Mastodynia is breast pain that can occur in both men and women, but is more common in women. It can range from minor to severe discomfort and affects around two-thirds of women of child-bearing age.

How Common is Mastodynia?

In the US, 60-70% of women will experience breast pain in their lives.

What are signs and symptoms of Mastodynia?

Signs and symptoms of Mastodynia (breast pain) include: - Pain that is only on one side of the breast - Activity-induced pain - Pain in the extreme sides of the breast - Chest pain that comes from pressing a specific area on the chest These signs suggest that the breast pain may be caused by something other than the breast itself. It is important to note these symptoms and discuss them with a doctor for further evaluation.

How do you get Mastodynia?

Mastodynia can be categorized into three types: cyclic, noncyclic, and extra-mammary. The causes of mastodynia vary depending on the type.

What else can Mastodynia be?

The doctor needs to rule out the following conditions when diagnosing Mastodynia: 1. Mental health conditions 2. Hormone changes, such as those before menstruation 3. Breast cancer 4. Scar tissue from previous breast surgery 5. Pain from the nerves in the space between the ribs (intercostal neuralgia) 6. Heart-related discomfort (cardiac discomfort)

How is Mastodynia treated?

Mastodynia is treated through a step-by-step approach. The first step is to ensure that the pain is not caused by breast cancer. Once breast cancer is ruled out, the cause of the mastodynia is determined, and a customized pain treatment plan is created. Initially, conservative treatment measures are recommended for at least six months. These measures include improving breast support, using harmless relaxation therapies like Evening Primrose Oil, making dietary changes, and using pain-killers such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. If the pain persists after six months, medication such as Tamoxifen or Danazol may be considered. It is important to discuss the potential side effects of these medications with the patient. Noncyclic mastodynia may not respond as well to treatment as cyclic mastalgia, but about half of noncyclic cases resolve on their own. For postmenopausal women using hormone-based medications, a decrease or removal of these medications might be necessary.

What are the side effects when treating Mastodynia?

The side effects when treating Mastodynia can include physical discomfort or breast pain, complications from medication such as headaches and nausea, and heavy periods (menorrhagia).

Are there long term effects of Mastodynia?

The prognosis for mastodynia, or breast pain, depends on the specific cause that is discovered. Here are the general prognoses for different types of mastodynia: - Breast pain without an identified cause often disappears on its own, usually within three months to three years. - Noncyclical breast pain may take longer to respond to treatment, but eventually resolves in about 50% of women without a known reason. - Cyclical breast pain, which follows a woman's menstrual cycle, may come and go for about 60% of women. Some women may still have symptoms returning even two years after treatment, but about 20% to 30% of women with cyclical breast pain will see their pain disappear naturally within three months.

Mastodynia

What is Mastodynia?

Mastodynia, or breast pain, is a common problem. Both men and women can experience it, but it’s more common in women. The level of discomfort could range from minor, spontaneous pain to severe pain. Though the cause of mastodynia is usually harmless, it affects around two-thirds of women of child-bearing age.

Even though only about 15% of people will need treatment to relieve the pain, it’s really important that you get properly checked out. A full check-up may include a physical examination of the breasts, some scans, and taking a complete history to find out what might be causing the pain. The pain can be brought on by a number of things, including mental health conditions, hormone changes like those that happen before a menstruation, or breast cancer.

One of the main reasons people go to the doctor about breast pain is the fear that it might be breast cancer. However, breast cancer is a relatively rare cause of breast pain. Once breast cancer has been ruled out, people often feel relieved and don’t seek further medical evaluation.

What Causes Mastodynia?

Breast pain, or mastodynia, can be categorized into three types: cyclic, noncyclic, and extra-mammary. The type of the pain decides how it is treated.

Cyclic breast pain usually shows up in women between their mid-twenties to 30 years old. This type of pain often feels spread out across both breasts, but sometimes, it can be felt more in one area, often in the upper outer part of the breast. Cyclic breast pain is believed to be tied to hormonal changes and shows up in about two-thirds of women with breast pain, typically peaking a week before their menstruation starts. This timeframe aligns with the luteal phase, or the second half of the menstrual cycle, and often gets better once menstruation begins.

