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Mastalgia (breast pain) is common and can be localized or diffuse and unilateral or bilateral.

Etiology

Localized breast pain is usually caused by a focal disorder that causes a lump (see Breast Disorders: Breast Lumps), such as a breast cyst, or an infection (eg, mastitis, abscess). Most breast cancers do not cause pain.

Diffuse, bilateral pain may be caused by fibrocystic changes or, uncommonly, diffuse, bilateral mastitis. However, diffuse bilateral pain is very common in women without breast abnormalities. The most common causes are:

• Hormonal changes that cause breast tissue proliferation (eg, during the luteal phase or early pregnancy and in women taking estrogens Some Trade Names
  PREMARIN
  Click for Drug Monograph
  or progestins)
• Large, pendulous breasts that stretch Cooper's ligaments

Evaluation

History: History of present illness should address the temporal pattern of pain and whether pain is focal or diffuse and unilateral or bilateral. The relation between chronic or recurrent pain and menstrual cycle phase should be ascertained.

Review of systems should address other symptoms suggesting pregnancy (eg, abdominal enlargement, amenorrhea, morning nausea) or fibrocystic changes (eg, lumpiness).

Past medical history should cover disorders that could cause diffuse pain (eg, fibrocystic changes) and use of estrogens Some Trade Names
PREMARIN
Click for Drug Monograph
and progestins.

Physical examination: Examination focuses on the breast and adjacent tissue, looking for abnormalities such as skin changes (as for breast lumps—see Breast Disorders: Physical examination) and signs of infection, such as redness, warmth, and tenderness.

Red flags: The following are of particular concern:

• Signs of infection

Interpretation of findings: Absence of abnormal findings suggests that pain is due to hormonal changes or large, pendulous breasts. Abnormal findings may suggest other specific problems.

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 physical findings suggest another problem that requires testing.

Treatment

For menstrual-related mastalgia, acetaminophen Some Trade Names
GENAPAP
TYLENOL
VALORIN
Click for Drug Monograph
or an NSAID is usually effective. If pain is severe, a brief course of danazol Some Trade Names
DANOCRINE
Click for Drug Monograph
or tamoxifen Some Trade Names
NOLVADEX
Click for Drug Monograph
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 Some Trade Names
GENAPAP
TYLENOL
VALORIN
Click for Drug Monograph
, or both, can help.

Key Points

• Diffuse, bilateral breast pain is usually caused by hormonal changes or large, pendulous breasts and causes no abnormal physical findings.

Last full review/revision November 2008 by Victor G. Vogel, MD

Content last modified November 2008