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MastalgiaAka: Breast Pain, Mastodynia

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  1. Differential Diagnosis
    1. Pain related to Menses
    2. Costochondritis
    3. Chest Trauma
    4. Sclerosing adenosis
    5. Breast Cancer (represents under 5% of breast pain)
  2. History
    1. Location
      1. Focal breast pain more concerning than diffuse pain
    2. Duration of breast pain
    3. Unilateral or Bilateral
    4. Changes with Menstrual Cycle
    5. Relationship to hormonal replacement therapy
    6. Rank breast pain on a 10 point scale
    7. Altered life style
    8. Excessive Worry or emotional stress
  3. Pathophysiology
    1. Breast pain thought to be related to Estrogen excess
  4. Algorithm
    1. Breast Mass present
      1. Evaluate as Breast Mass
    2. No Breast Mass present
      1. Younger than age 35
        1. Repeat Breast Exam in 1-2 months
      2. Older than age 35 years
        1. Breast Imaging
          1. Mammogram
          2. Breast Ultrasound
        2. Suspicious lesion
          1. Breast Biopsy
        3. Non-suspicious lesion
          1. Follow-up Exam
          2. Breast imaging
        4. Negative Imaging
          1. Follow-up Breast Exam in 1-2 months
  5. Associated Conditions
    1. Premenstrual Dysphoric Disorder (PMDD or PMS)
  6. Management
    1. Wear supportive Brassiere or Sports Bra
    2. Eliminate Caffeine
    3. Vitamin E Supplementation up to 800 IU qd
    4. Herbal therapies with variable efficacy
      1. Evening Primrose Oil 1500-3000 mg PO qd
      2. Chaste Tree Berry 30 to 40 mg qd (PMS)
      3. References
        1. Hardy (2000) J Am Pharm Assoc 40:234
    5. Medroxyprogesterone
      1. Dose: 150 mg IM q3 months
      2. Very effective in pre-menopausal women
        1. Marked reduction in mastalgia
      3. Reference
        1. Euhus (1997) J Am Coll Surg 184:596
  7. References
    1. Belieu (1994) Obstet Gynecol Clin North Am 21:461
    2. Conry (1994) Am Fam Physician 49(2):445

Mastodynia (C0024902)

ConceptsSign or Symptom (T184)
ICD9611.71, 611.71
EnglishBREAST PAIN, Breast painful, Mastalgia, Mastodynia, Pain in breast, Pain in the breast, Pain of breast, Painful breasts
Spanishdolor de mamas, mamas dolorosas, mastalgia, mastodinia
Parent ConceptsBreast signs and symptoms NOS (C0156323), Chest Pain (C0008031), Finding of sensation of breast (C0567492), Duplicate concept (C1274013)
SourcesCOSTAR, DXP, ICD9CM, MTH, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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