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mastodynia; mastalgia; breast pain
Also see breast lump/mass.
Etiology:
1) premenstrual syndrome
2) fibrocystic breast disease
3) premature ovarian failure
4) causes associated with breast lump/mass
5) pharmaceutical agents
- estradiol (Estrace, Estring, Estraderm, Estinyl, Climara, Delestrogen)
- Premarin (conjugated estrogens)
- estrogen-containing agents
- oral contraceptives
- hormone-replacement therapy (HRT)
- estramustine
- anastrozole (Arimidex)
- bicalutamide (Casodex)
- buserelin
- cabergoline (Dostinex)
- chlorpromazine (Thorazine, Ormazine)
- perphenazine (Trilafon)
- prochlorperazine (Compazine)
- thioridazine (Mellaril)
- thiothixene (Navane)
- trifluoperazine (Stelazine, Suprazine)
- aztreonam (Azactam)
- carboprost or 15-methyl-prostaglandin F2-alpha (Hemabate)
- fluphenazine (Prolixin)
- leuprolide (Lupron)
- medroxyprogesterone or acetoxymethylprogesterone (Provera, Cycrin, Amen)
- megestrol (Megace)
- methyltestosterone (Android, Testred, Metandren, Oretan, Virilon)
- metoclopramide (Reglan)
- minoxidil (Loniten, Rogaine)
- norethindrone (Norlutate, Aygestin, Micronor)
- norgestrel (Ovrette)
Physical examination:
- exclude palpable breast mass [2]
Clinical manifestations:
- cyclic mastalgia
- most prominent during luteal phase of menstrual cycle
- bilateral, throbbing discomfort
Radiology:
- annual screening mammogram should be recommended for women >= 40 years of age* [4]
- reassurance without imaging should be offered to patients <= 40 years of age* [4]
- breast ultrasound for non-cyclic breast pain [2]
* excluding palpable breast mass
Management:
- most women with breast pain respond to reassurance & supportive measures:
a) supportive, well-fitting bra (treatment of choice) [2]
b) dietary measures
1] low-fat
2] methylxanthine restriction
- no evidence that exclusion of methylxanthine from the diet improves symptoms [2]
- pharmaceutical agents reserved for women with severe, persistent pain, not responding to supportive measures
a) NSAIDs (topical diclofenac) first line for premenstrual breast pain [2]
b) danazol (only FDA-approved agent for cyclic mastalgia) [2]
c) tamoxifen
d) bromocriptine [2]
General
sign/symptom
References
- Stedman's Medical Dictionary 26th ed, Williams &
Wilkins, Baltimore, 1995
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Miltenburg DM, Speights VO Jr.
Benign breast disease.
Obstet Gynecol Clin North Am. 2008 Jun;35(2):285-300,
PMID: 18486842
- Kushwaha AC, Shin K, Kalambo M et al.
Overutilization of health care resources for breast pain.
AJR Am J Roentgenol 2018 Jul; 211:217
PMID: 29792736
https://www.ajronline.org/doi/10.2214/AJR.17.18879