Mastalgia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Mastalgia is usually a benign disorder in young women due to hormonal imbalance during their menstrual cycle. During a menstrual cycle the breasts swell and become lumpy and tender. During a period, the breasts reabsorb the extra fluid inside instead of discharging it, causing breast pain. A breast exam and a breast ultrasound should be performed to make sure nothing is hidden.

Breast pain can be categorized into 2 main clinical patterns, cyclical and non cyclical.

There is not really any way to prevent most breast pain, but wearing a well-fitting bra for support may help.

Template:WH Template:WS

Please help WikiDoc by adding content here. It’s easy! Click here to learn about editing.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Breast pain can be categorized into 2 main clinical patterns, cyclical and non cyclical.

It can be subdivided into 2 main clinical patterns:

• Cyclical when the pain is worse prior to each menstrual cycle
  • This may occur with a woman’s natural menstrual cycles and is not due to any hormone or breast disease.
  • It may be caused by use of hormonal contraception.

• Non-cyclical when the pain is unrelated to periods.
  • It may be related to the underlying muscle.
  • Trauma and resulting hematoma
  • Infection is sometimes responsible, particularly during times of breast feeding.
  • Breast engorgement during breast feeding (mastitis)
  • Arthritis pain in the chest or neck felt as if it is coming from the breast.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please help WikiDoc by adding more content here. It’s easy! Click here to learn about editing.

• Breast cancer is, in 19 out of 20 cases, normally not painful in the early stages. New onset of a painless lump should therefore be promptly assessed.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Hilda Mahmoudi M.D., M.P.H.^[3]

Two thirds of breast pains are cyclical and one third have non cyclical cause.^[1]

Cyclical breast pain is very often associated with fibrocystic breast changes or duct ectasia and believed to be caused by aberrations in dynamic hormonal changes mainly involving prolactin response to thyrotropin. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS).

Noncyclical breast pain has various causes and is harder to diagnose.It is more likely to be unilateral and variable in its location in the breast.Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause, during pregnancy and breastfeeding. Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis, shingles and some medications.

• Estrogen injection

• Fibrocystic changes

• Hormone replacement therapy

• Medroxyprogesterone injection

• Oral contraceptives

• Premenstrual syndrome

Cardiovascular	No underlying causes
Chemical / poisoning	Alcoholism
Dermatologic	No underlying causes
Drug Side Effect	Antibiotics, Antidepressants, Cardiovascular agents, Chlorpromazine, Cyclosporine , Digitalis, Drospirenone and Ethinyl estradiol, Estradiol topical , Estradiol transdermal, Estradiol valerate and estradiol valerate/dienogest, Estrogen injection , Estrogen vaginal, Ethinyl estradiol and etonogestrel, Etonogestrel, Hormone replacement therapy , Medroxyprogesterone injection , Methyldopa, Norethindrone acetate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, Oral contraceptives, Oxymetholone, Pramipexole, Ramelteon , Spironolactone, Tamoxifen , Tiagabine
Ear Nose Throat	No underlying causes
Endocrine	Diabetes mellitus, Puberty
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	Mondor’s disease, Thrombophlebitis
Iatrogenic	No underlying causes
Infectious Disease	Shingles
Musculoskeletal / Ortho	Chest wall pain, Costochondritis, Spinal and paraspinal disorders, Thoracic spine arthritis, Tietze’s syndrome
Neurologic	Intercostal neuralgia, Referred chest pain
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	Breast abscess, Breast cancer, Breast feeding, Breast fibroadenoma, Duct ectasia, Endometrial cancer, Fat necrosis, Fibroadenoma, Fibrocystic changes, Hidradenitis suppurativa, Intraductal papilloma, Lactation, Large pendulous breasts, Lipoma, Macrocyst, Mastitis,Menopause, Menstruation, Mondor’s disease, Nodular sensitive breast, phylloides tumor, Polycystic ovary syndrome, Pregnancy, Premenstrual syndrome, Prior breast surgery
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Pleuritic pain
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Thoracic spine arthritis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Caffeine, Postthoracotomy syndrome, Trauma

• Alcoholism

• Antibiotics

• Antidepressants

• Breast abscess

• Breast cancer

• Breast feeding

• Breast fibroadenoma

• Caffeine

• Cardiovascular agents

• Chest wall pain

• Chlorpromazine

• Costochondritis

• Cyclosporine

• Diabetes mellitus

• Digitalis

• Duct ectasia

• Endometrial cancer

• Estradiol topical

• Estradiol transdermal

• Estrogen injection

• Estrogen vaginal

• Ethinyl estradiol and etonogestrel

• Etonogestrel

• Fat necrosis

• Fibroadenoma

• Fibrocystic changes

• Hidradenitis suppurativa

• Hormone replacement therapy

• Intercostal neuralgia

• Intraductal papilloma

• Lactation

• Large pendulous breasts

• Lipoma

• Macrocyst

• Mastitis

• Medroxyprogesterone injection

• Menopause

• Menstruation

• Methyldopa

• Mondor’s disease

• Nodular sensitive breast

• Oral contraceptives

• Oxymetholone

• phylloides tumor

• Pleuritic pain

• Polycystic ovary syndrome

• Postthoracotomy syndrome

• Pregnancy

• Premenstrual syndrome

• Prior breast surgery

• Puberty

• Ramelteon

• Referred chest pain

• Shingles

• Spinal and paraspinal disorders

• Spironolactone

• Tamoxifen

• Thoracic spine arthritis

• Thrombophlebitis

• Tiagabine

• Tietze’s syndrome

• Trauma

Please help WikiDoc by adding content here. It’s easy! Click here to learn about editing.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please help WikiDoc by adding more content here. It’s easy! Click here to learn about editing.

• Most common breast symptom leading to office visit
• More common in premenopausal women
• Rarely a presenting symptom of cancer

  • Study of women with known breast cancer: 7% presented with mastalgia alone.
  • Women referred for mammogram because of mastalgia:

    • 0.4% had breast cancer (same as controls)
    • 87% had normal mammogram
    • 9% had benign abnormalities

Please help WikiDoc by adding content here. It’s easy! Click here to learn about editing.

Please help WikiDoc by adding content here. It’s easy! Click here to learn about editing.