Name
MASTALGIA
DESCRIPTION
DETAIL
CAUSES β’ Associated with fibrocystic breast disease and premenstrual syndrome β’ Hormonal influences; hormone replacement therapy β’ Duct ectasia β’ Trauma (including sexual) β’ Macromastia -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ The major alternate disease to consider is breast cancer, particularly if pain is localized β’ Manipulation or trauma can also make symptoms worse β’ Chest-wall pain or referred pain from splenomegaly must also be differentiated from mastalgia β’ Sometimes concurrent with premenstrual syndrome β’ Ductal ectasia of the breastLABORATORY No relevant fi ndings SPECIAL TESTS β’ Possibly TSH β’ Prolactin if galactorrhea β’ Pap test of discharge, if present IMAGING Mammography to differentiate from breast cancer, not always required DIAGNOSTIC PROCEDURES β’ Cysts may need to be aspirated for symptom relief and diagnostic verification β’ Biopsies may be indicated based on exam or mammography
TYPENOTES
RISK FACTORS: High saturated fat diet, Tobacco useGENERAL MEASURES β’ Stop or modify current hormonal therapy β’ Repeat examination may help establish any cyclic nodularity pattern β’ Well-fitting support bra (maybe fitted by a professional). β’ Reassurance (this is sufficient for most women) β’ Weight reduction, if obese β’ Stop smoking β’ Relaxation training SURGICAL MEASURES Reduction mammoplasty if cause is macromastia ACTIVITY No restrictions DIET β’ Decreased fat intake to 20% of total calories PATIENT EDUCATION β’ Explain that breast pain does not mean the patient has cancer β’ Explain relationship to menses DRUG(S) OF CHOICE β’ No drugs are needed unless required by severity of symptoms β’ Reassurance, acetaminophen, ibuprofen or topical NSAIDs may be all that is needed ALTERNATIVE DRUGS . Agents often used, whose value has been questioned: . Diuretics (usually spironolactone) prior to menses . Vitamin E 600 IU/day . Evening primrose oil, includes high content of fatty acids, believed to decrease prostaglandin synthesis . Oral contraceptives may help some patients . Oral progesterones . Other possibilities for refractory patients, used infrequently because of potential side effects: . Danazol 100 mg bid (possibly lower doses) - this may be the most effective. Major side effects - menstrual irregularities, weight gain, acne, hirsutism and voice change. May be used during luteal phase only. Approved by FDA for this indication. . Bromocriptine 2.5-5.0 mg/day. Major side effects - nausea, dizziness, orthostatic hypotension. . Tamoxifen 10 mg/day. Major side effects - cataracts, hepatocellular carcinoma, endometrial carcinoma. May be used during luteal phase only. . Gonadotropin-releasing hormone agonists - induces menopause PATIENT MONITORING β’ As needed for patients not on prescription medications β’ Time of followup will vary by type of prescription medication and patient problems PREVENTION/AVOIDANCE See Risk Factors EXPECTED COURSE/PROGNOSIS β’ Premenstrual mastalgia increases with age, then generally stops at menopause unless on hormone replacement therapy β’ Most patients will have control of symptoms without hormonal treatment β’ Several months of hormonal treatment may lead to several more months of relief, but the mastalgia may recur
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
TSH, SERUM PROLACTIN ( NONPREGNANT FEMALE ), PAP"S SMEAR, COMPLETE BLOOD COUNT, MAMMOGRAM