PMS Induced Mastalgia

Oh yeah, it's that time of the month -- time for sore breasts. My breasts have been killing me and I've been so freaking bloated during my LP that it is not even funny. I haven't been able to get to acu due to travelling out of town but I do have a massage scheduled for this Thursday afternoon. Yesterday morning I took a look back at my blog posts about PMS, estrogen and the like and came across my info about elevated estrogen, prolactin and then vitex to treat the same. I decided that I had to try something as I was just about to DIE or burst or something like that. I took 10 drops in a glass of water and by the time I got to work I was like crazy get-out-of-town peeing. It was like my body randomly decided to drop all that water -- well actually it felt more like the vitex coaxed it out of me. My breasts are still sore but not nearly as bad and my belly doesn't look like a balloon (though I swear my ankle are looking a little bloated still). I think I'm going to keep trying the vitex for a few days more to see if it takes my edge off.

So here's my question to you all, if I've had my prolactin checked and it has been fine then why does it seem like that might be the problem? I've also got that weird headache back, like right between my frontal lobes. I keep getting it during my LP, since January. What the heck is wrong with me and my stupid hormones! The problem is that I don't feel like any of my docs will really listen to me and if they give me a med it will likely be something really nasty. Grrrrr.

I have been feeling bit less painful today thankfully. Maybe I'm onto something.

Here are some links about breast pain, cyclic mastalgia specifically, that you might find interesting.

Cyclic Mastalgia

Painful Breasts

Severity of Mastalgia in Relation to Milk Duct Dilatation

Toremifen May Be Helpful for Mastalgia

Info about Vitex for PMS/mastalgia

More Thoughts About Fibrocystic Breasts

So the common things they say to do if you are having PMS and fibrocystic breasts are:

Increase calcium consumption

Decrease caffeine consumption

Make sure there isn't a thyroid problem

Cut back on refined sugars

Increase dietary fiber

Increase B-vitamin consumption

Increase magnesium consumption

Drink more water

Use natural progesterone cream

Increase vitamin E consumption



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So I used to eat a fair amount of dairy and I had bad PMS but cutting back to almost none hasn't made any difference so dairy doesn't seem to do anything for me favorable. Less dairy does seem to help with my allergies and digestion so I'm going to stick with that plan.

I've always been a very moderate consumer of caffeine, I didn't drink coffee or cola. I do eat chocolate and have some black or green tea but in moderation. So, that didn't seem to make any difference at all -- in fact I recently started drinking a little more coffee than usual (a few time a week instead of once a month) and it's made no difference.

I've had my thyroid checked several times including a full thyroid panel last summer as it comes up as related to many of my conditions (fibroids, elevated estrogen, PMS) -- each time the test results were so normal it was boring. My mother has thyroid trouble so I thought for sure this might be related for me but evidently not.

Due to my naturopathic and TCM treatment I was told to cut back on refined sugars. It's helped me to feel better but I was never a total nut about eating candy or anything. I've made a concious effort to be careful about my intake of simple carbs. Still I've got sore breast in my luteal phase.

Increase of dietary fiber does seem to help me feel better generally but it hasn't seemed to help with the breast issue at all. Since this helps your body to eliminate excess estrogen I'm sticking with this for general health.

I eat a largely vegetarian diet (though I am an omnivore) and the foods I eat contain a lot of vitamin B and magnesium. Stress depletes b-levels and my work can be stressful and sometimes I don't get enough foods rich in vitamins B or magnesium but I really do try. I was never on birth control pills which can rob the body of B vitamins and magnesium so that's not an issue with me. I have been trying to be better about taking my vitamins but the best I usually do is 4 times a week -- better than nothing in my book.

I am bad about drinking enough water every day -- mostly when I'm at work. I'm much better than I used to be I think.

Natural progesterone cream didn't really seem to do much to help, maybe a little, but it mostly makes my breasts seem to swell more, not necessarily become more lumpy or sore.

And then there's the Vitamin E thing. It's in my prenatal and that on it's own doesn't seem to do anything.

But then there's that DIM/Vitamin E thing. It really did seem to help over the past three days. Today I'm spotting so AF is just around the corner but previously I used to not have my breast stop hurting until I had full-blown AF. It seems so curious to me. And some of the links I've found mention that vitamin E can increase estrogen levels, and also that DIM might do the same -- it just doesn't seem to be doing that to me -- it seems to be helping something hormonally.

