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Breast Pain and Fibroid Relief

Melissa walked into my office and immediately exclaimed, “I absolutely cannot believe it.   I’ve got my boobs back!”

Now that’s a wildly-satisfied client!

After just six weeks of focus, Melissa’s highly sensitive and “lumpy” breasts were pain-free and softer – clearly healing.  An unfortunately common symptom in our female clients, fibrocystic breasts are a high-satisfaction and important issue that we can help them to resolve.

Over the years, I’ve worked with dozens of female clients who have struggled with fibrocystic breasts.  Lumpy and/or simply thickened tissue (perhaps with small nodules) that are sensitive or even painful.   For many women, the pain is felt particularly in response to menstrual cycling.  This is hormone-mediated inflammation!   And the root cause is localized hormonal toxicity, usually evidence of overall estrogen dominance.  Breast fibroids are benign in principle.  But they are also an early warning sign that (1) your client’s hormone-sensitive tissues need some help and (2) their lifestyle needs changing to reduce cancer risk.  Up to 2/3 of our female clients are wrestling with this concern.

Our collective estrogen emergency is a key issue for all of us to understand thoroughly as practitioners.  We have a rapidly rising incidence of estrogen-mediated cancers (breast/uterine/ovarian for women and prostate for men).  Many of our clients struggle with

  1. relative estrogen surplus or toxicity because of elevated exposure to xenoestrogens in our environment  (see my prior article for more details on how this happens).  As a practitioner, you can help them to understand and eliminate these sources.
  2. overall hormone imbalance.  Perhaps surprisingly, this is often driven by our insulin levels (a metabolic hormone secreted in response to carbohydrates in the diet).  Women with elevated insulin can become androgen dominant which impairs/prevents ovulation, resulting in insufficient progesterone to balance/counter the estrogen level.  This point is a good reminder that estrogen is not high in all patients who wrestle with estrogen dominance.  Helping your clients to counter any insulin resistance at play, reducing insulin and thus reducing androgens and restoring ovulation and overall hormone balance, is key for long-term resolution (yes, you can do it!).
  3. poor ability to detoxify and excrete estrogen effectively.  The liver must detoxify estrogen and secrete excess via our GI tract for removal from the body.  Impaired detoxification and/or chronic constipation can stand in the way of this process.  Among other nutrients, the liver must have sufficient magnesium and B vitamins in order to effectively detoxify and methylate estrogen into benign metabolites that the body can excrete.

Through the functional medicine lens, we understand that the collection of factors at play for each unique individual who struggles with breast fibroids is going to vary.  We have to do the deep dive to understand the puzzle pieces at play in each case  There is no black’n’white solution or single trigger/cause.  If you are fascinated by the whole topic of hormones, you will love our Deep Dive clinical course on Hormones where we explore hormone toxicity and balance in rich detail.  It’s amazing to me that substances we typically measure in picogram levels (that is parts per trillion!) can be so powerful.   But let me tell you right now exactly what Melissa did…

Of course, we first of all embarked on a huge wave of education.  Melissa wanted to thoroughly understand what interconnectedness might be at play in her body, so she could move ahead with informed intuition.  She wanted to check some targeted labs as a result.  In her case, we were able to verify that there was no notable insulin resistance at play.  And we also checked a full thyroid panel.  Her T4 to T3 conversion seemed quite optimal, but her Total and Free T4 were both suboptimal, though normal.  Here’s what she did…

  1. Cut way back on caffeine intake (down to only one mug of green tea daily).
  2. Started a good-quality B complex supplement (e.g  Jarrow B-Right).
  3. Started using chastetree berry during the latter, luteal half of her menstrual cycle in order to enhance her progesterone synthesis.
  4. Worked to reduce possible xenoestrogenic chemicals in her personal hygiene and beauty products.
  5. Started taking iodine.  Yes, iodine.  Specifically, she built up slowly (over ~3 weeks) to a 12.5mg of Iodoral daily on a full stomach.  Some of you might think, “Well, wait a minute, I thought iodine was  important for the thyroid.”  Indeed, it is.  But actually every cell in our body needs iodine, and our hormonally-sensitive tissue needs much more of it.   Second to the thyroid, tissues laden with steroid hormone receptors are the ones in most need of iodine. Namely, the breasts, ovaries, and uterus ( and the prostate in men).  It is important when using oral iodine to check thyroid function over time to ensure the iodine dose does not start suppressing thyroid function (and not to use this type of elevated dosage at all in those with autoimmune thyroid disease).**  She used this higher dose for about 7 months and then progressively dropped it down to 500 mcg/day for maintenance.

