Benign breast pain in women: a practical approach to evaluation and treatment.

The literature on breast pain etiology, practical approaches to evaluating benign breast pain, and effective treatments was reviewed. Medline, the Cochrane Database of Systematic Reviews, and Cancerlit were searched for 1975 to 2001. Researchers have found no clear hormonal or specific pathological processes that explain cyclical breast pain. Some investigations did find associations between breast pain and premenstrual syndrome, fibrocystic breast disease, and caffeine intake. Initial treatment with reassurance, a well-fitted brassiere, caffeine reduction, and primrose oil should be tried before prescribing pharmaceutical agents. Medications such as danazol, bromocriptine, and tamoxifen are effective, but often have side effects and contraindications. Future studies should indude double-blind, randomized, controlled trials of selective-serotonin reuptake inhibitors and primrose oil and single-blind, randomized, controlled trials advising caffeine reduction.