Fibrocystic Breast: Botanical Treatment

Botanical treatment for fibrocystic breasts has not been widely subject to scientific evaluation, in spite of this being a commonly treated condition in the herbal clinic. Treatment aims primarily at hormonal regulation through direct (i.e., hypothalamic-pituitary-adrenal and hypothalamic-pituitary-ovarian axes) and indirect (i.e., improved hormonal biotransformation and excretion) actions, and reduction of local congestion and symptomatic pain relief through topical applications (Table Summary of Botanical Treatment Strategies for Treatment of Fibrocystic Breasts). The liver plays a central role in metabolizing and detoxifying sex hormones. Consequently, herbal practitioners typically include herbs that are known or thought to enhance hepatic detoxification functions in formulae for treatment of fibrocystic breasts. Such herbs, many of them considered “bitters,” include dandelion root, burdock, root, licorice root, Oregon grape root, fringe tree, motherwort, blue vervain, and celandine. These botanicals are usually included in ranges of 5% to 20% of formulae, in tincture or decoction forms. Although there has been little investigation of such herbs to establish their pharmacologic or physiologic action for such use, they are nonetheless a common part of the protocol for many gynecologic concerns, including benign breast complaints, and their role in formulae should be considered and further evaluated.

Summary of Botanical Treatment Strategies for Treatment of Fibrocystic Breasts

Therapeutic Goal Therapeutic Activity Botanical Name Common Name
Hormonal modulation Herbs with putative or known hormonal activity Angelica sinensis

Caulophyllum thalictroides

Clycyrrhiza glabra

Leonurus cardiac

Smilax ornate

Trifolium pretense

Verbena officinalis

Vitex agnus-castus

Dong quai

Blue cohosh

Licorice

Motherwort

Sarsaparilla

Red clover

Blue vervain

Chaste berry

Hormonal modulation Essential fatty acids Linum usitatissimum

Oenothera biennis

Flax seed

Evening primrose

Enhanced clearance of estrogen by liver and bowel; improvement of liver function Aperients

Cholagogues

Hepatics

Calendula officinalis

Ceanothus spp.

Chelidonium majus

Chionanthus virginicus

Mahonia spp.

Taraxacum officinale

Calendula

Red root

Celandine

Fringe tree

Oregon grape

Dandelion root

Relief of local congestion and swelling through lymphatic clearance (topical / internal) Lymphatics Calium aparine

Phytolacca americana

Cleavers

Poke root

Chaste Berry

Chaste berry is extensively recommended by herbal practitioners for cyclic breast pain and fibrocystic breasts, both when it presents independently and when associated with PMS. This traditional use is supported by clinical trials. Chaste berry may be used singly or in combination with other herbs that enhance hormonal regulation and hormone metabolism (e.g., herbs that promote liver function and hormonal conjugation and elimination). There have been three placebo-controlled, double-blind, randomized clinical trials (RCT) examining the effects and safety of a proprietary chaste berry extract-containing solution (VAC) on cyclic mastalgia. VAC is sold as Mastodynon®, and manufactured by Bionorica Arzneimittel GmbH (Neumark / Opf. Germany). It contains 32.4 mg of chaste berry fruit extract / 60 drops as well as a mixture of homeopathic ingredients, including Caulophyllum thalictroides, Cyclamen, Ignatia, Iris, and Lilium. This product is available as both a tablet (MR 1025 El) and a liquid extract in Germany. German drug indications for the product include menstrual disorders based on a temporary or permanent corpus luteum insufficiency, infertility resulting from corpus luteum insufficiency, and menstrually related complaints, including mastodynia. All three of the studies used the liquid solution, which contained 53% (v / v) alcohol, although the study by Wuttke et al. also used the tablets. All three studies defined cyclic mastalgia as having at least 5 days of breast pain the previous cycle and treated women for three menstrual cycles with 30 drops two times daily of VAC (1.8 mL / equivalent to 32.4 mg extract of chaste berry drug). Researchers found that both the severity (assessed on a 1- to 100-mm visual analog scale [VAS]) and presence of breast pain (as measured by women’s diaries) were significantly improved in the women who were assigned to the chaste berry groups compared with placebo after the first month of treatment. Although pain intensity was reduced by 30% in the chaste berry group compared with 11% in placebo after one cycle, pain intensity was even more reduced at the end of the second month of treatment, with 53% of women receiving chaste berry having decreased severity of breast pain compared with 25% of the placebo group (p = 0.006). No further improvement was obtained with longer treatment periods. However, to reduce the number of days with severe pain women needed to receive VECS for three to four cycles before they had significantly fewer days with breast pain compared with the placebo group (p = 0.21). Two of the studies also measured serum hormone levels including estradiol, progesterone, follicle-stimulating hormone (follicle-stimulating hormone), luteinizing hormone (luteinizing hormone), and basal prolactin levels at baseline and in the premenstrual weeks of cycles 1, 2, and 3.S One study found a significant rise in prolactin levels and a decrease in progesterone levels, whereas another study found no effect on follicle-stimulating hormone, luteinizing hormone, and progesterone, but did see a decrease in estradiol levels and a significant decrease in basal prolactin levels (3.7 ng / mL tablets and 4.35 ng / mL liquid extracts) compared with placebo. Adverse events were rare and did not differ from placebo in any of the RCTs.