Data shows that at least 15% of the US adult female population is outright deficient in iodine (that is, about 1 in 7 women). We don’t, however, hear much about the much-more-prevalent  iodine insufficiency in the health media. Unfortunately, our national RDA for iodine was set to be only enough to prevent cretinism and goiter (overgrowth – or hypertrophy – of the thyroid gland as it swells in size to try to make thyroid hormone). Research shows the amount of iodine needed for optimal breast tissue may be 20-40x the amount needed to control goiter in the thyroid!  But as always, balance is key.

I have seen first-hand multiple times again how daily iodine supplementation can completely eradicate (or improve greatly) cystic breasts after only a  couple of months (full resolution occasionally takes 6-12 mos). Iodine helps to reduce sensitivity to estrogen in these vulnerable tissues.  Clinical research has clearly demonstrated a reduction in estrogen stimulation and breast symptoms when cellular iodine is increased This is another study that investigated the combination iodine, GLA (to reduce inflammation), and selenium (to enhance thyroid function and also glutathione production to counter oxidative stress).  This is a fascinating article about the possible early-life conditioning that might apply to young women via iodine deficiency for breast cancer diagnosis later in life.
**If women are unable to use oral iodine supplementation due to thyroid concerns, topical iodine may be applied to the breasts themselves for more concentrated, localized support.  If I were supporting this client in the present day, I would have also recommended coincident selenium support (200mcg/day) to minimize the likelihood of iodine-promoted thyroid issues.

While our needs are higher, we unfortunately are getting less and less iodine from our food. Due to rampant soil quality depletion caused by aggressive commercial farming, this is true of almost all essential minerals in the modern diet. Today, you have to eat 4 or 5 stalks of broccoli to get the same mineral nutrition you would have received in one stalk in the 1950s. That is an exponential reduction in our food’s nutrition!   While vitamins and antioxidants are grown  into vegetables and fruits by the sun, minerals must come from the soil. Thus, even healthy food choices are giving our clients less and less iodine as time passes.   Historically, commercial flours were fortified with iodine, but industry practice uses bromide compounds, a double negative whammy in denying iodine and also blocking the action of iodine biochemically.  There is also a false assumption that we get all the iodine we need from processed (iodized) salt. While this salt may provide enough to prevent goiter, you would have to consume absurd amounts of salt to get the iodine needed to replete all your cells. Dr. Kimberly Pryor explains it well, “Iodized salt contains 74 ug of iodine per gram of salt. Typically, we need a bare minimum of 5 mg of iodine a day to replete all cells. This would take 68 grams of salt. To reach the amount of iodine ingested by a typical Japanese woman, you would need to consume 168 grams of salt.” Obviously iodized salt cannot be our Only source of iodine!

Because of the onslaught of chemical estrogen mimickers in commercial use today and the prevalence of chlorine/bromine/fluoride-laden chemicals that can block the action of iodine, I believe most of our clients with estrogen concerns (men and women!) either need to make sea vegetables (seaweed) a regular part of their diet or consider daily iodine supplementation to some degree.  I will recommend “kelp sprinkles” to clients; it has only a light salty flavor and can be easily stirred in to most dishes.  Crispy seaweed snacks are also an increasingly  popular suggestion (delicious with cashews in my opinion).   I may also share a recipe for easy, seaweed salad.  But for women struggling with active fibroids, I find that a daily iodine supplement is needed. ** Do not recommend iodine supplementation to any clients with Grave’s Disease, hyperthyroid symptoms, or autoimmune thyroiditis that is notably oscillating between hyper- and hypothyroid symptoms.  It is also contraindicated for patients with breast cancer given the effect on estrogen receptors.

Iodine sufficiency is tough to measure reliably!  I believe the best way among widely available options is using a urinary excretion test.  Typically, the protocol calls for a person to take a larger dose of iodine (25-50mg) and then measure excretion levels over 12 hours. If the body does not need all of what you took, it will excrete it in your urine. Lower excretion levels indicate higher uptake – and thus, a higher iodine deficiency. Unfortunately, it can be difficult to find a physician able to offer such a test.  I do not generally recommend a fasting blood or random urine test because it does not give any insight on sufficiency. As with any nutrient supplement, it is important to increase iodine dosage slowly and pay careful attention to the body’s reaction.  If hyperthyroid symptoms develop (feeling flushed/hot, agitation, anxiety, increased heartrate or racing heart), simply stop taking it for several days and then resume with a much lower level or food-based sources they can use regularly.

