Mastalgia

Question 1

what is mastalgia?

Answer 1

breast pain

Question 2

how is breast pain classified? and which is the most common?

Answer 2

cyclical
non-cyclical
extra-mammary

most common - cyclical pain

Question 3

what is cyclical pain?

Answer 3

pain associated with the menstrual cycle. typically affects both breasts beginning a few days before the beginning of menstruation and subsiding at the end

Question 4

what are some causes of non-cyclical pain?

Answer 4

medication - hormonal contraceptives
anti-depressants - sertraline
antipsychotic drugs like haloperidol

Question 5

what are some examples of extramammary pain?

Answer 5

chest wall pain

shoulder pain

Question 6

what are some associated features which could indicate a pathological cause of mastalgia?

Answer 6

lumps
skin changes
fevers
discharge 
association with menstrual cycle

Question 7

what investigations should be done

Answer 7

pregnancy test - reproductive age

breast pain in isolation with no other relevant features on history or examination is not an indication for imaging

Question 8

how is mastalgia managed?

Answer 8

manage underlying cause
reassurance and pain control

cyclical breast pain - better fitting bra or soft-support bra during night

non-cyclical pain does not respond well to treatment

ibuprofen, paracetamol, topical NSAIDs

Question 9

what is done if first line management doesn’t work?

Answer 9

referral to a specialist

second line - use of Danazol, an anti-gonadotrophin agent - unpleasant side-effects (nausea, dizziness and weight gain)