From the Guidelines
Mastodynia, also known as breast pain or mastalgia, is a common condition that can be managed through a combination of lifestyle changes and medical treatments, with the primary goal of alleviating symptoms and improving quality of life. For mild to moderate mastodynia:
- Wear a well-fitted, supportive bra, especially during exercise.
- Apply hot or cold compresses to the breasts for relief.
- Consider over-the-counter pain relievers like ibuprofen (400-600 mg every 6-8 hours) or acetaminophen (500-1000 mg every 4-6 hours) 1.
- Reduce caffeine and salt intake.
- Maintain a healthy weight through diet and exercise. For severe or persistent mastodynia:
- Consult a healthcare provider for further evaluation.
- They may prescribe:
- Topical NSAIDs like diclofenac gel (apply 2-4 grams to affected area 3-4 times daily)
- Oral hormonal treatments such as birth control pills or danazol (200-400 mg daily for 3-6 months)
- Evening primrose oil supplements (1000-3000 mg daily) Imaging is not typically recommended for women with cyclical or bilateral nonfocal breast pain or tenderness, as the yield of finding a specific cause is low 1. However, in patients with noncyclical, unilateral, or focal breast pain, imaging may be pursued to exclude the unlikely presence of breast cancer or to determine a benign but treatable etiology 1. In symptomatic women less than 30 years of age, ultrasound (US) is more accurate in making a diagnosis than mammography 1. In the 30- to 39-year-old age group, adding unilateral or bilateral mammography may be appropriate, because some of the small cancers found at the site of pain as reported in several studies were only visible mammographically 1. Mammography should be performed with US in patients age 40 and older or in a patient of any age who would normally qualify for a mammogram based on risk factors and the date of the last mammogram 1. It is essential to note that mastodynia often occurs due to hormonal fluctuations during the menstrual cycle, causing breast tissue to swell and become painful, and in some cases, it may be related to fibrocystic breast changes or other underlying conditions 1. If breast pain is accompanied by lumps, discharge, or other concerning symptoms, seek immediate medical attention to rule out more serious conditions.
From the FDA Drug Label
Breast pain251 (8)169 (6) The diagnosis of Mastodynia (breast pain) is not explicitly stated in the provided drug labels. The treatment for Mastodynia (breast pain) is not explicitly stated in the provided drug labels. 2 2
From the Research
Diagnosis of Mastodynia
- Breast pain is a common symptom in most women during their lifetime, and many times is self-limited 3
- A good history, examination and targeted imaging can help to delineate the underlying cause of mastalgia and therefore guide treatment options 3
- Mastalgia is categorized into 3 main groups: cyclic, noncyclic and extramammary 3
- Breast cancer is rarely a cause but should be excluded 3, 4
Treatment of Mastodynia
- Reassurance, support, dietary changes, nonsteroidal anti-inflammatory drugs and occasionally hormonal medications are options to help with improving breast pain 3
- For mild to moderate pain, a trial of conservative, nonpharmacologic strategies should be tried first 4
- For those with severe symptoms impacting quality of life, a trial of pharmacologic therapy can be considered after appropriate counseling for medication-related adverse effects 4
- Evening primrose oil supplements, bromocriptine, danazol, some progestins, tamoxifen or GnRH analogues may be used in some cases 5
- Therapy of non cyclic breast pain is made according to the underlying pathology, and if no substrate is present, treatment is the same as for cyclical mastalgia but the response is diminished 5
Factors Contributing to Mastodynia
- Diet, medications, stress, hormonal fluctuations, and an ill-fitting bra can be contributing factors for physiologic causes of mastalgia 3
- Hormonal fluctuations, such as those experienced during the menstrual cycle, can contribute to breast pain 5, 6
- Other factors, such as oral contraception or hormone replacement therapy, may also contribute to breast pain 5