Caffeine consumption can also be a driver for breast fibroids in some people, as it creates an imbalance in cellular detoxification which prevents quick estrogen removal. Dietary caffeine (e.g. coffee, black tea, chocolate) reduction or elimination can help greatly – as the ongoing iodine support helps the body to detoxify more effectively. The same phenomenon is also caused by cigarette smoking, extremely high stress, and eating charred meats, so pay attention to whether these exposures might be making life harder for your client’s breast cells too.

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22 Questions for “Breast Pain and Fibroid Relief”

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  1. 9
    Sarah says:

    Thank you so much for the helpful post. Can you tell me if DIM is taken cyclically or every day of the month when it is taken for breast pain in early Perimenopause?

    • 9.1
      SAFM Team says:

      There’s no rule set in stone for that. We’ve seen this work both taken every day or pulsed during the unique woman’s cycle. It is quite individual and some experimentation is necessary.

  2. 8
    Samantha Press says:

    I breastfeed and have a cyst in my breast. I take iodine in through kelp, Dulse ect.. but no actual supplement. Do I need to wait until I’m done Bf to take iodine as a supplement? Will seaweeds help with breast fibroids? I read it needs to contain potassium iodide and to my knowledge the food isn’t.

    • 8.1
      SAFM Team says:

      Indeed, we would not recommend oral iodine supplementation while still breastfeeding unless under the guidance of your personal physician.

  3. 7
    Dina Assaad says:

    Hi Tracy,

    Do SSRIs such as Cipralex affect breast health too?

    • 7.1
      SAFM Team says:

      This is a simple question with no simple answer. There’s a clear relationship between serotonin and estrogen function, and as you know breast tissue is particularly vulnerable to hormone fluctuations due to an abundance of estrogen receptors. There are studies that show the effect of SSRIs on estrogen receptors. The effect of the SSRI drugs on estrogen receptors or on breast tissue in not fully understood. This study may be of interest to you:
      In light of this, the short answer to your question is that SSRIs may well be affecting the breast health, but it’s not clear whether this effect is protective from estrogen or potentiating its effect.

  4. 6
    Lauren Mullan says:

    In regards to Iodine supplementation, I have a question when involving Hashimoto’s. Client’s iodine serum/plasma levels were tested at 41 (RR 52-109mcg/L), obviously very low and her ferritin was at 23 (low). Client is on 45 NP thyroid and TSH was at 5.3, RT3: 11, FT3: 2.4, FT4: .98 (she did not take her normal NP on the morning of testing- so the last dose was 24 hours prior) and two months ago took her 45 NP the morning of testing and TSH was 3.36, RT3: 14, FT3: 4.2, FT4: 1.02. Her selenium was really high 2 months ago so she reduced her dosage. The doctor has now pushed her dose of NP from 45 to 60 and told her to take an iodine supplement. I started her on 1/4 tsp of kelp sprinkles daily. Can she take kelp sprinkles with the iron… any absorption issues? Can she take a higher dose of kelp sprinkles or should she use Lugol’s? Obviously, her lack of iron and iodine can be wreaking havoc on her thyroid by not only NOT making T4, but also not converting the T4 to T3. Does it make sense to go up on her NP medication (of course that decision is between her and her Dr) AND supplementing with iodine and Iron? I would really love to “wildly satisfy” her! Thank you!

