From the Guidelines
Mastodynia, also known as breast pain or mastalgia, can be managed through a combination of lifestyle changes and medical treatments, with the most recent and highest quality study suggesting that non-medical interventions and over-the-counter pain relievers are the first line of treatment 1.
Diagnosis and Treatment Approach
To diagnose and treat mastodynia, consider the following steps:
- Start with non-medical interventions:
- Wear a well-fitting, supportive bra, especially during exercise
- Apply hot or cold compresses to the breasts
- Reduce caffeine and salt intake
- Maintain a healthy weight
- If pain persists, try over-the-counter pain relievers:
- Ibuprofen (400-600 mg every 6-8 hours) or
- Acetaminophen (500-1000 mg every 4-6 hours)
- For cyclical breast pain related to menstrual cycles, consider:
- Evening primrose oil (1000 mg, 3 times daily)
- Vitamin E (400 IU daily)
Imaging Recommendations
According to the most recent study, imaging recommendations for women presenting with various types of breast pain as their only symptom are focused on “non–high-risk” women and assume that all women, with or without breast symptoms, will have routine mammography according to ACR guidelines based on their risk status and personal history 1.
- Women with cyclical or bilateral nonfocal breast pain or tenderness usually do not require nonroutine imaging due to the low yield of finding a specific cause.
- In patients with noncyclical, unilateral, or focal breast pain that is not extramammary in origin (such as chest-wall pain), imaging can be pursued to exclude the unlikely presence of breast cancer as the cause of pain, to determine a benign but treatable etiology, or to offer reassurance that there is no anatomic abnormality present.
Severe or Persistent Symptoms
If symptoms are severe or persistent, consult a doctor who may prescribe:
- Topical diclofenac gel (apply to affected area 3-4 times daily)
- Oral hormonal treatments like birth control pills
- Tamoxifen (10-20 mg daily) for severe cases, but only under close medical supervision It is essential to keep a pain diary to track symptoms and identify triggers, and to seek immediate medical attention if pain is accompanied by lumps, discharge, or skin changes to rule out more serious conditions 1.
From the Research
Diagnosis of Mastodynia
- A thorough history, physical examination, and targeted imaging can help to delineate the underlying cause of mastalgia and guide treatment options 2, 3, 4
- Breast cancer is rarely a cause but should be excluded 2, 3, 4
- Mastalgia is categorized into 3 main groups: cyclic, noncyclic, and extramammary 2, 3
Treatment of Mastodynia
- Reassurance, support, dietary changes, nonsteroidal anti-inflammatory drugs, and occasionally hormonal medications are options to help with improving breast pain 2, 3, 5
- 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 for treatment-resistant cases 3, 5
- In some cases, mastectomy with or without reconstruction may be considered as a viable alternative after exhaustion of all other nonsurgical options and when quality of life is significantly affected 6