Fibrocystic breast changes and breast pain

Fibrocystic breast changes and breast pain, previously referred to as fibrocystic breast disease, encompasses various non-malignant disorders which affect the breast. Symptoms can include a combination of breast pain, tenderness, and changes in breast texture, nodularity, and lumpiness. It is considered an exaggerated response by the tissue of the breast to circulating hormones and growth factors [1]. 

Specific nutrients, toxic reduction, liver support, dietary changes, and fat reduction are suggestions which may help reduce symptoms of fibrocystic breast changes and pain. Balancing the hormones is best achieved under the care of a naturopath.

Most changes which commonly occur in the breast are influenced by hormonal fluctuation and are normal, however it is important to have any breast changes assessed by a medical practitioner.

Fibrocystic breast changes and breast pain 

Common fibrocystic breast changes can include mastalgia (breast pain), trauma, cysts, fibroadenomas, breast hyperplasia, nipple discharge, and sclerosing adenosis (due to aging) [2]. It is the most common benign condition of the breast of women of reproductive age and older. 

The breast tissue is highly influenced by hormonal changes of the menstrual cycle. The three main hormones which influence breast tissue are oestrogen, progesterone, and prolactin. 

Polycystic ovarian syndrome (PCOS) is a risk factors for developing fibrocystic breast changes [6].

Premenstrual breast changes

Swelling, tenderness and pain are often felt in the 10 days preceding mensuration due to distention of ducts, oedema of interstitial tissue, and hyperaemia (increased blood to the breast area). Symptoms resolve during menstruation and the post menstrual phase. 

Mastalgia (Breast pain)

• Cyclic mastalgia occurs during the menstrual cycle and usually accompanies other premenstrual symptoms.
   
• Non-cyclical mastalgia is not related to the menstrual cycle and could be due to an infection, benign lump, or the cause may be unknown. Pain may be intermittent, occur in one area of one breast and is described as a burning, achy, and sore feeling. This type of pain occurs more often in women between the ages of 40 and 50 [3].

Benign cysts are typically mobile within the glandular tissue, chest wall, and skin and have a rubbery texture. Unless an inflammatory type of cyst, they are generally painless. They may be present as multiple cysts and are usually found in the upper quadrant of the breast. Thickening of breast tissue (fibrosis) and fluid-filled cysts can develop in one or both breasts. Cysts are responsive to fluctuations in hormones and may change (shape and size) or disappear altogether during the menstrual cycle. The breast may feel ropey, lumpy, or tender. There are various subtypes of cysts. Fibrocystic breast disease is mostly seen in women between the ages of 30 to 50 years [2].

Fibroadenomas are felt as a firm, rubbery, solid mobile mass. They typically appear singularly and are not usually painful. In most cases the cause is due to hormones. Fibroadenomas are a common forms of benign tumor seen more often in 17- to 20-year-olds [4].

Atypical hyperplasia describes an accumulation of abnormal cells in the milk ducts and lobules of the breast. Atypical hyperplasia is not breast cancer; however, it is associated with an increased risk [5].

Nipple discharge is associated with ductal ectasia (clogged ducts around the nipple, intraductal papilloma (a small growth inside a milk duct), and in rare cases – carcinoma [2].

Sclerosing adenosis is a benign breast condition which may occur due to ageing. Scar-like fibrous tissue which is lumpy to feel occurs in breast nodules (the glands which make milk). These lobules are larger than normal. It is associated with a risk of breast cancer.

Diagnosing fibrocystic breast changes

A diagnosis of fibrocystic breast is arrived at after a patient history, physical examination, and cancer risk assessment.

Further diagnostic test will be performed if appropriated. Benign lesions are generally not associated with increased risk of malignancy. Mammogram and ultrasound are investigative tools used to determine if a mass found in a breast is malignant or benign [2]. 

The diagnosis of fibrocystic breast is established when malignancy (cancer) is excluded.

Fibrocystic breast changes and breast pain: natural therapy support

Specific nutrients, toxic reduction, liver support, dietary changes, and fat reduction, are suggestions which may help reduce symptoms associated with fibrocystic breast changes and pain. Balancing the hormones is best achieved under the care of a naturopath.

Nutrients to consider

• N-Acetyl cysteine (NAC) may alleviate pain and inflammation in cyclical mastalgia [7].
• Vitamin E and Vitamin B6 were both found to reduce breast pain severity in cyclic mastalgia. Caution is advised when taking supplements which contain high doses of vitamin B6 due to toxic risk, and advice should be sought from your health care provider [8].
• Flaxseed and Evening primrose oils are essential fatty acids which help hormonal modulation.
• Magnesium is an important mineral for hormonal health. Magnesium can promote healthy excretion of oestrogen by supporting the COMT enzyme (catechol-o-methyltransferase) in the liver. Poor clearance is associated with conditions of oestrogen excess with symptoms of heavy and painful periods, fluid retention and weight gain. Excess oestrogen can contribute to the development of fibroids, fibrocystic breast and breast tenderness, and exacerbate endometriosis. 

