Description, Causes and Risk Factors:
Mastodynia is one of the most common complaints women have. Rest assured, in over 99% of women, this is benign. Mastodynia is NOT a typical symptom of breast cancer. Mastodynia can be described in many different ways including, but not limited to: sharp, stabbing, pulling, burning, sensations, dull ache, itching. These feelings can be constant or intermittent (come and go). Having symptoms in only one breast is also very normal. Mastodynia can occur in almost any part of the breast, but the upper outer aspect is the most common.
The etiology of mastodynia 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 mastodynia. 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. Preece found no correlation between women with mastodynia 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 mastodynia. The intensity of pain showed a significant positive correlation with the width of the milk ducts, suggesting an association between duct ectasia and mastodynia. Moreover, the site of pain positively correlated with the site of duct dilatation in the noncyclical type.
Recent weight gain.
Large pendulous breasts (caused by stretching of Cooper's ligament).
High caffeine intake.
Diet high in saturated fats.
In Western societies mastodynia, 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 mastodynia with a duration of 5 or more days each month. It can be severe enough to interfere with quality of life rating, and when compared with other conditions the mean pain-index has been found to be similar to chronic cancer pain. Fifteen percent of women who present to a breast clinic will need drug treatment. Mastodynia may be bilateral, may be in only one breast or part of one breast, and may radiate to the axilla and down the medial aspect of the upper arm. The affected breast is often extremely tender to touch and pain may be accompanied by swelling. Although breast nodularity is sometimes associated with breast pain, it is a separate entity and should be assessed independently.
Cyclic mastodynia 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 mastodynia 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 mastodynia is most common among premenopausal women in their 20s and 30s and perimenopausal women in their 40s, according to the researchers.
Noncyclic mastodynia, 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 mastodynia usually is felt primarily in a focused area of only one breast, though the pain may spread throughout that breast. Noncyclic mastodynia 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 mastodynia. However, your doctor may also perform a mammogram. Ultrasonography of the breast and mammography in patients with mastodynia is of little diagnostic value in the absence of physical signs, but they are still sometimes performed to reassure the patient and the physician.
While in many cases it would possible to predict which treatment will be most effective with a series of endocrinological investigations involving thyroid and complicated pituitary hormone testing, this is rarely done in practice.
Treatments which demonstrated some effectiveness:
Topical and systemic NSAIDs, analgesics.
Progestin based birth control pills or topical progesterone 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 agonists, best results with a better side effect profile than bromocriptine can be achieved with Dostinex. The older bromocriptine 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 lisuride and quinagolide.
Iodine: 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 thyroid health are better understood.
Danazol: 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 hypothyroidism or subclinical hypothyroidism has been diagnosed. However even levothyroxine supplementation in normal patients has been shown effective.
Tamoxifen has been shown effective but is very rarely used because of serious concerns about safety in premenopausal women.
Ormeloxifene, a SERM showed some effectivity in treatment of mastodynia and fibroadenoma.
Anthocyanins from bilberry.
Vitex agnus-castus extract: there is convincing evidence that Vitex agnus castus is safe and efficient in the treatment of cyclical mastodynia. It is assumed, that like bromocriptine it works by reducing prolactin secretion from the pituitary gland.
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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