    • 6.1
      SAFM Team says:

      Thank you for your question, Lauren, since we don’t address detailed case studies in these threads I have shortened it a bit.
      You are describing a situation in which focus seems to be on ‘getting the numbers right’ vs looking at this client’s situation through an FM lens. It may be helpful to ask a couple of questions such as how is your client really doing, does she still have hypothyroid symptoms? Next, why is her serum iodine and ferritin low? Are there underlying gut and digestion issues that need to be addressed? Then, what are the drivers for her low thyroid function? Toxicity? Stress? What unique interconnectedness in this woman’s body is creating this low mineral, low thyroid dynamic?
      As you noticed yourself, there is an intricate interplay between minerals that support the thyroid function and this is a great overview:
      Iron deficiency impairs thyroid hormone synthesis by reducing the activity of heme-dependent thyroid peroxidase. Interestingly, iron-deficiency negatively affects and iron supplementation improves the efficacy of iodine supplementation. Therefore, you may want to start with helping your client improving her iron status while adding in additional iodine.
      There are potential advantages of using seaweed over over pure iodine/iodide sources in that (1) it may be better absorbed in some individuals and (2) it contains other important trace minerals. Senlenium is also important for maintaining healthy iodine levels. You mention that it used to be high 2 months prior to the last testing ensuring that it is still adequate after two months is another key factor.
      Your concern about your client’s thyroid swinging the other way is well substantiated and such scenarios have been discussed in these case-study posts:
      Hope this is helpful to you.

  5. 5
    Mariner Garcia says:

    Hi Tracy, thank you for the privilege of early access to the Q&A. I am getting the understanding that uterine fibroids are hormone mediated, specifically estrogen.

    What about if a 41 y/o female who has uterine fibroid, ovarian cysts diagnosed as endometrioma post surgery (removed via lap cystectomy) and fibrocystic breast has low estradiol (1.0 pg/mL) and suboptimal DHEA (2.2ng/mL) via ZRT salivary hormone testing. Also tested via Labrix 1.5 years ago with same result. Progesterone Normal, testosterone low normal, and evening cortisol slightly elevated. Presents with severe menstrual cramps and pelvic pain as well as chronic back pain; monthly menstrual cycle lasts 25-29 days. Diet is clean, organic, dairy free, gluten free, low sugar, aware of xenoestrogens.

    Would this still be treated as estrogen dominant case? If not, what are other possible explanations for this kind of dynamic? ND prescribed Biest (estriol/estradiol/DHEA) cream because of the test result and been on it for 4 months but decided to stop it on her own as there’s no change in the menstrual pain.

    Would it be okay to use Chaste tree berry for pain relief? She takes Mg glycinate, B complex, CoQ10, probiotics, NAC.

    Thank you,


    • 5.1
      SAFM Team says:

      In the situation that you describe, I would invest in testing like DUTCH Complete to understand the interplay of your client’s hormones. Salivary testing has its limitations and you can read more about it here:
      I would also consider the possibility of low iodine as this may be a large contributor to her fibroids. Another thing ot think about, especially given the ovarian cysts is the PCOS dynamic. I hear you that your client seems to have already a good diet, but how is her stress? Are there any other sources of oxidative stress such as pathogens, dysbiosis or toxicity? Oxidative stress will create the insulin resistance even when the diet is clean.
      You can certainly try the Chaste Tree Berry, it may help with improving the progesterone levels – but the question is, does your client need that?
      The supplements that she takes provide a good detox and energy production support, but there’s clearly something missing and it would be best to ‘test don’t guess’.

  6. 4
    Samantha Press says:

    I have a history of Fibrocystic breasts and I am currently breastfeeding. When I remember I try to add things like Dulse Flakes or Kelp flakes to my food. I def need to up it. My question is, being that I am breastfeeding, if I were to supplement with iodine to help eliminate the lumpy breast issue, will the detoxification be harmful to my baby by getting in my milk?

    • 4.1
      SAFM Team says:

      Indeed, I would not recommend overt iodine supplementation while breast-feeding (beyond baseline amounts that might be included within a high-quality multivitamin e.g. Thorne’s); the dangers are uncharacterized and could be significant.

  7. 3
    Tammy Ruggiero says:

    What if the breasts are just painful and not lumpy ? and it is after hysterectomy – ovaries in tact so hormones should be producing. Seems cyclical but not every month. Should we test hormones for estrogen/ progesterone? Start with iodine? 49 year old with uterine fibroids which were removed resulted in hysterectomy last year. Thanks

    • 3.1
      SAFM says:

