Okay, I have been challenged to provide references thanks to you, Barbara Wilson-Clay (and thanks for the compliment). I decided that I would do a quick medline search rather than search thru all my old school stuff. So... the literature on this topic is mixed with some studies saying there is no relation between fibrocystic breasts and some proporting a link. Both of the studies supporting a link between caffeine intake and symptoms are a bit older but the references and abstracts are here FYI. The second one is probably more relevant to our discussion as what it really addresses is caffeine elimination and subsequent reduction of breast pain. Like Barbara, I really do not like giving women a list of "thou shalt nots" with breastfeeding, and try to refrain from ever doing so. As I mentioned in my earlier post, though, most of the women whom I see having problems (usually tenderness) with cyclic breast pain are in their late 30's to 40's. In my experience and the reported experiences of women I have worked with, cyclic breast pain has not generally been problematic during breastfeeding, but if it were, suggesting a trial of elimination of caffeine to see if symptoms improved would seem a reasonable first step, after ascertaining that it was cyclic breast pain that was really being dealt with, not pain from some other cause. References: Boyle, CA, Berkowitz, GS, LiVolsi, VA, Ort, S, Merino, MJ, White, C, & Kelsey, JL (1984). Caffeine consumption and fibrocystic breast disease: a case controlled epidemiologic study. J Natl Cancer Inst, 72(5), 1015-9. In a hospital based case controle study that included 634 women with fibrocystic breast disease and 1,066 comparison women in Connecticut, the occurrence of fibrocystic breast disease was positively associated with average daily consumption of caffeine. Women who consumed 31 -250 mg caffeine/day had a 1.5 fold increase in the odds of disease whereas women who drank over 500 mg/day had a 2.3 fold increase in the odds. Russel, LC (1989). Caffeine restriction as initial treatment for breast pain. Nurse Practitioner, 14(2), p. 37-8 The effects of methylxanthines (caffeine, theophylline and theobromine) on the symptoms associated with fibrocystic breast disease were studied in 147 patients. Disease was documented by mammography, physical examination and clinical symptoms. Only those individuals with breast pain (n=138) were included in the study. Questionaires were presented and explained to all patients by the same nurse examiner. Patients reported their degree of caffeine consumption as either light (two cups per day or less of caffeine containing foods or beverages), moderate (more than two cups, less than six cups per day), or hearvy (six cups per day or more of caffeine containing products). They additionally reported breast pain as milk, moderate, or severe. Past medical and family histories wer reported as well as medication intake. All patients were counseled to abstain from or reduce caffeine consumption and were given a list of commonly used caffeine-containing products. The results at the end of one year indicated that compliance was high with 113 patients reducing their caffeine intake substantially, and of those, 69% reproting a decrease or absence of breast pain. Ione Sims, CNM, IBCLC