Premenstrual Mastalgia Research Articles

The Role of Nutrition in Women with Benign Cyclic Mastalgia: A Case-Control Study.

Smoking, caffeine, oral contraception, and exercise are the most cited factors for premenstrual mastalgia in the literature, but remain controversial. In this study, we aimed to investigate the most often proposed nutritional factors for cyclic breast pain. Patients who met the criteria for participation in the mastalgia or control group were included in this case-control study. The age, body mass index, educational status, duration of breast pain, visual analog scale (VAS) pain score (0 to 10), number of births, use of oral contraception, exercise habits, drinking coffee, tea, alcohol and water, smoking history, and eating fast food and dessert were examined using a questionnaire. The mean age of mastalgia (n=256) and control (n=200) patients were 35.9±11.0 and 36.6±10.6 years, respectively. In the mastalgia group, the mean duration of cyclic breast pain time was 22.8±33.0 months and mean the VAS score 4.0±2.1. Body mass index and the mean number of births were higher in the mastalgia group than control group (p<0.005). There were no differences in smoking, oral contraceptive use, and drinking alcohol and tea (p>0.005). Compared to the mastalgia group, the control group ate more fast food and desserts, drank more water and coffee, and exercised less (p<0.005). The causes of mastalgia remain controversial. Our data supports some of the published studies, but not others. We propose that nutritional factors contribute less to the risk of mastalgia than is generally thought.

The Appropriateness of an Improved Diary for the Assessment of Pre-Menstrual Mastalgia

Current mastalgia assessment diaries are effective in reporting severity and frequency; however, literature suggests that timing and location should also be considered when assessing mastalgia alongside severity and frequency. This study aimed to assess validity, reliability, acceptability and minimal detectable change (MDC) of an improved mastalgia diary. Twenty premenopausal females who self-reported pre-menstrual mastalgia completed the diary once a day using paper, email or mobile formats, over one menstrual cycle. Predictive validity was assessed comparing pain pre- and post-menstruation. Test-retest and internal consistency established reliability. Acceptability was assessed using evaluation questions. MDC was calculated using a previously established method using the SEM to a 95% confidence interval. Results showed pre-menstrual mastalgia was significantly higher than post-menstrual, demonstrating diary validity. Reliability tests determined high test-retest reliability (ICC > 0.90) and internal consistency (α = 0.89). The diary was acceptable for >90% of participants. MDC-determined change of 1 on each question would be greater than measurement error and therefore representing ‘real’ change. This improved mastalgia diary is a more comprehensive, valid, reliable and acceptable tool for assessing mastalgia.

Der Stellenwert des Mönchspfeffers (Vitex agnus-castus) in der gynäkologischen Endokrinologie

The status of chaste tree ( VITEX AGNUS-CASTUS) in gynaecological endocrinology Extracts of the dried fruits of the chaste tree ( VITEX AGNUS-CASTUS, VAC) contain dopaminergic compounds which are inhibitory to pituitary prolactin release. The development of premenstrual mastalgia as well as of fibrocystic breast changes involves an action of prolactin. Hence, treatment with VAC is helpful to prevent these mammary gland symptoms. Prolactin is also involved in the function of the corpus luteum and patients with a latent hyperprolactinemia often suffer from a corpus luteum insufficiency where treatment with VAC extracts may also be helpful to improve fertility.

Cabergoline versus bromocriptine for symptomatic treatment of premenstrual mastalgia: a randomised, open-label study

Objective To compare the effectiveness and side effects of cabergoline with bromocriptine for the symptomatic treatment of cyclic mastalgia as a part of the premenstrual syndrome. Study design 140 women with premenstrual mastalgia were enrolled in this randomised, open-label trial. Two groups were created (bromocriptine and cabergoline) and consisted of 61 and 67 patients respectively at the end of trial. Bromocriptine was administered 5 mg daily during second half of the menstrual cycle. Cabergoline was administered 0.5 mg weekly during the second half of the cycle. Relief of pain was evaluated using a visual analog scale (VAS). The mean percentage decrease in score for all patients in each group was calculated. A 50% or greater decrease at the end of the third month from the basal VAS score was accepted as a positive response to drug therapy. Data regarding side effects were collected systematically with review of a symptom diary. Results The positive response rates to treatment were similar (bromocriptine 66.6% and cabergoline 68.4%). The pain reduction rates for each month were also similar. Moreover, the pain reduction rate was maximum in the second month of treatment for both groups. Vomiting (28%), nausea (39%) and headaches (23%) recorded in the bromocriptine group were significantly more frequent than vomiting (4.5%), nausea (20.9%) and headache (6%) recorded in the cabergoline group ( p = 0.023, p = 0.001, p = 0.006 respectively). A difference in the rate of dizziness was not statistically significant (26.4% vs. 14.9%). There was no correlation between the baseline breast pain score and prolactin level but post-treatment pain reduction was well correlated with prolactin level. Conclusions Cabergoline is as effective as bromocriptine for the treatment of cyclic mastalgia but has minimal side effects compared to bromocriptine.