Dong Quai and Blue Cohosh

Along with chaste berry, dong quai and blue cohosh are commonly employed by herbal clinicians to modulate hormone levels. Blue cohosh, as part of the German herbal formulation Mastodyn® (reviewed in the preceding), may provide some of the therapeutic benefit of that formulation. However, to date, no studies have demonstrated that blue cohosh has any effect on hormonal levels. Dong quai in vitro can weakly bind to estrogenic receptors and induce progesterone receptors. However, it did not stimulate vaginal cells or increase endometrial thickness and had no estrogenic effect showing no trans-activation of either alpha- or beta-estrogen receptors. ” Additionally, dong quai showed no significant effect on either hormonal levels or symptoms in an RCT in menopausal women. Consequently, dong quai appears to have a limited if any effect on hormone levels. In a recent study, dong quai was found to have significant anti-inflammatory effects because of one of its constituents, ferulic acid. Although this study is very preliminary, it may offer an alternative mechanism through which dong quai could be helping to decrease mastalgia in women with fibrocystic breasts. According to traditional Chinese medicine theory, dong quai dissolves blockages and relieves blood stagnation, and is thus a common ingredient in formulae for mastalgia.

Flax Seed and Evening Primrose Oil

Flax seeds are the richest source of plant-based omega-3 fatty acids, with alpha-linolenic acid (ALA) being the primary fatty acid (18:3n-3). These fatty acids are considered strongly anti-inflammatory, being precursors for the anti-inflammatory series prostaglandins (PGE3). Flax seeds are also rich in fibers called lignins. Like isoflavones in soy and other foods, lignins and their associated phenolic compounds are classified as phytoestrogens. Flax seeds are an especially rich source of dietary lignins, with 75 to 800 times more than any other food source. Research has shown lignins to be a promising agent for binding excess sex hormones, including testosterone and estrogens. Through both its anti-inflammatory and possible anti-estrogenic effects researchers believed that flax may prove a beneficial treatment for fibrocystic breasts. One study examined the effect of eating one muffin daily supplemented with 25 g of ground flax seeds in 127 women with mastalgia. Women experienced a significant reduction of symptoms; however, the full results of this study were never published and thus it is unknown how long women needed to take the flax seed-enriched muffins, what symptoms were reduced, what the degree of symptom reduction was, or if there was any placebo control to assess for the considerable level of spontaneous remission (60% to 80%) of symptoms in women with breast pain over time. Evening primrose oil (EPO), is a rich source of omega-6 essential fatty acids (EFAs). Essential fatty acids are precursors to either series 1 or 2 prostaglandins, depending on substrate availability. The more omega-6 essential fatty acids there are in the diet, the more likely it is for the inflammatory series prostaglandins to be made; conversely, the less omega 6 essential fatty acids there are in the diet, the more likely it is for anti-inflammatory series 1 prostaglandins to be produced. Because of evening primrose oil’s potential anti-inflammatory properties, two randomized placebo-controlled, double-blind clinical trials and one open-labeled trial of evening primrose oil in both cyclic and noncyclic mastalgia have been conducted. One double-blind, placebo-controlled randomized study in 73 women with either cyclic or noncyclic mastalgia found that 1000 mg of evening primrose oil or placebo three times daily over 3 months significantly reduced symptoms of pain and tenderness in the women who received evening primrose oil compared with placebo. In a similar study, 291 women with severe persistent breast pain given either placebo or 1000 mg evening primrose oil three times daily for 3 to 6 months found that 45% of women with cyclic pain improved. Further, 27% of women with noncyclic breast pain improved compared with 9% in the placebo group. In a nonrandomized open-labeled study, 94 women with cyclic and 32 women with noncyclic mastalgia received 3 g of evening primrose oil for at least 4 months. Severity of pain was diminished in a “clinically useful” manner in 58% of the women with cyclic mastalgia and 38% of the women with noncyclic mastalgia taking EP. Unfortunately, all three of these studies are difficult to assess because of lack of reporting of how pain and symptoms were measured and how great the effect, and thus how clinically relevant the effect of evening primrose oil is in women with breast pain. The recommended dose of flax oil to treat and prevent mastalgia and nodularity is two to four 500-mg capsules twice daily or 1 to 2 tablespoons of the oil daily. One to three grams daily is the recommended dose of ground seeds. A typical dose of evening primrose oil is 1500 mg daily.

