http://www.fpnotebook.com/
Mastalgia
Aka: Mastalgia, Breast Pain, Mastodynia
- Differential Diagnosis
- Pain related to Menses
- Costochondritis
- Chest Trauma
- Sclerosing adenosis
- Breast Cancer (represents under 5% of Breast Pain)
- History
- Location
- Focal Breast Pain more concerning than diffuse pain
- Duration of Breast Pain
- Unilateral or Bilateral
- Changes with Menstrual Cycle
- Relationship to hormonal replacement therapy
- Rank Breast Pain on a 10 point scale
- Altered life style
- Excessive Worry or emotional stress
- Pathophysiology
- Breast Pain thought to be related to Estrogen excess
- Algorithm
- Breast Mass present
- Evaluate as Breast Mass
- No Breast Mass present
- Younger than age 35
- Repeat Breast Exam in 1-2 months
- Older than age 35 years
- Breast Imaging
- Mammogram
- BreastUltrasound
- Suspicious lesion
- Breast Biopsy
- Non-suspicious lesion
- Follow-up Exam
- Breast imaging
- Negative Imaging
- Follow-up Breast Exam in 1-2 months
- Associated Conditions
- Premenstrual Dysphoric Disorder (PMDD or PMS)
- Management
- Wear supportive Brassiere or Sports Bra
- Eliminate Caffeine
- Vitamin E Supplementation up to 800 IU qd
- Herbal therapies with variable efficacy
- Evening Primrose Oil 1500-3000 mg PO qd
- Chaste Tree Berry 30 to 40 mg qd (PMS)
- References
- Hardy (2000) J Am Pharm Assoc 40:234-42
- Medroxyprogesterone
- Dose: 150 mg IM q3 months
- Very effective in pre-menopausal women
- Marked reduction in Mastalgia
- Reference
- Euhus (1997) J Am Coll Surg 184:596-604
- References
- Belieu (1994) Obstet Gynecol Clin North Am 21:461-77
- Conry (1994) Am Fam Physician 49(2): 445-50