Bad Estrogen

Sounds dramatic doesn't it but there really is estrogen known to be the bad kind, the kind that can lead to cancer. Since I'm not doing acu treatment or chinese herbs right now and its just up to me to try to fix me I decided to do some more research into PMS and estrogen. It's that time of the month (mid-luteal phase) and my breasts are so uncomfortable. The only time I've had real relief for a while was after both pregnancies, I guess due to the pregnancy types of estrogen being dominant then.

So here are some of the links I came across that interested me:

Predictors of the plasma ratio of 2-hydroxyestrone to 16-hydroxyestrone among pre-menopausal, nulliparous women from four ethnic groups

The relationship between physical activity and 2-hydroxyestrone, 16alpha-hydroxyestrone, and the 2/16 ratio in premenopausal women

DIM (Di-Indoly Methane)For Natural Protection from Estrogen's Effects

What I picked out that might relate to me are:

...that since dietary therapy alone hasn't helped, and my mother had PMS as well that there might be a heriditary factor.

...that exercise really might help my body to metabolize the bad estrogen more

...that taking DIM for a while might not be such a bad idea, at least to see if I can detect any changes.

DIM Plus for PMS? (and more about estrogen excretion)

On one of the discussion groups about healing fibroids naturally I learned about this dietary supplement called DIM Plus which was supposed to help your body rid itself of excess estrogen. Evidently some of the cancer circles were talking about it. I bought some a while back and tried it for a week or so, no side effects that I could see but since I was doing chinese herbs and trying to get pregnant and you aren't meant to take it if you are pregnant I didn't continue using it.

Well, with my breasts sore as ever for the second luteal phase in a row, I decided finally yesterday to take one capsule to see if it would help. Forget just about the fertility stuff for a minute and know that for me, feeling bad PMS symptoms mean that my body is still lined up for more fibroids -- something I really don't want. The recommended dose is 2 capsules but I took just the one, and then coincidence or not my breast pain receded. They are still sensitive and full and fibrocystic but not just aching me outright now. Was it possibly the DIM Plus?

Here's the link to the product page on the manufacturer's site:

DIM Plus by Nature's Way

Estrogen Metabolism and the Diet-Cancer Connection: Rationale for Assessing the Ratio of Urinary Hydroxylated Estrogen Metabolites (PDF)

Hormone Balance - Hormonal Health (about DIM)

Physiological Functions of Phytonutrients (PDF - info about DIM starts on p.9)

Foods for Cancer Prevention

Estrogen Dominance Syndrome

Nutritional Factors in Menstrual Pain and Premenstrual Syndrome

Liver Detoxification Pathways

Estrogen's Two-Way Street

Premenstrual Syndrome Types -- I mighta have posted this link elsewhere in this blog, but it might be helpful to you in this context so here it is.


It makes me think, why is it that many doctors don't consider things a problem until they might kill you? Why do I have to live with hormonal imbalance and cyclic breast pain for years. Pooh on them. And honestly I've tried the no caffeine, no dairy, no meat, no alcohol approaches and they didn't help me. No chocolate, well that's not really an option and my acu told me that with Spleen Qi deficiency it was a common craving. Like pica (craving and eating clay and ice and stuff) I guess but better.

Should I be happy or sad?

Ah sh*t I'll just be cranky, the PMS is really doing me in this month. All the acu and herbs and diet changes and here I find myself back at square one. At least I know how to manage my stress better and I can fight my anemia a little better without the heavy periods. My breasts are killing me, I'm feeling uncharitable to say the least and I would love to just go home and sulk by myself for the rest of the day.

I also think I'm coming down with a cold -- I'm sneezing and mid-LP my immunity always plummets. My theory is that it has something to do either with the hormones or the anemia or perhaps both. Progesterone compromises your immunity slightly and then with my body devoting more blood resources to building up my endometrium this time of month maybe it just tweaks my anemia and my resistance slumps. Who knows.

I've found out in the past day that two of my fibroid sisters are pregnant now, both moving along okay so it seems. I coached both of them through the pre-myo stress and now they are going to have babies. Considering how many more women with fibroids I know online who aren't getting pregnant I should be celebrating the miracle. Me, I just feel a bit dejected. I think I would rather know that someone in a similar situation to mine was having success but still it bites a bit.

