammogram difficult to perform and interpret. Women should perform self breast exams every month, a few days after the onset of the menstrual period. Women who notice a lump or thickening of breast tissue that does not resolve with the onset of the menstrual period should be examined by a physician. A screening mammogram should be performed at age 35 and then annually beginning at age 40. Once the diagnosis of fibrocystic breast changes is made then lifestyle modifications and/or medical therapy can be initiated.