Red Clover

Red clover is rich in isoflavones, especially genistein and daidzein. Genistein and daidzein have weak estrogenic effects, which have led researchers to hypothesize that genistein may compete with stronger endogenous estrogens such as estradiol for estrogen receptors; although what effects this may have on breast tissue is unclear at this time. One unpublished study found that a red clover extract had a significant effect on improving mastalgia. No further information is available concerning this trial.

Topical Applications

Castor Oil

Herbalists and naturopaths commonly recommend placing an absorbent cloth saturated with heated castor oil over the affected area of the breasts. The hot compress is typically applied for 1 hour for up to 5 days per week. The oil may be further medicated by the addition of essential oils as mentioned under poke root.

Poke Root

Poke root has traditionally been used to stimulate the immune system, relieve lymph congestion, and resolve lumps and cysts, and by extension, has been widely applied topically for the treatment of fibrocystic breasts. Poke root oil is applied topically by rubbing in a small amount (1 tsp) of the oil throughout the affected breast(s) for at least 5 nights per week for 1 to 2 months. The addition of 5 to 7 drops each of rose geranium and sandalwood essential oils makes the oil slightly more stimulating to the local circulation and also adds a pleasant scent to the oil. All parts of the plant are toxic and can lead to contact dermatitis or even toxicity from handling large amounts. Internal use is not recommended without the supervision of a qualified practitioner.

Botanical Protocol for the Treatment of Fibrocystic Breasts

Use the following combined protocol for at least 3 months for optimal results.

I. Prepare the Following Tincture:

Calendula (Calendula officinalis) 20 mL
Chaste berry (Vitex agnus-castus) 20 mL
Burdock root (Arctium lappa) 20 mL
Sarsaparilla (Smilax ornata) 20 mL
Dandelion root (Taraxacum officinale) 20 mL

Total: 100 mL

Dose: 5 mL twice daily for 3 months This tincture formula and infusion combination is designed to optimize liver function and promote the conjugation and elimination of excess estrogen and regulation of hormones.

II. Topical Application:

Ginger and poke root compress Prepare a strong infusion of ginger root using 2 tablespoons of fresh grated ginger root to 1 cup of liquid. Add 1 teaspoon of pokeroot tincture to the infusion, stir thoroughly, and soak a towel in the hot liquid. Apply for 15 minutes redippping the towel in the hot liquid to keep the compress hot. Repeat three or four times weekly for 3 months. The poke root may be omitted if practitioners are uncomfortable including it because of concerns about toxicity associated with the herb.

III. Nutritional Considerations

Eliminate caffeinated products. Reduce dairy consumption and exposure to environmental estrogens. A diet rich in essential fatty acids may be beneficial in hormonal regulation.

Vitamin E: 400-800 IU daily

Vitamin B6: 50-100 mg daily