Which of the following treatment(s) is/are of proven benefit in the treatment of mastodynia associated with fibrocystic breast disease?

a. Avoidance of methylxanthine compounds, particularly caffeine

b. Cessation of smoking

d. Danazol

The relationship of methylxanthines, particularly caffeine, to mastodynia and breast nodularity remains controversial. Most women do, however, experience diminution of their symptoms and are subject to improvement in breast nodularity by limiting or eliminating caffeine intake. Mastodynia patients should be advised to eliminate caffeine beverages for a period of 2 to 3 months to determine if there has been improvement in their symptoms. In addition to caffeine abstention, patients should be urged to stop smoking because nicotine is purported to worsen mastodynia. A number of medications have been advocated for the treatment of mastodynia. Unfortunately, because of the subjective nature of the disease and its propensity to be better tolerated by patients with reassurance, the exact method of most of these interventions is unclear. Vitamin E has been touted as beneficial, however, clinical data do not support the use of this or other vitamins for this condition. The use of hormonal agents to treat mastodynia has been more extensively treated. Danazol, a weak antigen, is the most effective drug available for treatment of mastodynia related to fibrocystic disease. Unfortunately, Danazol’s androgenic side effects are troublesome enough to restrict its use to the most problematic cases of mastodynia. Other hormonal agents have been investigated for the management of mastodynia. In young women, oral contraceptives have a variable effect on mastodynia. A trial and error search for optimal preparations may be necessary as the effect of oral contraceptives is dependent on the formulation of the pill.