Jay mentioned a case of fibrocystic breast disease a few days ago and
I haven't seen any comments about it so far.
Fibrocystic disease is really a misnomer, as it is not a disease at
all. Many women get lumpy or painful breasts, nipple discharge or
cysts - either cyclical (worse before menstrual periods), or
constant. The changes the breasts undergo are called fibrocystic
disease, mammary dysplasia, fibrocystic mastopathy and a heap of
other terrible sounding names.
These changes seem to be partly hormonally based, and partly due to
other causes. High oestrogen levels or low progesterone levels have
been blamed for causing breast changes (eg oestrogen acts in an
unopposed way on the breast), but this has never been proven. Up to
70% of women with fibrocystic disease do have a history of irregular
periods. Chemicals such as methyxanthines (caffeine, theophylline and
theobromine) which are found in tea, coffee, chocolates, cola and
some respiratory medicines - have been related to these breast
symptoms. Foods high in levels of tyramine (mature cheese, wine,
mushrooms, bananas, processed meats) also seem to worsen things for
some women.
Treatment may be plain reassurance - many women can live with
fibrocystic changes if they know what they are. They do not have an
effect on breastfeeding, and are not worsened by breastfeeding. I
have read a few comments on Lactnet that large cysts can make women
more prone to blocked ducts, but I would cross this bridge when I
come to it.
Other treatment could include reduction in caffeine, dietary fats
and tyramine, Vitamin E (600 IU per day) or evening primrose oil
(1000mg three times a day). Don't take the doses as gospel, this is
what I have read in a few studies. Diuretics ('fluid pills') don't
have any effect.
Hormonal treatment can be used - progesterone is often successful,
but symptoms return when it is stopped. The combined oral
contraceptive pill is not always useful - sometimes it can worsen
symptoms. Other treatments can include danazol, tamoxifen and
bromocriptine, but these would only be used in severe cases, and I
have never prescribed them for this problem.
The 'blue gnome cyst' that Jay describes is actually a blue dome cyst
(not an elf in a blue hat!!!). This is just one of the many names for
the cysts that occur in the breast. They may have been stirred-up by
the steroids she has taken, or the fact that her periods are not
regular at the moment.
Hope this helps
Fiona



Fiona Coombes MBBS IBCLC               [log in to unmask]
Lactation Consultant, Family Physician
Perth Western Australia