Breast magnetic resonance imaging findings in women treated with toremifene for premenstrual mastalgia

Toremifene, a selective estrogen receptor modulator, has been shown to be effective in alleviating premenstrual breast pain. However, the exact mechanism by which toremifene and related compounds work in premenstrual mastalgia is poorly understood. To find out if the effect of toremifene on breast would be detectable with dynamic magnetic resonance imaging (MRI). This randomized, double-blind crossover study was performed on women suffering from marked premenstrual mastalgia. Ten women were randomized to receive either toremifene (20 mg) or placebo from cycle day 15 until next menstruation for three menstrual cycles. After a washout period, the treatment was crossed over for three additional cycles. The MRI evaluations were performed premenstrually at the end of each treatment phase. Breast pain and quality-of-life scores were collected from one baseline cycle and from all the treatment cycles. Nine patients were evaluable for this analysis. Both the enhancement ratio and the maximum slope of enhancement tended to be smaller during the toremifene cycles as compared to placebo. On the left side, the difference in the maximum slope of enhancement between toremifene and placebo was statistically significant (median 5.150 [range 3.7-6.7] and 6.500 [range 4.9-9.5], respectively; P=0.047). T2 relaxation times as well as breast pain and quality-of-life scores were inconsistent. Use of toremifene is associated with measurable changes in dynamic breast MRI findings in women with cyclic breast pain.

Toremifene use does not alter serum inhibin A and B levels during mid-luteal phase in women with premenstrual mastalgia

Aims. To find out if there is any link between the therapeutic effect of toremifene on premenstrual mastalgia and luteal phase serum inhibin A and/or B levels.Methods. Forty-eight patients participating in a randomized cross-over trial on toremifene vs. placebo for premenstrual mastalgia gave three blood samples during the luteal phase of the menstrual cycle: the first at baseline, the second during the third toremifene/placebo cycle, and the third during the third placebo/toremifene cycle, respectively. The blood samples were analyzed for inhibin A and B with respective specific two-site enzyme-linked immunosorbent assays. Toremifene (20 mg/d) and placebo were administered during the luteal phase only.Results. When all the toremifene-treated cycles were compared with all the placebo cycles and with the baseline, the median inhibin A levels were 42, 38, and 40 pg/ml, respectively (baseline versus toremifene, p = 0.638; baseline versus placebo, p = 0.468; and toremifene versus placebo, p = 0.365). The median inhibin B levels were at baseline 19 ng/l, during placebo 20 ng/l, and during toremifene 17 ng/l (baseline versus toremifene, p = 0.983; baseline versus placebo, p = 0.519; and toremifene versus placebo, p = 0.880).Conclusion. A luteal administration of toremifene does not seem to result in any changes in mid-luteal concentrations of inhibin A or B in serum.

Toremifene use does not alter serum inhibin A and B levels during mid-luteal phase in women with premenstrual mastalgia

Toremifene use does not alter serum inhibin A and B levels during mid-luteal phase in women with premenstrual mastalgia

Breast Magnetic Resonance Imaging Findings in Women Treated with Toremifene for Premenstrual Mastalgia

Breast Magnetic Resonance Imaging Findings in Women Treated with Toremifene for Premenstrual Mastalgia

The Antioestrogen Toremifene has Luteotropic Effects in Women Suffering from Premenstrual Mastalgia

The Antioestrogen Toremifene has Luteotropic Effects in Women Suffering from Premenstrual Mastalgia

