Description, Causes and Risk Factors:
Mastalgia is one of the common breast symptoms that one would encounter in everyday clinical practice. Because of increasing awareness of breast cancer and the possibility that mastalgia may indicate disease, more women now seek advice for mastalgia. Mastalgia can be broadly divided into 2 groups - cyclic and noncyclic. Cyclic means the severity of pain fluctuates with the menstrual cycle and usually the most severe pain would be experienced in the premenstrual period and the pain dissipates with the onset of menses. It presents mostly in the third decade of life. Spontaneous resolution occurs in about 22% of patients. Non-cyclic mastalgia usually presents a decade later and about 50% of patients may have spontaneous resolution. Overall, about 2/3 of mastalgia are cyclic, 1/4 non-cyclic and the rest are due to non-mammary causes of which the commonest is costochondritis. Cyclic mastalgia is more amenable to treatment as compared to non-cyclic mastalgia. Overall, about 90% of patients with cyclic mastalgia and 2/3 of patients with noncyclic mastalgia can expect a clinically useful response after adequate medical treatment.
In Western societies mastalgia, or breast pain without underlying pathology, is a common complaint that may affect up to 70% of women in their lifetime. Interestingly, it is less common in Asian cultures, affecting as few as 5%.
It is not unusual for women to have 2-3 days of mild breast pain premenstrually but 8-30% of women report moderate-to-severe breast pain with a duration of 5 or more days each month.
The etiology of mastalgia is not well understood. Hormonal assays of estrogen, progesterone, and prolactin have shown no consistent abnormalities despite the relationship to the menstrual cycle. Even so, pregnancy, lactation, menopause, oral contraceptives, and hormone replacement therapy variously affect the course of mastagia.
Methylxanthines and saturated fat have been suggested to be the cause of mastalgia.
Some studies have shown hyperresponsiveness of prolactin to stimulation by thyrotropin-releasing hormone, while others have suggested elevated levels or abnormalities of lipid metabolism. It has been proposed that breast pain during the luteal phase of the menstrual cycle may be due to higher serum estrogen-to-progesterone ratios. This may be related more to an insufficiency of progesterone rather than an excess of estrogen. Researchers found no correlation between women with mastalgia and controls when determining total body water. Therefore, as fluid retention is not a factor, there is no rationale for the use of diuretics or sodium restriction. A recent study investigated morphological structures by ultrasound of 335 women in Germany, 212 of whom had breast pain. The intensity of pain showed a significant positive correlation with the width of the milk ducts, suggesting an association between duct ectasia and mastalgia. Moreover, the site of pain positively correlated with the site of duct dilatation in the noncyclical type.
Cyclic mastalgia clearly correlates to the menstrual cycle, typically growing more and more intense during the two weeks before the start of your period, and then easing up, according to the researchers. Cyclic breast pain usually is dull, heavy or aching, and may occur along with breast swelling or "lumpiness." Both breasts are typically affected, especially the upper, outer areas. Cyclic mastalgia is most common among premenopausal women in their 20s and 30s and perimenopausal women in their 40s, according to the Researchers.
Noncyclic mastalgia, as the name suggests, is not related to the menstrual cycle. This pain may come and go or be constant, and is usually characterized as a feeling of tightness, burning or soreness, according to the researchers. Noncyclic mastalgia usually is felt primarily in a focused area of only one breast, though the pain may spread throughout that breast. Noncyclic mastalgia is most common among postmenopausal women in their 40s and 50s, according to the Researchers.
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Breast cancer does not commonly cause pain. However, your doctor may also perform a mammogram. Ultrasonography of the breast and mammography in patients with breast pain is of little diagnostic value in the absence of physical signs, but they are still sometimes performed to reassure the patient and the physician.
You may be able to relieve breast pain by using nonprescription medications, including:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin), naproxen (Aleve or Naprosyn), ketoprofen (Actron or Orudis), or aspirin (Anacin, Bayer).
Acetaminophen, such as Tylenol or Panadol.
Supportive measures that may be helpful include good mechanical support (bra), heat and/or cold therapy, breast message, and even relaxation techniques. Dietary recommendations include decreasing fat intake and reducing caffeine (coffee, tea, chocolate, etc.) intake is particularly helpful in women who consume a large amount of fatty foods or caffeine each day. Supplementations with selenium, iodine, vitamin E, B1, or B6 have shown minimal benefit over placebo in clinical trials that were performed. Evening primrose oil (EPO) is a gamma-linoleic acid and has been shown to be quite effective in treating moderate-to-severe mastalgia. Its proposed mechanism of action involves the restoration of abnormal fatty acid profiles which then decreases the sensitivity of the breast epithelium to steroid hormones such as estrogen and progesterone. It is given as 1 gram three times per day while assessing the response over the next three to six months. This therapy should be avoided in women on certain blood thinners or with seizure disorders as it may decrease the seizure threshold.
Be sure to follow all labels and instructions. If you are pregnant or trying to become pregnant, talk to your health professional before using any medication.
You may also be able to relieve breast pain by:
Magnesium supplements taken in the second half of the menstrual cycle (usually the 2 weeks before the next period) relieve cyclic breast pain as well as other premenstrual symptoms.
Reducing dietary fat to 15% or less of your dietary intake. However, you will have to cut out almost all fat from your diet for many months before you notice a difference. Discuss extreme diet changes with your health professional.
Studies have not shown that avoiding caffeine relieves breast pain. However, some women feel they have a decrease in breast pain when they decrease the amount of caffeine they consume.
Using birth control pills (oral contraceptives). These may help reduce cyclic breast pain and breast swelling before periods. However, some women say that their symptoms get worse when using birth control pills.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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