It’s worth noting that some breast discomfort during the menstrual cycle can be seen as normal; the hormone estrogen increases during this time and stimulates different parts of the breast. Other hormonal changes, like a decrease in progesterone and an increase of a hormone called prolactin, are natural parts of a woman’s menstrual cycle.

Certain hormonal treatments, like birth control pills, and hormonal changes related to pregnancy, breastfeeding, and menopause can also influence cyclic pain. Some women find that their pain gets better during these times. Between 20% and 30% of cyclic breast pain goes away on its own, but about 60% of cases will come and go.

Noncyclic breast pain makes up about 25% of breast pain cases and is most common in women who are 40 years or older, often those going through perimenopause. This pain does not follow a pattern related to the menstrual cycle, and can be either constant or intermittent, affecting one breast more than the other. About half of the cases resolve spontaneously.

There can be many causes of this type of pain, often linked to changes in the breast or chest wall, including things like breast cysts, stretched ligaments due to larger breasts, dilation of the duct due to accumulation of fatty material causing inflammation, fever, and pain, inflammation or abscess in the breast, and lifestyle factors like a high-fat diet, high caffeine consumption, and smoking. Hormone therapy in menopausal women and inflammation of veins in the breast and chest wall can also cause this type of pain.

Other sources of breast pain that don’t fit into the above categories can include disorders like tumors, pregnancy, injuries, certain medications, and prior breast surgery.

Moreover, injuries to the muscles and related structures can lead to chest wall pain. This could be due to repeated strain on the pectoralis major muscle (the muscle that sits at the front of the chest), scarring from earlier biopsies, nerve pain along the ribs, and other spinal and near-spinal disorders.

Risk Factors and Frequency for Mastodynia

Breast pain is a common issue, particularly among women aged 30 to 50. In the female population of the US, between 60-70% will experience breast pain at some point during their lives. However, only around 30% of these individuals will seek medical help, and of these, about 20% will have severe symptoms. Breast pain negatively affects many women’s quality of life, interfering with sexual and physical activity or even work and social occasions.

The prevalence of breast pain around the world depends on the specific population being studied. A study in the UK suggested a link between higher prevalence of breast pain and lower levels of physical activity. Yet, there was no difference in the intensity of the pain suffered by those varying groups. Different regions and ethnicities also report different prevalence rates, for example the prevalence is 60% in UK women while it is just 5% in women of Asian ethnicity.

Breast pain most commonly affects women aged 30 to 50.
In the US, 60-70% of women will experience breast pain in their lives.
Out of those, about 30% will seek medical attention.
Severe cases of breast pain comprise about 20% of cases seeking medical aid.
Many women experiencing breast pain report a negative effect on their quality of life, including interference with sexual activity (40%), physical activity (30%), and work or social activities (10%).
Research suggests a correlation between higher occurrences of breast pain and lower levels of physical activity.
Breast pain prevalence varies by region and ethnicity, with a 60% prevalence in the UK and only 5% in women of Asian descent.

Signs and Symptoms of Mastodynia

It’s crucial to get a comprehensive history and thorough physical examination to correctly diagnose the patient. Keeping a “pain diary” where the patient tracks when and how intense their pain is can also be very informative.

During the physical check-up, doctors should pay close attention to the breasts and chest area. Part of the exam involves checking the chest wall. This check is important because it helps identify whether the pain comes from the breast (referred to as true mastalgia) or elsewhere. To do this, the doctor asks the patient to lie on each side. This position allows the breast tissue to move away from the chest wall, giving room to feel the chest wall muscles and ribcage. It is important that while doing this, the breast is lifted with one hand, and the chest wall is examined with the other.

Some signs that breast pain is caused by something other than the breast itself include pain that is only on one side, activity-induced pain, pain in the extreme sides of the breast, or chest pain that comes from pressing a specific area on the chest.