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Is anyone actually reading this blog? I get so few comments that it makes me feel like I'm a bad blogger or something. I appreciate the few of you who drop notes now and again. Thanks so much for your continued support.

In spite of my aching ovaries we went out for a nice dinner together last night. My partner ordered a fabulous bottle of red wine, 1998 vintage from Europe (he loves '98 and '99 from Europe as they were noted as great years for growing grapes). The wine helped, getting a little tipsy helped.

I was so tired by the end of the day yesterday, it's be a long week. I had work to do last night but I couldn't do it so I just made do today.

My spotting has progressed some, it reminds me more of what you get after the peak of your period. Still there is more stuff in there than my lining and that will have to come out sooner or later. I felt bad this morning so I called in sick and told them I had food poisoning. Whatever. I've been working from home but so far nothing exciting happening on the miscarriage end of things. Maybe soon, over the weekend.

I was just thinking that for all the time I said "Please God. Please God" it didn't work. I've had to work so hard to get pregnant and then I lose another one. My partner did get me pregnant twice within a year period. And the third cycle since our last pregnancy and my surgery. That's not too bad right? We should have hope.

A bunch of my infertile and miscarriage buddies have just gotten pregnant recently, I'm a tiny bit jealous but I'm also so excited for them. They too have worked hard and waited a long time for their tiny heartbeats. Hopefully I'll be pregnant again soon enough.

I got a letter in the mail from my RE's office yesterday; she's leaving the clinic. That's 3 for 3 RE's that I've seen and they all left that practice. They do excellent work. During my d&c last July one nurse mentioned that the hospital administration was the issue. Too bad and sad because people really need good help and they were all excellent. I would never go to the group that had formerly been at the University of Washington so let's just hope that we can do this on our own. Again, so far so good right?

Saturday Morning

I came home from work last night and took a nap for maybe an hour. I just needed to give my nervous system a break. After I got up I realized that I just felt blocked inside so I decided to do some qigong. My acupuncturist told me that I needed to be careful what I did since certain types of qigong movements can cause you to miscarry. I haven't practiced in months but I had to try something, nothing was moving in my body. I did a portion of the Jade Body routine I learned at the beginning of the year and right away I started getting that shivery feeling of energy starting to move in my body. I felt a lot better afterwards. Later after dinner and a movie we had a bath in our new jetted tub and soaking in the warm water helped me feel more relaxed.

My breasts hurt. They have continued hurting, but not in the same way from day to day. Last night the pain started building again and this morning they are killing me, almost like that knives sensation again. How fun. How completely distracting.

Here is a list of my symptoms as they peaked and what I've noted over the past week:

Fatigue -- was needing to take naps from the week after AF was due until Tuesday after Memorial Day when I strangely didn't need them anymore.

Sore Breasts -- On and off but became significantly less a week ago Wednesday though the pain picked up again today.

Swollen Belly -- peaked Memorial Day weekend and gradually has receded so that you can't really tell but I'm still more bloated than normal.

Hair growth -- My chin hair (yes, it's true) was growing so quickly up until last week that I needed to tweeze every day because a new hair would show up. It was freaking me out.

Nausea -- only faint boughts, last episode was at the beginning of this past week

Thirst -- I normally don't get thirsty very much but I've noticed that the increased hormones make me more thirsty. I wasn't thirsty for much of the past week.

Increased need to pee -- I was having to pee lots all the time, though thankfully not at night. That wasn't really happening this past week.


Who the heck knows. My partner wants me to go for the scan on Wednesday. I asked him if just he and my uterus could go and that I would stay home. Either that or that I be able to be drunk when I go in so I don't have to deal. I'm not a big drinker at all (to such a degree that many of my friends don't think I drink at all) but it is just that painful and stressful to be dealing with all this.

My scan is in 24 hours (3pm PST). I can't wait for it on one hand and in denial on the other. I think to myself that maybe I can just ignore and things will happen or not. Right? I'll either have a miscarriage or a won't. I'll either have a baby in 8 months or I won't. Seeing the scan will just mean that I have to do something, feel something and part of me doesn't want to feel anything.

I feel a bit pregnant but nothing compared to last time when I was exploding with my fibroid. Realistically if there is an embryo inside of me it is the size of a pea or something, with the sac around it. Fairly small over all. My pregnancy symptoms have been pretty easy over the past week, my breasts still hurt but gone is that feeling of knives stabbing into them, my uterus feels a bit full, sometimes at the end of the day it actually feels extra swollen. My abdomen has adjusted to the hormonal bloat. I'm a bit moody -- alternating feelings last night of frustration, anger and wanting to cry. Overall it just feels like a bad case of weird PMS - is that how pregnancy is supposed to feel?

