Advising perimenopausal and menopausal patients on benign breast symptoms and lifestyle interventions

Dec 19 / Dr. Helen Cappuccino, MD, FACS
This article, excerpted from a conversation with Perry Academy Instructor Dr. Helen Cappuccino, MD, FACS, outlines strategies for assisting perimenopausal and menopausal patients with benign breast conditions.

It focuses on nutrition, supplements, and guidance to reduce anxiety around breast symptoms.
Much of the available evidence on lifestyle interventions for benign breast symptoms is observational rather than derived from randomized trials. Nonetheless, as Dr. Cappuccino notes, “there is a growing body of anecdotal evidence that exists about some foods and some supplements that we can use to ameliorate breast pain.” These observations can be applied in clinical practice. 

Explaining mastalgia to patients

Hormonal fluctuations typical of perimenopause can lead to a variety of breast symptoms, including mastalgia. This can be categorized as:

  • Cyclical mastalgia, linked to the menstrual cycle, usually appearing in the luteal phase when progesterone rises.
  • Non-cyclical mastalgia, not clearly related to the menstrual cycle, more common in women in their 40s and during perimenopause and more often unilateral.
  • Extramammary mastalgia, discomfort that originates outside the breast, often from chest or rib muscles.


Dr. Cappuccino emphasizes that “Breast pain generates a lot of anxiety surrounding breast health”. Therefore, when counseling patients, it is crucial to reinforce that these symptoms are common and generally benign.

Importantly, clinicians can also highlight potential benefits of perimenopause and menopause for breast health, including reduced breast tenderness, decreased lumpiness, and lower breast density. Decreased density can improve the sensitivity and accuracy of breast imaging.


Nutrition and lifestyle interventions for benign symptoms

Several lifestyle strategies may be discussed with patients experiencing mastalgia, fibrocystic breasts, or other benign breast conditions. These approaches largely overlap.
Emphasizing fruit, vegetables, and healthy fats, especially omega-3 fatty acids, is key. When patients find dietary changes challenging, clinicians can encourage small, achievable goals, such as adding one extra fruit or vegetable per day.

The Mediterranean diet supports both breast and overall health.

This dietary pattern focuses on vegetables, fruits, legumes, whole grains, nuts, seeds, olive oil, and fish, while limiting red meat, processed foods, and saturated fats.

While alcohol is traditionally included in this diet, Dr. Cappuccino clarifies that, from a breast health perspective, minimizing alcohol intake is advisable.

One commonly discussed intervention is reducing or avoiding caffeine intake. Clinicians can encourage patients to try a gradual reduction, with the possibility of avoiding it entirely if symptoms improve.

Finally, soy foods and isoflavones have been associated with a lower risk of fibroadenoma in some observational studies. 


Supplements: how to counsel

According to Dr. Cappuccino, certain supplements may help mastalgia, most notably evening primrose oil, which provides linoleic acid, and vitamin E (2000 IU twice a day), an antioxidant.

For fibrocystic breasts, gamma-linolenic acid (GLA), iodine, and selenium may be considered.

Given the limited evidence, clinicians may prioritize food-based strategies first. However, maintaining an individualized approach allows selected patients to benefit from supplements. 

Empowering and reassuring patients

When counseling patients with benign breast symptoms, the first priority is to rule out any underlying pathology. Once this is established, lifestyle interventions become central to care.

Shared decision-making, personalization of strategies, and flexibility over time are essential. As Dr. Cappuccino recommends, patients may benefit from mixing and matching interventions to identify the smallest combination that effectively reduces symptoms.

This approach empowers patients, reduces anxiety, and reinforces the message that meaningful steps toward comfort and long-term breast health are achievable.

About Perry Academy

Perry Academy is a CME/CE-accredited education platform translating emerging menopause research into multidisciplinary clinical practice. Our faculty includes Dr. Mary Jane Minkin, Suzanne Gilberg, MD Stacy T. Sims, PhD Jayne Morgan, M.D. leaders in women’s health.

Members gain access to:

  • Live and on-demand expert sessions
  • Multidisciplinary case studies across orthopedics, endocrinology, cardiology, nutrition, and mental health
  • Downloadable clinical tools and patient handouts
  • A professional community advancing evidence-based midlife care

“Perimenopause is the decade to act — not react.” — Dr. Jocelyn Wittstein, Duke University

The science is clear. The next step is implementation.