Fibrocystic Breast Changes
Acetaminophen and NSAIDs
Acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen are often considered first-line treatment for breast pain (Jones 2011; Sugg 2014; Kosir 2013). While these over-the-counter medications are usually effective at temporarily relieving mild-to-moderate breast pain, long-term, chronic use is associated with potentially severe side effects. For example, chronic NSAID use can cause gastrointestinal bleeding (Seager 2001; O'Neil 2012) and can damage the liver and kidney (Bessone 2010; Plantinga 2011).
Topical application of NSAID preparations directly to the breasts has proven effective for relief of both cyclical and non-cyclical breast pain. Importantly, unlike oral NSAIDs or acetaminophen, topical NSAIDs do not carry systemic risks to the gastrointestinal tract, liver, or kidneys (Qureshi 2005; Colak 2003; Kataria 2014). Professional medical societies have recommended topical NSAIDs for the treatment of breast pain (mastalgia), and some sources consider topical NSAIDs first-line treatment for mastalgia (Olawaiye 2005; Sugg 2014). Localized skin reactions are possible with topical NSAIDs (Klinge 2013).
For persistent, severe breast pain, medications that influence hormones may be recommended (Sugg 2014).
Oral contraceptives. Combined oral contraceptives (estrogen and progesterone) are sometimes recommended to help reduce symptoms of fibrocystic breasts, and are believed to work by supplying controlled amounts of estrogen and progesterone (Jones 2011). However, clinical trials of combined oral contraceptives for fibrocystic breast changes have yielded mixed results (Leonardi 1997; Carbonaro 2012).
Cabergoline. Cabergoline (Dostinex) is a drug that activates certain receptors for the neurotransmitter dopamine in the brain. One effect of this medication is the suppression of prolactin production in the pituitary gland (NIH 2012). Studies have shown that cabergoline helps reduce breast pain and other symptoms associated with fibrocystic breast changes (Aydin 2010; Castillo-Huerta 2013). It is not entirely clear why reducing prolactin levels helps treat fibrocystic changes, though sex hormone influence on the action of the pituitary gland may contribute (Srivastava 2007; Peters 1984). Another drug that functions similarly to cabergoline is called bromocriptine (Parlodel, Cycloset). Although there is some evidence that bromocriptine might help reduce symptoms caused by fibrocystic changes, cabergoline has been shown to perform better and cause fewer side effects in some studies (Aydin 2010; Castillo-Huerta 2013). Nevertheless, both of these drugs can cause serious side effects, such as intense nausea and neurological, psychological, and vascular problems (Mayo Clinic 2015b; Jones 2011; Onstad 2013).
Tamoxifen. When fibrocystic changes result in severe and chronic pain, physicians may prescribe a powerful drug called tamoxifen (Nolvadex, Soltamox) (Srivastava 2007; Jones 2011). Tamoxifen is best known as a treatment used in conjunction with chemotherapy for certain breast cancers. The usage of tamoxifen for breast pain is considered off label and should be supervised by a specialist (EBCTCG 2005; Jones 2011). Tamoxifen is effective for treatment of fibrocystic changes but has a significant side effect profile and is not often prescribed for this condition (Vaidyanathan 2002; Onstad 2013; Alvero 2015).
Danazol. Danazol (Danocrine) is currently the only drug approved by the Food and Drug Administration (FDA) for the treatment of breast pain, and in this capacity is used at a low dose, continuously for 3–6 months (Jones 2011). Danazol acts upon the pituitary gland in a way that suppresses estrogen and progesterone, and favors a masculine hormonal pattern (Beaumont 2002; NLM 2015). Sources differ regarding the effectiveness of danazol, but are in agreement that its serious side effect profile often makes it poorly tolerated (Alvero 2015; Onstad 2013; Goyal 2011). Among danazol’s side effects are masculinization symptoms (deepening of the voice, acne, abnormal hair growth patterns), vision problems, liver and lung problems, joint pain, irregular periods, and heart attack (NHS 2015).