A Comprehensive Approach to Fibrocystic Breasts: Testing and Getting to The Root Cause

About 50% of women of reproductive age will experience breast tissue changes in the form of fibrocystic breasts. This condition is a common presentation in premenopausal women due to the fluctuations that occur during the menstrual cycles. Women typically notice these changes on self-examination, which may alarm them with thoughts of breast cancer. 

While that may be an initial fear, medical experts have concluded that fibrocystic breasts do not increase your risk for breast cancer. Understanding the characteristics of these breast tissue changes, the common cause, and what steps you can take to mitigate or reduce the occurrence are all beneficial to supporting your health. 

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What Are Fibrocystic Breasts?

Benign texture changes to the breast tissue can result in a condition known as fibrocystic breast. Fibro meaning fibrous thick tissue, and cystic, meaning fluid-filled sacs, will result in a ropey, lumpy, or knotty feeling along the breast tissues. 

While this is a non-cancerous condition, it can be painful, especially during menstrual cycles. The most common age range to see these changes is between 30 and 50 years old due to hormonal fluctuations. After menopause, these breast changes can also occur with the use of hormone replacement therapy. 

Fibrocystic Breast Signs & Symptoms

You may notice changes in your breast tissue as you age. If you are experiencing any of these symptoms, they could be a sign of changes to your breast tissue. Here are examples of how breast tissue changes could feel:

• Nodules or lumpy tissue changes
• Symmetrical breast tissue changes
• Breast pain or tenderness 
• Worsening pain from ovulation to menses
• Discomfort in the upper outer part of the breast
• Fluctuation in the size of the lumps during menses
• Green or dark brown nipple discharge

What Causes Fibrocystic Breasts?

Universally, this condition is poorly understood but has primarily been linked to hormonal fluctuations. Elevated estrogen, with lower levels of progesterone, seems to play a key role in developing fibrocystic breasts in reproductive years. One study evaluated this by measuring estradiol (E2) and progesterone (P), along with symptoms rating during days 21 and 24 of the luteal phase of the menstrual cycle. The study found that those with fibrocystic breast disease had a significant drop in progesterone on day 24 and an increase in estrogen. The imbalance of estradiol to progesterone ratio, explicitly having a low E2/P, is correlated to an increased probability of developing fibrocystic breasts.

Additionally, women who are on hormone replacement therapy (HRT) of estrogen have a two-fold risk of experiencing breast tissue changes than those who do not take exogenous estrogen during menopause. One other area to consider is young adulthood alcohol consumption. One study found that 15 grams, around three alcoholic beverages, or more per day from ages 18-22, showed an increased association with benign breast diseases like fibrocystic breasts. This constitutes a small percentage of the population and should be assessed based on an individual's current or past lifestyle history. 

Functional Medicine Labs to Test For The Root Cause Of Fibrocystic Breasts

Hormone imbalances are the primary driver of fibrocystic breast disease. Evaluating sex hormones through hormone testing, while also assessing gut health, can provide insight into the root cause of this condition. 

Comprehensive Hormone Panel

DUTCH Complete is a dried urine test that looks at hormone metabolites. The urine collection is a multi-day which provides insight into hormone fluctuation. This is ideal for women who are experiencing potential hormone imbalances or for monitoring hormone levels while taking HRT. 

Gut Health Assessment

Microbiome health is essential to the metabolism and use of circulating estrogen. Having a healthy balance of bacteria in the gut can promote estrogen balance. While gut health has not been directly linked to fibrocystic breast disease, it is worthwhile to investigate gut microbiome health as it’s essential in hormone health. 

The GI-MAP + Zonulin test by Diagnostic Solutions and the GI Effects® Comprehensive Profile from Genova Diagnostics are two tests that can help determine your status of beneficial versus pathogenic bacteria. They also tests for beta-glucuronidase-producing bacteria and beta-galactosidase-producing bacteria, which are both involved in estrogen metabolism. 

Additional Lab Tests 

Depending on your presentation, your primary care provider may want you to have multiple tests done. The most common assessment is through a clinical breast exam. Additional investigation may include a mammogram, ultrasound, or biopsy if the abnormal findings are indicated on imaging. 