      Either way, this is still a dynamic of estrogen dominance. To your point, hysterectomy simply removes the uterus, but the ovaries are intact and producing as they would otherwise. A 49-year-old is very likely to have suboptimally low progesterone be a part of estrogen dominance simply given the perimenopausal stage of life. Salivary or urinary hormone testing is an option, but under the circumstances, you could simply work on the low-hanging fruit options for reducing estrogen dominance that will perhaps have beneficial benefits everywhere e.g. dramatically reducing caffeine (this simple thing can be a major driver!), ensuring optimal Vitamin D, ensuring optimal magnesium, eliminating xenoestrogens from the lifestyle, choosing organic foods, eliminating dairy, adding a DIM supplement (e.g. Pure Encapsulations DIM-Pro) and a B complex to help with estrogen detoxification. Given uterine fibroids were removed, this is another sign of estrogen dominance. I would indeed also add iodine via something like kelp granules (I typically recommend 1/4 to 1/2 tsp daily) e.g. . If more help is needed, she might add in some chastetree berry for the typical ~10 days prior to her period to help to boost progesterone.

      • Tammy Ruggiero says:

        Thank you. When would you add Chaste Tree Berry if no period…given the hysterectomy. What is your thought on calcium d glucarate vs DIM and also any thoughts on adding a topical progesterone cream?

        • SAFM says:

          Ah yes, with no menstrual period at all, then chastetree can be taken daily. DIM and Ca d-glucarate help in very different ways. DIM is modulating liver detoxification of estrogens to choose less estrogenic or inflammatory pathways. Ca d-g only help if there is an overgrowth of microbes in the gut that are impairing the excretions of estrogens once they are process/packaged by the liver for exiting the body. Certainly both of these can be taken without data if the symptoms strongly indicate estrogen dominance, though I would prioritize the former. You definitely need urinary or salivary hormone test data in order to safely and effectively gauge whether and how much progesterone is needed. Adrenal health plays a big role here, as the adrenal must produce the necessary progesterone in the absence of ovarian production.

          • Tammy Ruggiero says:

            Holistic Doctor said to take the calcium d glucarate but there was no data on gut….interesting….what do you think about this instead of dim-pro rather…..

          • SAFM says:

            Sure, this is an excellent, comprehensive formula. It’s more expensive typically, and it has half as much DIM. So of course it helps to know what you are addressing. If you have something like DUTCH data and you know that you are primarily trying to simply improve phase 1 estrogen metabolism (that is, the front line of ensuring less estrogen in the body; more metabolites in the urine), then DIM-PRO will be a better choice. The DIM-Detox is designed to address that phase 1 pathway as well as phase 2 (methylation) and phase 3 (gut clearance) as well as overall liver health, but it has less DIM per capsule. The amount of calcium d-glucarate in this formula is also quite small, so likely not an issue for ongoing use. If you did have stool test data, and you knew that beta glucuronidase was quite high, you would want to use a much more concentrate calcium d-glucarate formula for a short time (while addressing the microbial overgrowth that causes it). So the DIM-Pro formula is a good idea if you want a moderate “all purpose” support in the absence of data. If symptoms of strong estrogen dominance don’t disappear within a few weeks of use, you’ll know you need to shift/increase the approach. I prefer to use higher DIM doses when someone is clearly struggling with strong estrogen dominance (extremely heavy/clotty menstrual flow or strong PMS breast pain) to provide rapid relief. Both are excellent supplements.

  8. 2
    Daryl Moss says:

    I have a new client who has painful, cystic breasts and has had uterine and anal polyps removed in the past. She has a history of depression, has low energy, and needs to lose about 40 pounds. Thinking of recommending iodine, but she also reports some anxiety and rapid/pounding heart rate on her HH form (1 for both). She is on Lithium, Prozac, Zyprexa, and Zocor. Should I start with seaweed snacks and kelp sprinkles before moving on to the supplement?

    • 2.1
      SAFM says:

      Wow – that is a serious drug cocktail. With an excess 40 lbs of weight, it’s very likely that your client simply has strong estrogen dominance – a common cause of anxiety. Yes, I would start with the food-based items as you recommend and increase from there. I would also recommend 200mg doses of l-theanine once or twicce a day to counter anxiety. Stop all caffeine and chocolate and gluten (huge issue with mood issues in my practice!). Recommend she check her sex hormones – especially progesterone. I would also add a B-complex (e.g. Thorne Basic B), twice-daily DIM (e.g. Pure Encapsulations), twice-daily magnesium taurate (given heart palps), and 2 Tbsp ground flaxseed daily to help with estrogen metabolism and anxiety.

  9. 1
    Heather Conley says:

    Would the same hold true for any type of fibroids in a female?

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