A 30-year-old woman is evaluated for severe breast discomfort that is worse in the week before her menstrual periods. Both breasts ache and hurt with movement, and to the touch, the left breast is more painful than the right. She has not noted any lumps, skin changes, or nipple discharge. She otherwise feels well with no fever, cough, or joint pain. Her menses are regular. She has never been pregnant, and she does not smoke or use illicit drugs. She drinks one to two cups of coffee each morning. Her maternal aunt had breast cancer at age 52 years. She takes vitamin D daily but no other medications.
On physical examination, vital signs are normal. BMI is 27. Except for diffuse tenderness, the results of the breast examination are normal bilaterally, with no skin changes or dimpling, no focal abnormalities or masses, no nipple discharge, and no supraclavicular, cervical, or axillary lymphadenopathy. There is diffuse symmetric nodularity, which is most prominent in the upper outer quadrant of both breasts. There is no chest wall tenderness, and the heart and lungs are normal to examination.
Which of the following is the most appropriate management?