Mastalgia cíclica pré-menstrual: placebo versus outras drogas

To compare therapeutic effects of placebo with intake of low doses of acetyl-salysilic acid (aspirin) and a compound of retinol, pyridoxine chlorhydrate and tocopherol acetate. The study is a prospective, controlled, triple blinded, randomized trial. From 259 patients, 81 were selected in order to follow rigid criteria of inclusion. They were divided into three groups of 27 patients, taking aspirin, vitamins or placebo respectively. The number of patients in each group was considered satisfactory for statistical analysis. Pain was scored as Grade 1 (without pain), Grade II (moderate pain) and Grade III (severe pain). The Tukey test was applied for comparison of results (statistical significance 5%). Clinical parameters, age, weight, BMI, parity and lactation period were similar for each group. There was a decrease of pain intensity in all groups, that was even more pronounced for the placebo group. Emphasis was given to symptomatic treatment of cyclic premenstrual mastalgia with symptoms considered to be the expression of a physiological process that can be treated with simple drugs or placebo. Usual therapeutic approaches with several drugs are criticized, including results and contraindications. This study based upon acceptable trial methodology (randomized, triple blinded, placebo controlled, prospective) did not show significant differences in the treatment of cyclic mastalgia.

Toremifene for premenstrual mastalgia: a randomised, placebo‐controlled crossover study

To investigate the efficacy of toremifene in the treatment of premenstrual mastalgia. Double-blind, placebo-controlled crossover study. Three Finnish general practices from the districts of Satakunta Central Hospital and Tampere University Hospital. POPULATION A total of 62 women aged 25-45 years with premenstrual mastalgia during at least three previous menstrual cycles. Women were randomised to receive toremifene 20 mg daily or placebo from day 15 of the menstrual cycle until menstruation for three consecutive cycles. After a wash-out cycle, the women were crossed over to receive placebo or toremifene for three additional cycles. Cyclic breast pain relief assessed by visual analogue scale (VAS) score. Quality-of-life scores assessed by a modified 36-item Finnish Depression Scale, with a score ranging from 0 to 108. Acceptability of treatment. About 32 women were randomised to receive toremifene first and 30 to receive placebo first. Twenty-nine and 27 participants in the groups treated with toremifene first or placebo first completed the treatment, respectively. There were significant reductions in VAS scores in both groups after three treatment cycles. This was significantly greater in the toremifene-treated group (VAS: 1.8 in the toremifene group and 3.7 in the placebo group, P= 0.004). Treatment effect between treatment cycles was significant (P= 0.001). Quality of life was similar during the toremifene and placebo cycles. CONCLUSION This study demonstrates that the antiestrogenic compound, toremifene, is able to relieve premenstrual breast pain without major adverse effects. There was a 64% reduction in median pain scores in the toremifene-treated cycles compared with a 26% reduction in placebo-treated cycles.

Dopamine Agonist Successfully Treats Premenstrual Mastalgia

Premenstrual mastalgia is a common problem for many women of reproductive age, and up to 10 percent of these women experience breast pain severe enough

Symptomatic treatment of premenstrual mastalgia in premenopausal women with lisuride maleate: a double-blind placebo-controlled randomized study

Objective: To determine the therapeutic effect of lisuride maleate on premenstrual mastalgia in premenopausal women. Design: Double-blind randomized prospective study. Setting: Department of obstetrics and gynecology at a university hospital. Patient(s): Sixty women with premenstrual mastalgia were included in the study. Study and control groups consisted of 30 women each. Intervention(s): Women enrolled in the study and control group were given one tablet daily (0.2 mg) of lisuride maleate or placebo orally for 2 months. Severity of mastalgia was evaluated using the visual analog scale. Main Outcome Measure(s): Severity of mastalgia and side effects of the drug administered. Result(s): Mastalgia subsided significantly in women receiving lisuride maleate compared with controls. There were no significant side effects from lisuride maleate. Prolactin levels decreased significantly in the group receiving lisuride, which correlated well with pain resolution. Conclusion(s): Lisuride maleate may be useful for the symptomatic treatment of premenstrual mastalgia.

Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase–only danazol

Objective: Our goal was to evaluate the efficacy and side effects of danazol 200 mg daily given only in the luteal phase of the menstrual cycle to treat premenstrual syndrome and premenstrual mastalgia. Study Design: We conducted a randomized, double-blind, placebo-controlled study of 3 menstrual cycles in a postgraduate medical school and National Health Service hospital. The subjects of the study were 100 women who had been referred to the premenstrual syndrome clinic at the North Staffordshire Hospital for the management of premenstrual syndrome and premenstrual breast pain. Outcome measures for the study included assessment of improvement in symptoms measured by specific daily visual analogue scales for 4 principal symptoms of premenstrual syndrome and for premenstrual mastalgia and assessment of side effects and adverse events. Results: Significant improvement in symptoms was seen in visual analog scores for mastalgia in months 1 ( P = .03), 2 ( P = .004), and 3 ( P = .01) of the study during active therapy compared with placebo. No improvement was seen for any other symptom or for the global premenstrual syndrome score. Side effects on danazol and on placebo were equal and minimal. Conclusions: Luteal phase–only danazol is not effective for the treatment of the general symptoms of premenstrual syndrome but appears highly effective for the relief of premenstrual mastalgia. This approach to therapy is associated with few side effects. Studies of cyclic mastalgia using strict diagnostic criteria are required to see whether the freedom from symptomatic side effects is found in longer-term studies and to determine whether such a regimen avoids potentially detrimental effects on the lipid status. (Am J Obstet Gynecol 1999;180:18-23.)

Risk factors for breast fibroadenoma in young women

In a case-control study, 178 women diagnosed with fibroadenoma (FA) between 1976 and 1982 were compared with 178 age-matched controls in order to assess the risk factors for FA. Women who had a previous diagnosis of breast disease were excluded. The odds ratios (OR) of FA were calculated for different risk factors of breast disease from bivariate analysis as well as multivariate regression analysis. The highest ORs were found for a previous premenstrual mastalgia before first childbirth and a familial history (FH) of breast cancer (BC). Oral contraceptive (OC) use before a first full-term pregnancy (FFTP) does not modify this risk. Also current use of standard oral contraceptives (SOC) containing 50 μg of ethinyl estradiol per pill appeared to be protective and the correlation with FA was negative. These findings underline: (a) the predictive value of premenstrual mastalgia for the subsequent development of breast disease; (b) only current high-dose OC use is protective.

Treatment of Premenstrual Mastalgia with Tamoxifen

Thirty-four women with normal menstrual cycles but suffering from severe premenstrual mastalgia were randomly treated with either tamoxifen (10 mg daily) (18 women) or placebo (16 women) from cycle day 5 to 24 for six consecutive cycles. At the end of the treatment, 89% of the tamoxifen-treated patients were free from the symptoms and the remainder experienced partial alleviation. In contrast, six patients treated with placebo showed only partial alleviation (38%)(p < 0.001). Twelve months after the end of tamoxifen treatment, 53% of the medicated women were still free of symptoms as compared with none of the placebo-treated patients. These results suggest that tamoxifen is highly effective for the management of severe premenstrual mastalgia and should be useful for the treatment of this disorder.

Treatment of Premenstrual Mastalgia with Tamoxifen

Thirty-four women with normal menstrual cycles but suffering from severe premenstrual mastalgia were randomly treated with either tamoxifen (10 mg daily) (18 women) or placebo (16 women) from cycle day 5 to 24 for six consecutive cycles. At the end of the treatment, 89% of the tamoxifen-treated patients were free from the symptoms and the remainder experienced partial alleviation. In contrast, six patients treated with placebo showed only partial alleviation (38%) (p less than 0.001). Twelve months after the end of tamoxifen treatment, 53% of the medicated women were still free of symptoms as compared with none of the placebo-treated patients. These results suggest that tamoxifen is highly effective for the management of severe premenstrual mastalgia and should be useful for the treatment of this disorder.

The use of bromocriptine in hyperprolactinemia and galactorrhea in Singapore

Ninety-four women and seven men were treated with low dose bromocriptine for (a) hyperprolactinemia or (b) normoprolactinemia but with galactorrhea and a pituitary adenoma. All the pituitary adenomas became smaller or remained the same. Prolactin levels decreased with treatment and inappropriate galactorrhea improved in the 53 patients except for 7 where there was no change. Of the 41 women with premenstrual mastalgia 78% improved with treatment. Of the 74 women with ovulatory problems, a biphasic pattern was restored in 65 patients. Thirty-two patients out of the 92 trying to conceive achieved a pregnancy with an abortion rate of 12.5% and non-lethal congenital abnormality of 9.8% (2.1% in Singapore population). Fertility was restored in 3 hyperprolactinemic oligospermic males and improved libido was professed by most of the treated men. Side effects were present but were on the whole tolerable. Pregnancy rate was better in those with high levels of prolactin (>1000 miU/l) than in those with hyperprolactinemia of between 500 and 1000 miU/l although this was not statistically significant χ 2 = 0.69. In the lower hyperprolactinemic range there was noticeable number of patients with endometriosis and increased luteinizing hormone (LH) levels.