As a fellow painful boob sufferer, I sympathize completely.  Let me share some of the info I’ve dug up within the past few years; you can use it or toss it out as you see fit.

First off, Terri is right about the progesterone.  If you are only having pain in the latter two weeks of your cycle, that’s probably the culprit.  You produce your own progesterone at that time, so maybe you shouldn’t be adding more.

If you haven’t done it already, I’d suggest getting a little day calendar and logging when the pain starts, when it peaks, when it ends, etc.  You’ll only need to do this for a few months before you get a real handle on what’s going on.  If you can, try to connect bad days with anything you might be eating or a cycle- related event--for instance, a sudden desire to eat mountains of Ben and Jerry’s.  (Your doctor will also find a diary quite handy, as it will give him something to immediately dismiss patronizingly.  Nothing pleases a doctor more.)  To be quite frank, I’ve never discovered any correlation between anything I eat or drink and mastalgia (as it’s known to us aficionados).

A lot of doctors insist that coffee is the culprit; Susan Love deals with that idiotic idea succinctly in "Dr. Susan Love’s Breast Book."  Just for shits and grins, I’ve included the below, and since these are the first abstracts I’ve posted, I hope I’ve done it correctly.

Am J Epidemiol 1986 Oct. 124:4 603-11
Schairer C, Brinton LA, Hoover RN

Methylxanthines and benign breast disease.

Abstract:
The relation between methylxanthine consumption and biopsied benign breast disease was investigated by using data from a case- control study which included 1,569 cases and 1,846 controls identified between 1973 and 1980 through a nationwide screening program.  There was no evidence of an association between methylxanthine consumption and benign breast disease in the total study population.  When histologic types of benign breast disease were examined, there were no trends in risk according to methylxanthine consumption among the 813 cases with fibrocystic disease, the 508 cases for whom detailed pathology data were not available, the 172 cases with benign neoplasms, or the 158 cases with other benign conditions.  When cases with fibrocystic disease were examined according to presence of atypia, hyperplasia, sclerosing adenosis, or cysts, there was, again, no association between methylxanthine consumption and risk of disease.  In addition, no relation was found between methylxanthine consumption and menstrual breast tenderness among premenopausal women with fibrocystic disease or unknown conditions.

Surgery 1987 Jun 101:6 720-30
Allen, SS, Froberg DG

The effect of decreased caffeine consumption on benign proliferative breast disease:  a randomized clinical trial.

Abstract
A single-blind, randomized clinical trial of 56 female subjects was conducted to determine whether decreased consumption of caffeine decreases breast pain/tenderness or nodularity in  patients with suspected benign proliferative breast disease.  The subjects were randomly assigned to one of three groups: a control group ( no dietary restrictions), a placebo group (cholesterol-free diet), and an experimental group (caffeine-free diet).  At the initial examination, the subjects reported on the presence of breast pain, the degree to which pain affects daily activities, the frequency of pain, the degree of pain associated with breast examinations and the degree of pain associated with close-fitting clothing.  Subjects were then examined and the four quadrants of each breast were rated on a scale of 0 to 3 (0= normal, fatty  tissue, 1=little seedy bumps or fine nodularity, 2= discrete nodules or ropy tissue, 3=confluent areas, hard or soft masses).  Subjects in all three groups returned for 2- and 4- month follow up examinations.  Total nodularity scores, degree of pain/tenderness, and compliance with dietary restrictions were analyzed.  The data showed that decreased caffeine consumption did not result in a significant reduction of palpable breast nodules or in a lessening of breast pain/tenderness.

By the way, I can highly recommend "Dr. Susan Love’s Breast Book."  Her web page also has some information; it’s at http:// hometown.aol.com/suelovemd/index.htm

As for Evening Primrose Oil, here is a URL for a review of the available research; http://www.epi.bris.ac.uk/rd/publicat/dec/ dec65.htm  I am particularly enchanted with the idea that "it doesn’t work, but it has so few side effects, let’s tell ‘em to take it anyway!"  It’s my current favorite piece of "Le Dumb Medicine."

One of the problems I’ve run into REPEATEDLY is that doctors confuse lumps and nodularity with breast pain; the two are not necessarily related.  You can have pain without lumps, you can have lumps without pain.  In fact, lumps are a normal part of the aging breast.  If you have them, keep an eye on them, but don’t spend a lot of effort worrying about them.  My own completely unscientific hunch regarding all this is that the pain is caused by certain events, some of which are definitely hormonal, some of which may not be; or by a constellation of events or a one from column a, one from column b scenario; and that this expresses itself as breast pain IN SOME WOMEN.  Headaches can be caused by a variety of things, I don’t see why breast pain has to be pinned to one cause.

As to relieving it, a detailed search of the medical literature has led me inexorably to the conclusion that YOU’RE ON YOUR OWN. If a heating pad helps, by all means use it (although I’d like to be a fly on the wall when you clap a heating pad to your boobs at work!).  You might try using a topical analgesic such as Aspercreme or Ben Gay.  NSAIDs such as Motrin can be used, but be aware that if you take too high a dosage or take them for too long, they can cause a whole series of nasties such as gastrointestinal problems, kidney disease, etc.  I’m taking them in HUGE amounts, but that’s because I don’t give a damn if my kidneys fall out onto the floor.  I want pain relief now.  If you are not at that point yet, weigh the drawbacks and the advantages carefully.  Acupuncture is a possibility, too.  I would suggest getting a comfortable bra, but that’s like suggesting you get a comfortable Iron Maiden.

I don’t want to rain on your parade, but you will find very little info available.  That is because no one in the medical or scientific field gives a holy goddam about the condition, unless it provides them with an excuse to patronize and preach.  It seems that whenever we start dealing in a scientific way with women’s medical problems, we first have to run through several years and many millions of dollars disproving a load of puritanical claptrap before we begrudgingly start on the real issues.  Over the past ten years, I have been told that breast pain is caused by drugs (coffee or cigarettes), my chosen childless state (an offense to nature), and my own clearly inferior female brain (it’s all in her head).  No one has yet told me that it’s caused by "voting for McCarthy in 1968" but I suspect I’ll be hearing that any day now.

OK, I’m beginning to rant and drool.  Time to shut up.

I hope this has been of some help.

Frederica