Brief Answer:
Medical / Surgical as discuss in details.

Detailed Answer:
Hi.
Thanks for your query and an elucidate history and reports.
Multiple hypoechoic lesions, in both breast, which become painful just before or during menstruation are definitely indicative of fibro-cystic disease of both the breasts and is definitely benign.
Since these are hormone responsive, the pain will continue to occur during each period and which is quite severe in some patients.
Since these are hormone responsive/dependent, there is no actual good medical treatment which can cause cure in such patients.

I would discuss and advise as follows in such patients:
- Medical management: In old days we used to give Aspirin 1/2 tablet three times a day during the painful period and Vitamin E, can be tried in her case and see the results, she may respond well to it.
- Surgery:
One option is to remove the diseased part and as per the reports all the lumps are small around 1 cm.. If the removal of the lumps in both the breasts is not going to cause any disfigurement and is accepted by both of you, this is curative. Since the lumps will be removed, we shall be pain-free for ever (unless new ones form).
Another option which we try is not from the text-book. We expose the tumor and make multiple incisions like stab-would for the capsule of the lumps to be opened. This helps in a way that there is not much of fluid accumulation during periods and the excess fluid will drain away from the lumps hence reducing the pain. This is with some success, I repeat, this is out of personal experience and depends upon the patho-physiology of the disease. Helps in many patients. You may please discuss this with your Surgeon, he may either laugh at it or m,ay accept and try.

I hope this answer help her to get a relief.
Please feel free to sk further relevant queries if you both need t or if you feel that there is a gap of communication.

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