Continuing with the breast exam, doctors should systematically check all four quadrants of each breast. This should be done with the patient lying down and sitting up, with her hands on her hips and also with her hands above her head. During this process, doctors should also check the areas behind and around the nipple, above and below the collarbone and in the armpits, looking for things like swollen lymph nodes. They should also look for other signs that could indicate breast cancer like changes in skin or nipple, swelling, color change, dimples, sores, asymmetry, scars, inflammation, or unusual nipple discharge.

If anything unusual is found during this exam, the doctor should make a note of it and describe its characteristics. If this abnormality is in an area that the patient noted as painful, referral to a specialist for further evaluation is required.

Testing for Mastodynia

After carefully reviewing your medical history and examining you, doctors will decide if further tests or scans are needed.

Breast pain is usually checked by mammography or breast ultrasound. If a woman shows physical signs of an issue, such as changes in the skin, a lump, or bloody fluid from the nipple, mammography or breast ultrasound might be necessary. The main goal of these tests is to rule out the possibility of breast cancer.

On the other hand, women who come in with breast pain, but don’t show any physical signs of concern, should still have breast imaging done. The decision of which test to use should follow The American College of Radiology Appropriateness Criteria and take into consideration the woman’s age and the characteristics of the pain.

Patients with pain in both breasts, non-specific, or cyclic mastalgia- a type of pain that comes and goes in cycles – don’t necessarily need imaging as long as they are current with their regular breast cancer screenings. This is because there’s a low chance of identifying the specific cause of pain with imaging. However, patients with pain in one breast, non-cyclical, or specific mastalgia should have breast imaging done. The goal here is to figure out what’s causing the pain and to rule out breast cancer.

The choice between mammography or ultrasound depends on age:

– For women under 30: Ultrasound is favored because of its accuracy. However, mammography may be recommended if the ultrasound shows something concerning, or if the patient has a family history of premenopausal breast cancer.

– For women aged 30-39: Both ultrasound and mammography is recommended. This is because there are many cases in which small cancers identified through mammography were missed by ultrasound.

– For women aged 40 and older: Both mammography and ultrasound should always be conducted.

Breast imaging not only helps to investigate the cause of breast pain, but can also help to alleviate patients’ anxiety. Once patients are assured by negative breast imaging results, they often stop seeking further medical care.

Treatment Options for Mastodynia

Many women find relief from breast pain, known as mastodynia, when they are assured it’s not breast cancer. However, around 15% still need further treatment due to the impact on physical and sexual activity, as well as work and social life.

The key steps for doctors are to ensure the pain isn’t from breast cancer, determine the cause of the mastalgia, and then customize a pain treatment plan. Initially, conservative treatment measures are recommended for at least six months before considering more intense therapies.

Some general treatment methods include:

– Improving breast support: Using supportive clothing like a well-fitted bra can often help. Around 70% of women are believed to wear the wrong bra size.
– Use of harmless relaxation therapies: For instance, Evening Primrose Oil (EPO) contains a particular fatty acid which is thought to help in pain management. While the exact way it works isn’t known, many doctors agree this is a good option, having no apparent harmful effects.
– Dietary changes: Reducing consumption of substances like methylxanthines found in coffee, chocolate, tea, and some soft drinks is recommended. It is also suggested to lower the intake of saturated fatty acids and increase unsaturated fatty acids. For some people, exercise can also be helpful for reducing mastalgia due to the release of endorphins (‘happy hormones’).
– Pain-killers: Nonsteroidal anti-inflammatory drugs (NSAIDs) & acetaminophen can be quite effective for many women with mastalgia, with very few side effects. These could be applied as patches or gels on the skin, or taken orally.

If the breast pain continues even after six months of these treatments, then medication might be considered. Medications such as Tamoxifen or Danazol could be used in such cases. Potential side effects of these medications – which range from vaginal dryness and hot flashes to weight gain and voice deepening – should be discussed with the patient before starting the medication.

It’s important to note that noncyclic mastodynia, which doesn’t follow a menstrual cycle pattern, might not respond as well to treatment as cyclic mastalgia. But about half of noncyclic cases resolve on their own. While cyclic mastalgia can be more responsive to treatment, it could also recur in up to 60% of cases once the treatment stops.