Diet suggestions

The liver is important in its role of metabolising and detoxifying. You can support liver function by eating a wholesome diet.

Include green leaves, green tea, cruciferous vegetables – bok choy, broccoli, cabbage, cauliflower, cress; citrus fruits and foods from the allium family - chives, garlics, leeks, onions, and scallions.

Include lots of dark berries – blueberries, raspberries, and cranberries, they contain polyphenols which help protect the liver from damage. 

Exclude non-nutritious foods, saturated fats, alcohol, and caffeine-based beverages. This includes cakes, biscuits, processed foods, and take-aways etc. 

• A naturopath or herbalist may suggest a herbal formula to enhance liver detoxification such as dandelion root (Taraxacum officinale), burdock root (Actium lappa), licorice root (Glycyrrhiza glabra), and oregon grape (Mahonia aquifolium). These help with oestrogen clearance.

Eliminate toxic elements

Endocrine disruptors are found in plastics, foods, water, and many other places within our everyday. An endocrine disruptor is any substance that interferes with the function of glands, the creation and secretion of hormones, the function of receptors, or the ability for hormones to exert their effects on the body. They can also block the excretion of hormones and cause unwanted endocrine effects [1]. 

• Endocrine disruptors create a response that is more powerful than the original hormone; create a less powerful response, or create a completely different response. 

There are a few tips in avoiding endocrine disrupting chemicals.

Removing toxic chemicals around the home environment can help support the lymphatic system. The lymphatic system helps clear toxins and waste from the body and removes fluid which may have leaked from blood vessels and accumulates in tissue spaces. Toxic chemicals may be found in products used for cleaning, personal use products such as cosmetics and skin care, and cigarettes, for example.

Fat reduction and increased lean body mass

A lean body mass was found to represent a powerful endocrine, immune, and hormonal influence within the body.

One study concluded a decrease in fat mass and increased lean mass might reduce the risk of fibrocystic breast disease [9]. 

Avoid over exercising or activities which may aggravate breast tissue. Consider being fitted for a well supporting sports bra and a soft bra for sleep.

The information provided is not intended to be used for diagnosis or treatment. If you are experiencing any health concerns, please consult your doctor for advice.

References

1. https://www.sciencedirect.com/topics/medicine-and-dentistry/fibrocystic-breast-disease
2. Fibrocystic Breast Disease https://www.ncbi.nlm.nih.gov/books/NBK551609/
3. Breast Pain (Mastalgia) | Family Planning NSW (fpnsw.org.au)
4. Romm, Aviva; 2010, Botanical medicine for woman’s health; Churchill Livingstone Elsevier Missouri USA
5. Atypical hyperplasia of the breast - Symptoms and causes - Mayo Clinic
6. Kohnepoushi P, Dehghanbanadaki H, Mohammadzedeh P, Nikouei M, Moradi Y. The effect of the polycystic ovary syndrome and hypothyroidism on the risk of fibrocystic breast changes: a meta-analysis. Cancer Cell Int. 2022 Mar 19;22(1):125. doi: 10.1186/s12935-022-02547-5. PMID: 35305643; PMCID: PMC8933953. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8933953/
7. Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, Hauser R, Prins GS, Soto AM, Zoeller RT, Gore AC. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev. 2009 Jun;30(4):293-342. doi: 10.1210/er.2009-0002. PMID: 19502515; PMCID: PMC2726844. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726844/
8. Kashi EA, Salmani AA, Shafagh S, Mousavi GA, Mousavi N, Heydari M, Hajian A. Effects of oral N-acetyl cysteine on pain and plasma biochemical parameters in fibrocystic breast disorder: A randomized controlled trial. Surg Open Sci. 2022 Jul 2;10:69-73. doi: 10.1016/j.sopen.2022.06.006. PMID: 36016767; PMCID: PMC9395654.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9395654/
9. Shobeiri F, Oshvandi K, Nazari M. Clinical effectiveness of vitamin E and vitamin B6 for improving pain severity in cyclic mastalgia. Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):723-7. doi: 10.4103/1735-9066.170003. PMID: 26793260; PMCID: PMC4700694.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700694/
10. Chen YY, Fang WH, Wang CC, Kao TW, Chang YW, Yang HF, Wu CJ, Sun YS, Chen WL. Examining the Associations among Fibrocystic Breast Change, Total Lean Mass, and Percent Body Fat. Sci Rep. 2018 Jun 15;8(1):9180. doi: 10.1038/s41598-018-27546-3. PMID: 29907750; PMCID: PMC6003905.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003905/