mastodynia; mastalgia; breast pain
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Introduction
Also see breast lump/mass.
Etiology
- premenstrual syndrome
- fibrocystic breast disease
- premature ovarian failure
- causes associated with breast lump/mass
- pharmaceutical agents
- estradiol (Estrace, Estring, Estraderm, Estinyl, Climara, Delestrogen)
- Premarin (conjugated estrogens)
- estrogen-containing agents
- 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:
- supportive, well-fitting bra (treatment of choice)[2]
- dietary measures
- low-fat
- 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
- NSAIDs (topical diclofenac) first line for premenstrual breast pain[2]
- danazol (only FDA-approved agent for cyclic mastalgia)[2]
- tamoxifen
- bromocriptine[2]
More general terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 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: https://www.ncbi.nlm.nih.gov/pubmed/18486842
- ↑ 4.0 4.1 4.2 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: https://www.ncbi.nlm.nih.gov/pubmed/29792736 https://www.ajronline.org/doi/10.2214/AJR.17.18879