Breast pain

Disease Description (Causes and Symptoms)

• Definition: Mastodynia (breast pain, Mastodynia) is pain felt in the breast and is relatively common.
• Causes and pathophysiology:
  • Cyclic breast pain: Hormonal fluctuations related to menstruation (imbalance between estrogen and progesterone) cause swelling and a feeling of pressure in the connective tissue and mammary glands, resulting in pain. It usually begins 7–10 days before menstruation and improves when menstruation begins. It is generally reversible and bilateral.
  • Noncyclic breast pain: This may be localized to one area or persistent and may result from structural causes such as cysts, mastitis, abscesses, trauma, tumors, or referred pain from the chest wall, neck, or shoulder, or from medications (hormonal medications, some psychiatric medications, etc.).
• Main symptoms: Aching, soreness, or tingling in the breast; a lump may also be present; pain may be bilateral or unilateral; pain radiating to the shoulder, arm, or back may occur.

Treatment Methods

• General principles: First, evaluate the cause (medical history, examination, imaging, and, if necessary, biopsy), then provide cause-specific treatment. If there is no significant structural lesion, conservative treatment is used to relieve symptoms and monitor the course.
• Conservative and nonpharmacological treatment:
  • Well-fitting supportive underwear (sports-bra style or specialized bra), warm/cold compresses, and activity modification
  • Reduce caffeine (coffee, cocoa, cola, etc.) and high-fat foods and chocolate; adjust salt intake (to relieve swelling)
  • Weight management; limit smoking and excessive alcohol consumption
• Pharmacological treatment:
  • Pain relief: Short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen)
  • Hormonal medications (selectively): Consider when symptoms are severe and interfere with daily life. Medications that have shown significant effects in the past include danazol and tamoxifen, but because of side effects (androgenic symptoms, risk of blood clots, etc.), they should be used cautiously under the judgment of a specialist.
  • For pain associated with excess prolactin, bromocriptine or similar medications may be considered.
  • Topical treatment: Use of topical NSAID creams/gels or analgesic ointments (evidence is limited).
  • Supplements: Vitamin E, omega-3, evening primrose oil, and others may be tried by some people, but the evidence is inconsistent.
• Procedures/surgery:
  • Significant cysts (particularly pain-causing cysts) may be treated with ultrasound-guided drainage (aspiration) to improve symptoms.
  • If a suspicious lesion (solid mass) is present, a biopsy (fine-needle aspiration or core biopsy) is necessary.
• Precautions and complications:
  • Immediate additional testing is needed if there is localized, persistent pain on one side; a palpable hard lump; skin changes (redness or dimpling); nipple discharge; or localized lymph node swelling (to rule out cancer).
  • Be aware of treatment-related side effects (systemic side effects of hormonal medications and drug interactions).
  • Delaying appropriate evaluation may delay the diagnosis of a malignant lesion.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items/information to prepare:
  • A list of medications currently being taken (including prescription drugs, OTC medications, herbal medicines, and supplements)
  • Records of the menstrual cycle, the first day of menstruation, and when the pain occurs (its relationship to menstruation)
  • The location of the pain (bilateral/unilateral), its nature (aching, stabbing, persistent), intensity (pain score), onset, and duration
  • Photographs of breast changes associated with the pain (lumps, redness, nipple discharge, etc.), if possible
  • Copies of previous breast examination results (mammography, ultrasound, or biopsy)
• Examples of questions and information to provide to the doctor during the outpatient visit:
  • "What is the relationship between the pain and my menstrual cycle? How should I record changes before and after menstruation?"
  • "Could any medications (or supplements) I am taking affect the pain?"

Examples of General Questions to Ask the Doctor

• "What is the most likely cause of my pain?"
• "Do I need additional tests (mammography, ultrasound, or biopsy)? If so, when should they be performed?"
• "What are the effects and side effects of the medication you plan to prescribe, and how long should I take it?"
• "What lifestyle change should I make first to relieve the pain?"
• "When should I return if my symptoms do not improve or get worse?"

Examples of Condition-Specific Questions

• "Is my pain clearly cyclic and related to menstruation, or is it noncyclic? If it is noncyclic, what additional tests do you recommend?"
• "I have a palpable lump. At this point, which test should be performed first: mammography, ultrasound, or biopsy?"

(Note: The information above is general medical information. Individual diagnosis and treatment should be determined in consultation with a specialist.)