Mastalgia
Encyclopedia
Mastodynia, mastalgia or mammalgia are names for a medical symptom that means breast pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
(from the Greek masto-, breast and algos, pain).
Pain can range from minor discomfort to severely incapacitating pain. Many women are more worried about a possible cancer risk than about the pain.
Breast pain during lactation or after weaning is not included into this definition but usually classified as breast engorgement
Breast engorgement
Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk.It can be a cause of mastodynia....
or mastitis
Puerperal mastitis
Puerperal mastitis is the inflammation of breast in connection with pregnancy, breastfeeding or weaning. It is caused by blocked milk ducts or milk excess and is relatively common; estimates range depending on methodology between 5–33%. However only about 0.4–0.5% of breastfeeding mothers develop...
.
Types
It can be classified into 2 main clinical patterns:- cyclical when the pain intensity is changing during the menstrual cycleMenstrual cycleThe menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....
. - non-cyclical when the pain remains essentially unchanged during the menstrual cycle. This type is less frequent.
Causes
Cyclical breast pain (cyclical mastalgia) is very often associated with fibrocystic breast changesFibrocystic breast changes
Fibrocystic breast changes or fibrocystic breast disease is a condition of breast tissue affecting an estimated 30-60% of women. It is characterized by noncancerous breast lumps in the breast which can sometimes cause discomfort, often periodically related to hormonal influences from the menstrual...
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
Menstruation
Menstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
and/or premenstrual syndrome (PMS).
Noncyclical breast pain has various causes and is harder to diagnose. Noncyclical pain has frequently its root cause outside the breast. Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
(both in girls and boys), in menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
and during pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
. After pregnancy, breast pain can be caused by breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
. Other causes of non-cyclical breast pain include alcoholism
Alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
with liver damage (likely due to abnormal steroid metabolism), mastitis
Mastitis
Mastitis is the inflammation of breast tissue. S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.-Terminology:...
and medications such as digitalis
Digitalis
Digitalis is a genus of about 20 species of herbaceous perennials, shrubs, and biennials that are commonly called foxgloves. This genus was traditionally placed in the figwort family Scrophulariaceae, but recent reviews of phylogenetic research have placed it in the much enlarged family...
, methyldopa
Methyldopa
Methyldopa is an alpha-adrenergic agonist psychoactive drug used as a sympatholytic or antihypertensive. Its use is now mostly deprecated following the introduction of alternative safer classes of agents...
(an antihypertensive
Antihypertensive
The antihypertensives are a class of drugs that are used to treat hypertension . Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from...
), spironolactone
Spironolactone
Spironolactone , commonly referred to as simply spiro, is a diuretic and is used as an antiandrogen.It is a synthetic 17-lactone drug that is a renal competitive aldosterone antagonist in a class of pharmaceuticals called...
, certain diuretic
Diuretic
A diuretic provides a means of forced diuresis which elevates the rate of urination. There are several categories of diuretics. All diuretics increase the excretion of water from bodies, although each class does so in a distinct way.- Medical uses :...
s, oxymetholone
Oxymetholone
Oxymetholone is a synthetic anabolic steroid developed in 1960 by Zoltan 'Anadrol Z' F. Its primary clinical applications include treatment of osteoporosis and anaemia, as well as stimulating muscle growth in undernourished or underdeveloped patients. The drug was approved for human use by the FDA...
(an anabolic steroid
Anabolic steroid
Anabolic steroids, technically known as anabolic-androgen steroids or colloquially simply as "steroids", are drugs that mimic the effects of testosterone and dihydrotestosterone in the body. They increase protein synthesis within cells, which results in the buildup of cellular tissue ,...
), and chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...
(a typical antipsychotic
Typical antipsychotic
Typical antipsychotics are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis...
). Also, shingles can cause a painful blistering rash on the skin of the breasts.
Treatments for cyclical breast pain
While in many cases it would possible to predict which treatment will be most effective with a series of endocrinological investigations involving thyroidThyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...
and complicated pituitary hormone testing , this is rarely done in practice.
