What should a woman do if she develops breast tenderness on the combined oral contraceptive pill (OCP)?
Mild mastalgia is common in first few months of combined OCP use and usually resolves spontaneously. This symptom may be troublesome for women with fibrocystic breast disease and for women who have chosen to take combined OCPs continuously to avoid menstrual associated side effects (like headache). For women on continuous combined OCPs a brief break (3-5 days at the end of a pill pack) every two months will usually allow breast symptoms to abate. Severe or persistent mastalgia warrants careful breast examination to rule out local lesions and galactorrhea. A decreased caffeine intake may be helpful when mastalgia is mild. For women with fibrocystic breast disease, where this symptom is distressing, a non-hormonal contraceptive method may be preferable. If mastalgia persists despite discontinuation of the combined OCP the use of low doses of Danazol (50-100 mg daily) will usually provide dramatic relief for the mastalgia.
