Merck Manual

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Mastalgia (Breast Pain)

By

Lydia Choi

, MD, Karmanos Cancer Center

Last full review/revision Mar 2022
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Mastalgia (breast pain) is common and can be localized or diffuse and unilateral or bilateral.

Etiology of Mastalgia

Diffuse bilateral pain may be caused by fibrocystic changes Etiology Etiology 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

  • Hormonal changes that cause breast tissue proliferation (eg, during the luteal phase or early pregnancy, in women taking estrogens or progestins)

  • Large, pendulous breasts that stretch Cooper ligaments

Evaluation of Mastalgia

History

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.

Physical examination

Examination focuses on the breast Evaluation Breast symptoms (eg, masses, nipple discharge, pain) are common, accounting for > 15 million physician visits/year. Although > 90% of symptoms have benign causes, breast cancer is always a concern... read more Evaluation , looking for abnormalities such as mass, nipple inversion or discharge, skin changes including erythema, rash, eczematous appearance, edema, or dimpling (sometimes termed peau d’orange [orange peel]), and signs of infection, such as redness, warmth, and tenderness.

Red flags

The following is of particular concern:

  • Signs of infection

  • Mass, nipple inversion, or skin changes

Interpretation of findings

Absence of abnormal findings suggests that pain is due to hormonal changes or large, pendulous breasts.

Testing

Pregnancy testing should be done if pain is unexplained and has lasted less than several months, particularly if other symptoms or signs are consistent with pregnancy.

Other testing is indicated infrequently—only if breast examination detects abnormal findings.

Treatment of Mastalgia

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.

Evening primrose oil may reduce the severity of mastalgia.

Key Points

  • Diffuse, bilateral breast pain is usually caused by hormonal changes or large, pendulous breasts.

  • First-line treatment is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID).

  • Severe pain caused by hormonal factors is treated by stopping estrogen or a progestin (if either is being taken) or by giving tamoxifen or danazol.

Drugs Mentioned In This Article

Drug Name Select Trade
PREMARIN
TYLENOL
No US brand name
SOLTAMOX
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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