Mastalgia

Question 1

How is mastalgia usually classified?

Answer 1

Cyclical

Non-cyclical

Extra-mammary

Question 2

Most common form of mastalgia

Answer 2

Cyclical

Question 3

Explain cyclical mastalgia

Answer 3

Pain associated with the menstrual cycle.

This pain affects usually both breast and begins a few days before the beginning of menstruation and subsides at the end

It is caused by hormonal changes

Question 4

Explain non-cyclical pain

Answer 4

Unrelated to the menstrual cycle

Can be caused by medication like anti-depressants (sertraline), antipsychotics (haloperidol) and hormonal contraceptives

Question 5

Relevant clinical features to ask about

Answer 5

Lumps?

Skin changes?

Fever?

Discharge?

Association with menstrual cycle?

DH

Breast feeding?

Pregnancies?

PMH
FH

Question 6

Is breast pain in isolation without any other findings an indication for imaging?

Answer 6

It is not

However they should have a pregnancy test

Question 7

Management if in isolation

Answer 7

Ressurance and pain control

Oral ibuprofen or topical NSAIDs

If first line is unsuccessful -> Referral to a specialist is warranted.

Question 8

2nd line treatment

Answer 8

Danazol (anti-gonadotrophin agent)