Mastalgia (breast pain) is common and can be localized or diffuse and unilateral or bilateral.
Localized breast pain is usually caused by a focal disorder that causes a mass Breast Masses (Breast Lumps) The term breast mass is preferred over lump for a palpably discrete area of any size. A breast mass may be discovered by patients incidentally or during breast self-examination or by the clinician... read more , such as a breast cyst, or an infection (eg, mastitis Mastitis Mastitis is painful inflammation of the breast, usually accompanied by infection. Fever later in the puerperium is frequently due to mastitis. Staphylococcal species are the most common causes... read more , abscess). Most breast cancers Breast Cancer Breast cancer most often involves glandular breast cells in the ducts or lobules. Most patients present with an asymptomatic mass discovered during examination or screening mammography. Diagnosis... read more do not cause pain.
Diffuse bilateral pain may be caused by fibrocystic changes Etiology The term breast mass is preferred over lump for a palpably discrete area of any size. A breast mass may be discovered by patients incidentally or during breast self-examination or by the clinician... read more or, uncommonly, diffuse bilateral mastitis. However, diffuse bilateral pain is very common in women without breast abnormalities. The most common causes in these women are
History of present illness should address the temporal pattern of pain and its nature (focal or diffuse, unilateral or bilateral). The relation between chronic or recurrent pain and menstrual cycle phase should be ascertained.
Review of systems should seek other symptoms suggesting pregnancy (eg, abdominal enlargement, amenorrhea, morning nausea) or fibrocystic changes (eg, presence of many masses).
Past medical history should cover disorders that could cause diffuse pain (eg, fibrocystic changes) and use of estrogens and progestins.
For menstrual-related mastalgia, acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) is usually effective. If pain is severe, a brief course of danazol or tamoxifen may be given. These drugs inhibit estrogen and progesterone. If estrogen or a progestin is being taken, stopping may be necessary.
For pregnancy-related breast pain, wearing a firm, supportive brassiere, taking acetaminophen, or both, can help.
Recent evidence suggests that evening primrose oil may reduce the severity of mastalgia.