Mastalgia Flashcards
What is mastalgia?
Breast pain
What are 3 categories of mastalgia? & How common are they?
- Cyclical (Most common)
- Non-cyclical (1/3 of mastalgia cases)
- Extra mammary (Least common)
What is cyclical pain? & What causes it?
Pain associated with the menstrual cycle affecting both breasts, beginning a few days before the beginning of menstruation and subsiding at the end.
Caused by hormonal changes, therefore most cases come in those actively menstruating or using HRT
What is non-cyclical mastalgia? & what causes it?
Breast pain unrelated to the menstrual cycle.
Typically caused by medication:
- Hormonal contraceptives
- Anti-depressants (e.g. sertraline)
- Antipsychotic drugs (e.g. haloperidol)
What is extra mammary pain? Provide examples.
Pain felt in the breast originating from another source.
For example, chest wall pain or shoulder pain.
What should you ask about when taking a history from a patient with breast pain?
- Red flag symptoms:
- Lumps
- Skin changes
- Fevers
- Discharge
- Association with menstrual cycle
- Drug history
- Breast-feeding
- Pregnancies
- Previous medical history
- Family history
What investigations would you order for a patient presenting with breast pain?
- Pregnancy test
* For all patients within reproductive age
No indication for imaging in breast pain alone with no other relevant features
What is the management of mastalgia?
- Investigation & management of underlying cause
However, in most cases mastalgia is idiopathic:
- Reassurance
- Pain control
- Ibuprofen, paracetamol, topical NSAIDs
- NICE guidance states cyclical breast pain should be managed by wearing a better fitting bra or soft-support bra during the night.
- Specialist referral
* If first line management options are unsuccessful, - Danazol (Anti-gonadotrophin agent) - 2nd line
- Unpleasant side-effects
- Nausea, dizziness, and weight gain