Treatments which demonstrated some effectiveness:
- Vitex agnus-castusVitex agnus-castusVitex agnus-castus, also called Vitex, Chaste Tree, Chasteberry, Abraham's Balm or Monk's Pepper, is a native of the Mediterranean region. It is one of the few temperate-zone species of Vitex, which is on the whole a genus of tropical and sub-tropical flowering plants...
extract: there is convincing evidence that Vitex agnus castus is safe and efficient in the treatment of cyclical mastalgia. It is assumed, that like bromocriptine it works by reducing prolactin secretion from the pituitary gland. - Topical and systemic NSAIDs, analgesicAnalgesicAn analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s - ProgestinProgestinA progestin is a synthetic progestogen that has progestinic effects similar to progesterone. The two most common uses of progestins are for hormonal contraception , and to prevent endometrial hyperplasia from unopposed estrogen in hormone replacement therapy...
based birth control pills or topical progesteroneProgesteroneProgesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
application. This method is effective only in a minority of women but is often tried because of its well known safety profile. Cyclic progestin on days 14-25 did show promising results. - Dopamine agonistDopamine agonistA dopamine agonist is a compound that activates dopamine receptors in the absence of dopamine. Dopamine agonists activate signaling pathways through the dopamine receptor and trimeric G-proteins, ultimately leading to changes in gene transcription.-Uses:...
s, best results with a better side effect profile than bromocriptine can be achieved with Dostinex.The older bromocriptineBromocriptineBromocriptine , an ergoline derivative, is a dopamine agonist that is used in the treatment of pituitary tumors, Parkinson's disease , hyperprolactinaemia, neuroleptic malignant syndrome, and type 2 diabetes.- Indications :Amenorrhea, female infertility, galactorrhea, hypogonadism, and acromegaly...
has been found very efficient with relatively good safety, is however associated with many unpleasant adverse side effects. There is very little although promising data on lisurideLisurideLisuride is an antiparkinson agent of the iso-ergoline class, chemically related to the dopaminergic ergoline Parkinson's drugs. Lisuride is described as free base and as hydrogen maleate salt.Lisuride is used to lower prolactin and, in low doses, to prevent migraine attacks...
and quinagolideQuinagolideQuinagolide is a selective, D2 receptor agonist that is used for the treatment of elevated levels of prolactin....
. - IodineIodineIodine is a chemical element with the symbol I and atomic number 53. The name is pronounced , , or . The name is from the , meaning violet or purple, due to the color of elemental iodine vapor....
: supplementation with supraphysiologic levels of iodine has been shown effective in the treatment of breast pain. Not yet widely recommended until the long term effects of supraphysiologic doses of iodine on thyroidThyroidThe thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...
health are better understood. - DanazolDanazolDanazol is a derivative of the synthetic steroid ethisterone, a modified testosterone. Also known as 17alpha-ethinyl testosterone. Before becoming available as a generic drug, Danazol was marketed as Danocrine in the United States. It was approved by the U.S. Food and Drug Administration as the...
: low dose danazol treatment has been found very efficient with modest side effects. The lowest dose tested in one trial produced the most favorable long term results and was associated with least adverse effects. - Thyroid hormone supplementation, especially when hypothyroidismHypothyroidismHypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
or subclinical hypothyroidism has been diagnosed. However even levothyroxin supplementation in normal patients has been shown effective. - TamoxifenTamoxifenTamoxifen is an antagonist of the estrogen receptor in breast tissue via its active metabolite, hydroxytamoxifen. In other tissues such as the endometrium, it behaves as an agonist, hence tamoxifen may be characterized as a mixed agonist/antagonist...
has been shown effective but is very rarely used because of serious concerns about safety in premenopausal women. - Anthocyanins from bilberryBilberryBilberry is any of several species of low-growing shrubs in the genus Vaccinium , bearing edible berries. The species most often referred to is Vaccinium myrtillus L., but there are several other closely related species....
.
Treatments for non-cyclical breast pain
Determining the appropriate treatment for noncyclical breast pain is more difficult, not only because it is hard to pinpoint where the pain is coming from, but also because the pain may not have hormonal causes and very often does not respond to hormonal treatment.Breast cancer risk
Great majority of breast cancerBreast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
cases do not present with symptoms of pain.
Some epidemiological investigations suggest that women with symptoms of breast pain may have an increased risk of subsequently developing breast cancer and risk increases with duration of symptoms. This is consistent with the observation that a few special subtypes of fibrocystic breast changes
Fibrocystic breast changes
Fibrocystic breast changes or fibrocystic breast disease is a condition of breast tissue affecting an estimated 30-60% of women. It is characterized by noncancerous breast lumps in the breast which can sometimes cause discomfort, often periodically related to hormonal influences from the menstrual...
exhibit increased breast cancer risk – see breast cancer risk of fibrocystic breast changes.