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Conventional Treatment for Fibrocystic Breasts

In most cases, there is no conventional treatment to dissolve these breast tissue changes, but there are recommendations to help decrease the associated pain. Pain meds, warm compresses, and wearing a supportive bra can all assist with associated pain. More severe situations may require a procedure, which will consist of puncturing simple cysts. This is done under guided ultrasound in which the needle is precisely placed for aspiration of the cyst. This is only warranted in cases where pain has been persistent and impacting someone's daily life. In more complex cases of recurring, painful cysts, surgical excision may be necessary. 

Functional Medicine Treatment for Fibrocystic Breasts

From diet to integrative healthcare options, functional medicine can provide complementary support to cases of fibrocystic breast.  

Diet and Fibrocystic Breast Health

Consuming food that fuels your body without creating inflammation and imbalance is an ideal route to take in order to support your hormone health. Since elevated estrogen and lower progesterone are the patterns most associated with this condition, it’s important to eat food that will support a balance between these two. A whole-foods high in fiber diet, such as legumes, flaxseed, oats, spinach, various nuts, and fruits, will help the body metabolize and excrete extra estrogen. 

Eating adequate amounts of lean protein daily, in the form of chicken, fish, and organ meats, is a great source of vitamins and fuel. Fats, primarily anti-inflammatory omega-3s, will also assist in hormone function. Great sources of omega-3s include wild-caught salmon, chia seeds, oysters, and sardines. Combining all these critical components in your daily meals can provide the nutrients your body needs to thrive. 

Supplements & Herbs for Fibrocystic Breasts

The use of nutraceuticals and herbs have shown to help reduce inflammation, balance hormones and reduce the pain associated with fibrocystic breasts. Here are some options to consider if you have been diagnosed with this condition. 

Evening Primrose Oil (EPO) 

This fatty acid plant source derivative provides a source of gamma-Linolenic acid (GLA). Women deficient in this can have an increased chance of breast tissue sensitivity to sex hormones, leading to breast pain. Multiple clinical trials have shown that supplementing with EPO can reduce pain mastalgia (breast pain), a common symptom of fibrocystic breast. One source states that EPO can be dosed at 1000 mg two to three times daily for up to three months. 

Vitex Agnus-Cactus 

This botanical, commonly called chasteberry, is utilized for hormone imbalances. In cases of estrogen dominance and progesterone deficiency, chasteberry can be helpful. It’s also known to be helpful in cases of cyclical breast discomfort. The dosage for this herbal extract is between 20 to 40 mg per day, depending on the patient's case and intended goals. It’s best to consult with a practitioner trained in botanical medicine who can recommend an individualized dosage.  

Vitamins

There are two vitamins that have been shown to decrease inflammation and, therefore, the pain associated with breast pain. These include vitamin B6 and vitamin E. The dosage for vitamin B6 that was proven to be effective was 50 mg twice a day, while vitamin E was 200 IU twice a day for two months.

Complementary and Integrative Medicine

Incorporating holistic health modalities to assist with this condition can provide a multifaceted approach. Acupuncture and exercise therapy are two options for addressing fibrocystic breasts. 

Traditional Chinese Medicine-Acupuncture

Acupuncture uses tiny needles inserted at specific energetic points to help facilitate balance within the body. When it comes to pain, acupuncture has been widely used to help the body process pain synergistically. Acupuncture is also a tremendous integrative health practice to help balance hormones, which is often the underlying dysfunction causing fibrocystic breasts. 

Exercise Therapy

There is some evidence suggesting the percentage of body fat and total lean body mass may be predictors of the development of fibrocystic breast changes. Maintaining a healthy percentage of body fat through both diet and exercise may be one avenue to assist you in decreasing your risk of developing this condition. Participating in at least 150 minutes a week of moderate-intensity physical activity such as biking, walking, or other aerobic exercises can help you stay fit while also supporting your hormone health. 

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Summary

The condition of fibrocystic breasts may be common, but it does not necessarily mean that it is normal. If you have found yourself with these changes, it's most likely indicative of an underlying imbalance. Investigating this imbalance through functional medicine and then taking a root cause approach to healing can both reduce your symptoms and lead you down a path to a healthier you!