What is the most appropriate initial management for a woman with bilateral breast tenderness, worsening at menses?

The most appropriate initial management for a woman experiencing bilateral breast tenderness that worsens at menstruation is reassurance and lifestyle changes. This condition is often indicative of cyclic mastalgia, which is frequently linked to hormonal fluctuations related to the menstrual cycle. Such breast tenderness can be a normal part of the premenstrual syndrome (PMS) experienced by many women.

Reassurance is important because it helps to alleviate concerns about potential serious underlying conditions, such as breast cancer. Additionally, lifestyle modifications can have a significant impact on symptoms. Recommendations may include dietary changes (like reducing caffeine and salt intake), wearing a supportive bra, and maintaining a healthy weight, which can all contribute to symptom relief.

Pharmacological options, while available, are typically considered only if lifestyle changes and reassurance do not alleviate the symptoms. For instance, medications like Danazol and Tamoxifen might be used in more severe or persistent cases, but their use carries potential side effects and risks, making them less appropriate as an initial management strategy. Therefore, reassurance and encouraging lifestyle changes are the most suitable first steps in managing cyclic breast tenderness.