For postmenopausal women experiencing mastodynia who are using hormone-based medications, a decrease or removal of these medications might be needed. Potential risks and benefits of changing these hormone-based therapies should be discussed thoroughly with the patient.

When people come to the doctor because of breast pain, the first worry is often breast cancer. However, in reality, a very small number of people with breast pain end up being diagnosed with this disease. The chance of having cancer when you have breast pain varies between 0.5% and 3.3%. Even though it’s less common, the fear of being diagnosed with breast cancer is a big reason why women seek medical help.

Other factors can also cause breast pain. For instance, if you’ve previously had a surgery on your breast, you could experience pain due to scar tissue sticking to your chest wall. This highlights the importance of the doctor knowing your complete medical history when they first examine you.

Also, you may think you are experiencing breast pain when the discomfort is actually coming from somewhere else in your torso, like your ribs or heart. Considerations in this category include:

Pain from the nerves in the space between your ribs (intercostal neuralgia)
Heart-related discomfort (cardiac discomfort)

What to expect with Mastodynia

Breast pain without an identified cause often disappears on its own, usually within three months to three years. The likelihood of it going away is influenced by the age when the breast pain first started and the cause of the pain.

For a kind of breast pain that doesn’t consistently follow a menstrual cycle (noncyclical pain), it might take longer to respond to treatment, but eventually, it resolves in about 50% of women, without a known reason. Some of these improvements might be related to natural changes in hormones due to events like pregnancy or menopause.

As for the breast pain that follows a woman’s menstrual cycle (cyclical breast pain), about 60% of women experience a pattern of the pain coming and going. Some women may still have symptoms returning even two years after receiving treatment. However, about 20% to 30% of women with cyclical breast pain will see their pain disappear naturally within three months.

Moreover, because breast pain (also known as mastodynia) can have many possible causes, how long it lasts often depends on the specific cause that is discovered.

Possible Complications When Diagnosed with Mastodynia

The cause of breast pain (mastalgia) can vary greatly, and any complications a patient may experience often depend on what is causing the pain. However, in many instances, patients don’t have any other issues beyond this discomfort.

Certain medications used to treat breast pain can also cause complications. For instance, some patients have reported headaches and nausea after using bromocryptine and danazol. Additionally, oral contraceptive pills may cause heavy periods (menorrhagia), nausea, and headaches.

Possible Complications and Side Effects:

Physical discomfort or breast pain
Complications from medication, such as headaches and nausea
Heavy periods (menorrhagia)

Preventing Mastodynia

Breast pain is a common issue faced by many women. In fact, as many as 70% of women will experience an episode of breast pain severe enough to make them think about seeking health advice. However, only 36% of women actually end up talking to a doctor about their discomfort. Often, the primary reason women will seek help is due to a fear of potentially having breast cancer. Another reason could be that the breast pain, also called mastodynia, is getting in the way of their daily activities.

That’s why it’s important to keep up to date with breast cancer screenings. And if you are experiencing any episodes of breast pain, it’s crucial to consult with your primary physician or an OB/GYN (a doctor specializing in women’s health). The advice to seek help from a doctor is to ensure that your medical history and physical health are thoroughly checked, and based on your age or what might be causing the pain, any necessary breast imaging is done.

There are different types of breast pain – cyclical (related to your menstrual cycle), noncyclical (not related to your cycle), or extramammary (originating from a source other than the breast). Properly identifying the type of pain you’re experiencing is vital in ensuring an accurate diagnosis and relevant treatment to reduce the pain and improve your overall well-being while avoiding any harmful side effects.

The first line of treatment usually involves simple solutions like physical support (like a good fitting bra), pain relievers like acetaminophen, and NSAIDs (medications that reduce pain and inflammation). It’s important to know that if your pain persists after six months, your doctor may consider other treatment options. During this process, doctors should involve you in the choices about your treatment and inform you of any potential side effects to look out for. Also, they should tell you the signs to watch for indicating a more serious underlying condition.