Breast pain, which is not caused by either a focal lesion, such as a cyst, or focal mastitis generally falls into one of three categories:

I.	Dietary. Often, women do not get enough vitamin E or an essential fatty acid called linoleic acid. Deficiencies of these can cause breast pain. Conversely, an excess of caffeine can cause breast pain in some women. Therefore we recommend:       1. Vitamin E 800 units/day.       2. Oil of Evening Primrose - one pill/day (found in health-food stores).       3. Decrease or eliminate caffeine. This includes chocolate, caffeinated colas and           coffee.
II.	Hormonal variations. Women often have breast pain as some hormones begin to surge prior to their menstrual period. Remember, a hysterectomy ceases the menses but does not stop the cyclic surge of hormones, even if you are not experiencing a menstrual period. To control these hormonal swings is somewhat difficult. Rarely, the pain is so bad that we have to place patients on low dose birth control pills. Postmenopausal women on estrogen replacement therapy (termed ERT or HRT) may need to lower their dose, or stop it entirely if their pain is severe. In addition, a small amount of estrogen is made in the fatty tissues of everyone's body. Reducing weight can often decrease the amount of this estrogen which may decrease breast pain. Rarely, in severe cases caused by excess hormones, a medication such as danazol (Danocrine®) can be used to lower hormone levels.
III.	Structural. The breasts are held onto the chest wall by ligaments within the breast called Cooper's ligaments. Stretching of these ligaments can cause breast pain. Studies have shown that the majority of these women have poor-fitting bras. Therefore a firm, supportive, well-fitting bra is critical to some women to relieve their pain.

      In addition to the above recommendations, some patients need a mild analgesic (pain medicine). Acetaminophen (Tylenol®) or ibuprofen (Advil®) will suffice for most patients. However, a prescription medication such as propoxyphene (Darvocet N100®) or a tramadol/acetaminophen combination (Ultracet®) may be needed.