I talked to my partner last night about not wanting to tell anyone about our pregnancy and he said that he felt the same way. We're kinda of feeling like letting people find out if/when it gets noticible. We have no plans either way for telling or not telling -- I guess we'll just have to see how our appointment goes tomorrow.

I slept in this camisole with a built in shelf bra and I woke up in the middle of the night with my breasts absolutely killing me so I yanked it off and went back to bed. I've decided to go bra-less today which has felt a lot better. It's easier to do when the weather is cooler since the layers will hide my enlarged pregnant nipples better. They aren't grossly enlarged but still I like to leave a little more to the imagination when walking about, ya know?

My mother-in-law is in town for the weekend and so we've been around family more. That's all been fine but the key things are to avoid getting into discussions about my fertility since I don't want to outright lie about my pregnancy but we don't want to share about it either, and also to not give away any signs that something is up. The 2-3 hour naps I like to take now, my big boobs and my bloated belly are all things that we need to distract them from. So far so good (knock on wood).

I haven't mentioned it here yet, but at the end of the week when we found out we were expecting my mother called to let me know that she was diagnosed with breast cancer. It's really small and only in one breast and they caught it early but she'll be having surgery this coming Friday. Why is it that life has to send a good with a bad, it's almost like there was this trade-off that happened in the negotiations and it was decided that I could get pregnant but that something else bad had to happen in my life. Sigh. My mother and I haven't been getting along very well for a year now and still I'm making a better effort to call her and the like. She's loving the extra attention. We decided not to tell her about the pregnancy since she didn't deal well with my loss last year, not helpful to me and I think it brought back unresolved memories of her own losses. Better to wait until there really is good news.

Only 10 days until our ultrasound. My partner took the day off from work. I keep saying to myself over and over "Please God. Please God. Please God..."

Vitex to the rescue

I was reading someone's post about B6 for PMS and decided to look up food sources of B6 and came up with this abbreviated list: "Vitamin B6 is found in beans, nuts, legumes, eggs, meats, fish, brewer's yeast, bananas, green leafy vegetables, wheat germ, wheat bran, milk, whole grains, and fortified breads and cereals."

I eat a good amount of B6 rich foods but I was still having similar problems -- lame LP, PMS, etc. I had my CD# bloodwork done again last week and my estradiol was high -- darn estrogen dominance anyway -- though it is totally part of the pattern that leads to fibroids. So I started looking up stuff about estrogen, and prolactin since having sore breasts for the past 3 weeks hasn't been any fun.

And then I did a search again and came across, of all things -- vitex and this:
quote:

Chaste berry (also spelled chasteberry) contains several different constituents, including flavonoids, iridoid glycosides, and terpenoids. Chaste berry (the fruit of a small Eurasian tree, also called Vitex agnus) does not contain hormones. The benefits of chaste berry stem from its actions upon the pituitary gland. Chaste berry keeps prolactin secretion in check. The ability to decrease mildly elevated prolactin levels may benefit some women with breast tenderness associated with PMS. Chaste berry may also be helpful in menopause and cyclic mastalgia. New research indicates that certain compounds in chasteberry may have activity similar to the brain chemical dopamine.
http://www.raysahelian.com/chasteberry.html

So I conferred with my acupuncturist and he said I could try it if I wanted to. I started yesterday morning and I was in a better mood than I had been in weeks and by evening my breast pain had dissipated. It had to be the vitex as drinking water, taking vitamins, exercise, low stress all had no affect. And it wasn't optimism either as there was the great news about my partner's sperm morphology (increase from 2% to 5% with supplements) and that didn't affect my mood for the better -- I still felt like growling at everyone in sight.

