The place to begin to understand any mystery is to collect information about the problem, try out a few solutions, collect more data, sit with it, and then discover what works best for you. We were never taught much about the breast itself or to look at it as the miracle organ it is with the power to transform water, protein and blood into milk. Breasts are made of a mixture of fat, fibers and glands. The glands or ducts and lobules are ready to make milk and prepare to do so each month during our menstrual cycle. The fibers, like strands of thread or rope, support the breasts and hold up the glands. The fat cushions and stuffs up the breast. Different women have differing amounts of these three components which are determined by our genes. Our breasts change throughout our life, from puberty, through child bearing and nursing years, to old age. They also change monthly with a menstrual cycle.

The most common type of breast pain is related to our hormones during a monthly cycle. The breasts, stimulated by the estrogen and progesterone during the second half of the cycle, swell, getting more lumpy and more tender. Then during the period when the uterus sluffs off its lining, the breasts reabsorb the extra fluid instead of discharging it. At different times, often in the years before menopause, the hormones are a bit off balance and the breasts suffer more tenderness. Many women can identify when they ovulate by the sensations in their breasts or nipples. For some women this may mean too little or too much estrogen, for others too little progesterone. This type of cyclic breast pain occurs in both breasts, sometimes more on one side than another. It is often felt more in the lateral aspect where there is more breast tissue. It may differ from month to month but always gets worse before a period and then lets up with menstruation.

Cyclic breast pain can be made worse by some foods we eat or drink and some medications we take. An obvious one is caffeine, which has a chemical (methyixanthine) which causes vessels to dilate. This microscopic swelling can cause distention in the breasts and add to the pain. Again, it doesn't cause or lead to cancer, so a woman may want to balance her desire for coffee with the discomfort it causes in her breasts. Decaf coffee and teas have less caffeine and most sodas and chocolates do too. Excedrin has as much caffeine in one pill as a cup of coffee. Likewise, high-salt diets increase swelling by retaining fluid and this also puts a strain on the breast tissue.

There is some recent evidence that fatty foods, mostly animal fats, also contribute to breast pain. The reason here is less clear but may have to do with the animals' own hormones or what they have been given to eat or the way the fat is broken down. For some women, dairy products are the culprit. Again the exact reason is unclear. These women may have an underlying allergy to the dairy products or the source maybe what the cows have been fed themselves. The most common medications that cause breast pain are pills with hormones in them — either birth control pills or hormone replacement therapy. The amounts of either estrogen or progesterone or both may just not be right for a particular woman. Or she may react to the additives in the pill or the synthetic compounds. Some psychiatric medications or antidepressants may increase breast pain. Even some cholesterol-lowering and heart medications can cause breast changes.

The other big contributor to exacerbating breast pain is stress. Again the exact mechanism is unclear. Scientists are beginning to understand the links between the immune system, our emotions and our hormones. Everyone has different stress levels and stressors, but it is a truism that too much stress is not good. And likewise, we could all benefit from learning how to relax and take time for ourselves. It was more natural and expected for our ancestors to take time out monthly during the "bleeding" than now. With Tampax and Midol we can go on as if nothing is different. I've come to think that breast pain may be a reminder for us to step back and look around.

The question always arises, "do bras help the pain or make it worse?" Again the answer depends on who you are. Bras are not medically necessary; however, society expects women to wear them and bras do make some clothes fit better. Many women feel better wearing a bra for support or up-lift. Other women prefer not to wear them. It is important to wear a bra that fits well and is comfortable. Some underwire bras or too tight bras can pinch or cause constant rubbing which irritates skin and breast tissue, leading to pain. It was an old theory that trauma led to breast cancer, but that idea has fallen out of favor. A study that concluded bras cause cancer has not been replicated. If breast pain persists for several months and does not appear to be cyclic, a few standard medical tests, a chest X-ray, thyroid tests, and a dental exam should be done to rule out some rare diseases.

Treatments for breast pain vary widely, again partially depending on your cultural setting. Women in England tend to use Evening Primrose Oil or teas; in Italy they take Vitamin E; the French use a cream to rub on their breasts; and in the United States we are told to Grin and Bear It. In Russia, I'm told, women put cabbage leaves on their breasts, then wrap themselves with a warm cotton linen and go to bed for the night!  All the above may work for some women. Women in the United States are also offered birth control pills or a stronger male hormone, Danazol, to control the pain. I, however, usually suggest women start with Vitamin E 400-800 IU/day or EPO or Progest cream — now available here. Castor oil packs help loosen up the tissue and also force a woman to take at least 20 minutes off and lay down. It seems more rational to me to try and identify the source or cause of your pain and deal . with it specifically. Sometimes reassurance that it isn't something bad is enough. Given some time and support, I've found that women can find their unique, personal answers and let go of the pain.

The as-of-yet unsolved epidemic of breast cancer has put fear and terror into most women's hearts. While this increased awareness may bring increased funding and research, it has unfortunately alienated most of us from an important part of our body. We have forgotten that our breasts are a natural part of us that serve a very healthy function of nurturing our offspring. They also can give us much more pleasure. Breasts are much more than simplex sex symbols but are symbols of our nurturing strengths and life force and evidence of our own intuitive powers.

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Dixie Mills, MD, is a practicing physician at Women to Women, a holistic women's medical practice in Yarmouth, ME. For more information on breast pain, the products mentioned or for audiotapes on "Honoring Our Breasts" or "Creating Breast Health," contact Women to Women, 3 Marina Rd., Yarmouth, ME 04096, 207-846-6163 or visit www.womentowomen.com.