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Mastalgia is breast pain and is generally classified as either cyclical (associated with menstrual periods) or noncyclic. Noncyclic pain may come from the breast or may come from somewhere else, like nearby muscles or joints, and may be felt in the breast. Pain can range from minor discomfort to severely incapacitating pain in some cases. Many women with mastalgia worry more about the consequences of cancer than about the pain itself. Breast pain is only rarely associated with breast cancer, so mastalgia should not be considered a possible symptom of breast cancer.
The most common type of breast pain is associated with the menstrual cycle. It is nearly always hormonal. Some women begin to have pain around the time of ovulation and it continues until the beginning of their menstrual cycle. The pain can either be barely noticeable or so severe that the woman cannot wear tight-fitting clothing or tolerate close contact of any kind. The pain may be felt in only 1 breast or may be felt as a radiating sensation in the underarm region.
Some healthcare providers have women chart their breast pain to determine if the pain is cyclical or not. After a few months, the relationship between the menstrual cycle and breast pain will emerge.
Researchers continue to study the role that hormones play in cyclical mastalgia. One study has suggested that some women with cyclical mastalgia have a decreased ratio of progesterone to estrogen in the second half of the menstrual cycle. Other studies have found that an abnormality in the hormone prolactin may affect breast pain. Hormones can also affect cyclical breast pain as a result of stress. Breast pain can increase or change its pattern with the hormone changes that happen during times of stress.
Hormones may not provide the total answer to cyclical breast pain, since pain is often more severe in 1 breast than in the other (hormones would tend to affect both breasts equally). Many researchers believe that a combination of hormonal activity and something in the breast that responds to this activity may hold the answer. However, more research is necessary in order to draw this conclusion.
Specific treatment for cyclical breast pain will be determined by your healthcare provider based on:
Your age, overall health, and medical history
Extent of the condition
Your tolerance for specific medicines, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Treatments vary significantly and may include the following:
A low-fat diet
In some cases, various supplemental hormones and hormone blockers are also prescribed. These may include:
Birth control pills
Bromocriptine (which blocks prolactin in the hypothalamus)
Danazol, a male hormone
Tamoxifen, an estrogen blocker
Supplemental hormones and hormone blockers may have side effects. In addition, the risks and benefits of such treatment should be carefully discussed with your healthcare provider.
Noncyclic breast pain is fairly uncommon, feels different than cyclical mastalgia, and does not vary with the menstrual cycle. Generally, the pain is present all the time and is in only 1 specific location.
One cause of noncyclic breast pain is trauma, or a blow to the breast. Other causes can include arthritic pain in the chest cavity and in the neck, which radiates down to the breast.
Determining the appropriate treatment for noncyclic breast pain is more difficult, not only because it is hard to pinpoint where the pain is coming from, but also because the pain is not hormonal. Specific treatment for noncyclic breast pain will be determined by your healthcare provider based on:
Generally, healthcare providers will perform a physical examination and may order a mammogram. In some cases, a biopsy of the area is also necessary. If it is determined that the pain is caused by a cyst, the cyst will be aspirated (a small needle will be used to remove the liquid contents of the cyst). Depending on where the pain originates, treatment may include analgesics, anti-inflammatory drugs, and compresses.
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