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
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 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ 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