I looked up more about vitex and liver qi stagnation since that is my chronic diagnosis. I found a few things that mentioned it:

"Vitex (V. Agnus-castus) -- acrid, spicy, warm; goes to the Liver and Spleen. It contains essential oil, fatty oil, flavonoid casticin, iridoglyside and aucubin. It is used for menstrual irregularities and irregular symptoms associated with menopause. It stimulates progesterone production and regulates the menses. It effectively treats ovarian cysts and non-cancerous breast lumps. Dose: 3-9 gms"
http://www.planetherbs.com/articles/fivestag.html

"TCM Usage:regulates the Blood, nourishes the Kidney, moves Qi in the lower Jiao.
Contra Indications: Vitex is a bit hot, so use with this in mind (not for use in ovarian cysts?)."
http://www.rchm.co.uk/articles/western_herbs.html

In The Infertility Cure, Randine Lewis says that vitex is a kidney yang tonic, but since what happens in the kidneys affects the liver in chinese medicine it might make sense that it would help me out. Also my feet get really cold at night which is supposedly a sign of a kidney yang deficiency.

I'm just amazed! I know it doesn't work for everyone, evidently it isn't good to take if you have cysts, and even I haven't been psyched about how it worked when I took it previously but talk about a perfect fit for me right now.

Other than that, my acupuncturist told me that he still thinks I'm a bit blood deficient and that's why I'm craving chocolate, that and overthinking. Oh well.

Updated to add: it delayed my ovulation by as many days as I took it though I did end up getting pregnant again this same cycle. The delayed ovulation might have contributed to my subsequent miscarriage though that is entirely conjecture on the part of the NP at my RE's office.

Updated to add 4/6/06 -- it did help me with PMS and mastalgia during my LP

What I've learned so far

I thought I would share some of what I've learned over the past year from various doctors including a naturopath. This may differ from what you've been told and I'm just a regular old person so you should definately talk to your doctor about any treatments options you might like to pursue.

Fibroids are spongy tissue that change size with the levels of your hormones in your cycle. They respond particularly much to estrogen, they aren't as sure about progesterone. Un-opposed estrogen in your body, that is estrogen that is not matched with a comparable level of progesterone, is believed to be a factor. Pain is caused partially by prostaglandins which fluctuate during the month as well; ibuprofen may be taken preventatively to help manage prostaglandin production but it isn't good for your liver.

Your liver is a key organ in balancing your hormones. This organ filters out excess hormones from your system and packs them up for excretion through the bowels. Constipation and sluggish bowel movements mean that your body isn't able to efficiently expel waste from the system; you should be having a bowel movement at least once a day otherwise this is you. What is worse is that in your intestines the body will reabsorb the excess hormones back into the system causing a build-up and making your liver work double-time. Many women have problems with constipation and progesterone during the second half of our cycle (post ovulation) is partially to blame.

Small dietary changes can really help your liver out; I tried these things suggested by my naturopathic doctor and my fibroid did not grow at all during the next 8 months.

* Drink at least 6 glasses of water each day
* Increase your consumption of foods that help detoxify your liver:
green leafy vegetable (chard, collard greens, spinach, etc.), garlic,
onions, artichokes, lemons
* Decrease your consumption of refined sugars (this can increase your body's production of stress hormones which might be linked)
* Eat organic foods only
* Decrease your consumption of meat
* Increase your consumption of fish to 2-3 times a week

I was taking vitamins and herbal supplements and used castor oil packs for about a month (they are a pain but they sure help you slow down and take a break before bed. I also greatly reduced the amount of stress in my life and increased the amount of exercise I was doing. I read about progesterone supplementation but my naturopath said that doing that would actually compromise my body's ability to produce progesterone on its own; instead she wanted to help coax my body back into balance. After about 6 months of treatment my cycle had changed. I no longer have PMS for 2 weeks out of every month and even my allergies have subsided. I'm amazed.

I have a 6cm intramural fibroid and the doctors have told me that you can't have a fibroid as large as I do without a major distortion of the uterus (an x-ray in June revealed that my uterus is wrapped around the fibroid to the right). Women who have one large fibroid tend to not get addition fibroids, women with multiple fibroids tend to get re-growth. I'm scheduled for an abdominal myomectomy at the beginning of October.

My younger sister just had an abdominal myomectomy this past March for multiple fibroids, she even had one pressing on a major artery at the back to the abdomen that doctors shrugged off for year as pain "in her head" without doing any diagnostics on her. She was on birth control pills (BCP) for the past 10 years at least, on "continuous cycling". I was never on BCP and I only have one fibroid. We've learned that our mother had a fibroid when she was in her 40s but was able to wait it out until menopause and our great grandmother had one the size of a "cantaloupe" and needed emergency surgery.

I hope this is helpful for you.