Cyclic Mastalgia

Case History: Cyclic Mastalgia

Tanya, 47-year-old perimenopausal woman consulted for increasingly painful cyclic mastalgia occurring 2 to 3 days prior to the onset of menses. Her pain had begun 2 years prior during a stressful time in her life at which time she also started having mild menstrual irregularities and bloating around the time of her periods. At that time, she started eating red meat again regularly and drinking several cups of caffeinated beverages daily. Tanya walks and rides an exercise bike 30 minutes daily five times weekly and has recently joined Weight Watchers and started eating cold water fish three to four times weekly as well as increasing her vegetable and fruit intake after finding out that she had high cholesterol (total cholesterol 251). She is drinking three to six glasses of water per day. She has some problems sleeping because of pain in her left hip and a history of gastroesophageal reflux disease (GERD), and was recently diagnosed with mild depression. Tanya has a history of numerous sinus infections and vaginal yeast infections. She is taking Effexor (150 mg daily) for depression. Physical exam of the breast revealed bilateral tender spots on left lower quadrant that felt like “bags of lentils.” Patient claimed that she was aware of these areas due to self-breast exam and that it appeared to worsen around the time of her menstrual cycle. She was prescribed the following tea for her to take after supper to help her sleep:

Passionflower(Passiflora incarnata)2 parts
Chamomile(Matricaria chamomilla)2 parts
Skullcap(Scutellaria lateriflora)1 part

Dose: Infuse 1 level tablespoon of dried herbs per cup of boiling water, covered, for 15 minutes. Strain. Drink 2 cups within 2 hours before going to bed.

For her mastalgia and menstrual irregularities, she was

prescribed the following tincture:

Chaste berry(Vitex agnus-castus)20 mL
Burdock root(Arctium lappa)20 mL
Cleavers(Galium aparine)20 mL
Dong quai(Angelica sinensis)40 mL

Total: 100 mL

Dose: 3 mL, three times daily in water. She returned 4 weeks later saying that her sleep had greatly improved. She also said that her gastroesophageal reflux disease (GERD) was about 75% improved. She estimated that she had about a 25% improvement in breast pain and tenderness. Her menstrual irregularities had not changed. The patient then returned 8 weeks later, and reported about a 75% improvement in breast tenderness and pain. She said that her last period was less irregular and closer to “being on time.” Her sleep remained improved.